self measured blood pressure monitoring: comparative effectiveness

You've successfully added to your alerts. National Library of Medicine In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. As self-measurement requires patient participation, certain patient characteristics may affect compliance with SMBP monitoring, such as the willingness and ability to self-monitor BP and the technical literacy in operating the device or an interface for telemonitoring. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. What is the correct way to measure blood pressure? All information these cookies collect is aggregated and therefore anonymous. These cookies may also be used for advertising purposes by these third parties. This graphic from Target: BP demonstrates how to prepare for a blood pressure reading, the correct position to take your own blood pressure, and how to measure it. The Forum convenes online quarterly. SMBP monitoring may be used as a tool for disease self-management and to improve adherence with lifestyle and diet modification, or with drug treatment. Background Hypertension often requires lifelong treatment. Limitations: Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2013. SMBP means you regularly use a personal blood pressure measurement device away from a doctor's office or hospitalusually at home. National Library of Medicine We included studies that used arm (not wrist) monitors for at least 8 weeks and excluded studies of pregnant women or people on hemodialysis. BP may rise in the clinic in response to the medical environment (referred to as white coat hypertension), or may be normal in the clinic but not outside of the clinic (referred to as masked hypertension).19,20 Prevalence of white coat hypertension ranges from 10 to more than 20 percent,21,22 and the prevalence of masked hypertension (MH) reaches 40 percent in some studies.23 The prognostic significance of either is unclear.24. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. The trials were greatly heterogeneous, varying in population, intervention, and outcome measures and definitions. Patient-provider feedback loops may involve patients reporting blood pressure readings for a given time period, concerns about medications, and progress on lifestyle changes to their providers. Sit correctly. Comparative Effectiveness Review Number 45 Self-Measured Blood Pressure Monitoring: Comparative Effectiveness Executive Summary Background High blood pressure (BP), or hypertension, is a common, long-term health condition, particularly among older adults. This video from NACHC, showcases several community health centers work to implement SMBP monitoring programs in their clinics. This 1-hour continuing medical education (CME) course focuses on the appropriate use of SMBP monitoring in clinical practice and trains physicians, care teams, and other participants who are registered for Target: BP. Patient-provider feedback loop with clinical support for SMBP monitoring. This site needs JavaScript to work properly. The https:// ensures that you are connecting to the There is growing evidence that selfmonitoring of blood pressure (SMBP) with guided support beyond usual primary care improves BP control. By using the site you are agreeing to this as outlined in our privacy notice and cookie policy. This AMAAHA joint initiative can help health care professionals launch an SMBP monitoring program. AHRQ Publication No. 2013 Aug 6;159(3):185-94. doi: 10.7326/0003-4819-159-3-201308060-00008. Providers can help with SMBP implementation by promoting SMBP to their hypertensive patients and establishing clinical feedback systems. Given clinical heterogeneity and limited head to head comparisons, the evidence limits our ability to draw definitive conclusions about the incremental effect of any specific additional support. This article outlines high-level SMBP barriers that federal/national partners have encountered and offers potential solutions to achieve widespread SMBP implementation. This may facilitate direct communication with a provider via phone call or email and result in shorter turn-around times in responding to a BP reading and thus ultimately to better BP control. This website also contains material copyrighted by 3rd parties. In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. Europe PMC is an archive of life sciences journal literature. This site provides a list of clinically validated blood pressure devices, based on the American Medical Associations (AMA) established criteria to independently validate clinical accuracy. The bold lines indicate the comparisons addressed in the Key Questions (see below). Systematic Review: John M. Eisenberg Center for Clinical Decisions and Communications Science. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. This resource from the Public Health Informatics Institute provides a checklist of helpful characteristics for SMBP telemonitoring software. The Community Preventive Services Task Force (CPSTF) Recommendations on Self-Measured Blood Pressure Monitoring Interventions E-mail questions about the Forum toMillionHeartsSMBP@nachc.com. To address comparative effectiveness, we included prospective comparative studies of SMBP with or without additional support versus usual care or an alternative SMBP intervention. Apr 11, 2011. HHSA 290-2007-10055-I.) Future research should standardize patient inclusion criteria, BP treatment targets for home BP, and SMBP and additional support protocols to maximize the interpretability and applicability of SMBP trials. This report addresses questions regarding the clinical value of SMBP monitoring with or without additional support and what factors may predict adherence with SMBP monitoring. Self-measured BP (SMBP) monitoring is another option that allows for more frequent measurements, and possibly more accurate readings of a patient's typical BP. For additional assistance, please contact us. In addition, SMBP may carry the risk of unreliable BP readings if not obtained in a standard fashion, inappropriate self adjustments of antihypertensive medications, as well as increased anxiety in susceptible patients. Patient-provider feedback loop.Source:Centers for Disease Control and Prevention. January 2012 As they were scoping their work for SMBP, they started by searching multiple databases Past forum recordings, slides, and other resources can be found on the SMBP ForumConfluence page. 2012 Sep 21. This SMBP coverage summary from the American Medical Association shows Medicaid coverage by state for automated SMBP blood pressure devices, standalone cuffs, and related clinical services. We take your privacy seriously. Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. Accessibility Self-Measured Blood Pressure Monitoring . Disclaimer. 8600 Rockville Pike To systematically review the trial evidence on the comparative effectiveness of hypertension management with versus without SMBP monitoring, and of different additional support interventions with SMBP. ECG Challenge: What's Causing This Woman's Slow Pulse? Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. People who have high blood pressure may need to measure their blood pressure more often than people who do not have high blood pressure. This document provides action steps for public health practitioners to facilitate the implementation of SMBP monitoring plus additional support in five key areas: Understanding the environment; Working with payers and purchasers; Working with health care providers; Spreading the word to the public; and Monitoring/assessment of SMBP, plus additional support implementation. 2011 Jan-Feb;46(1):99-102. doi: 10.4085/1062-6050-46.1.99. (Prepared by the Tufts Evidence . b W 35D43zi&J &lbP K 7X hXio8EIbHr)_cBCq{(1KLL)}]IDb)Pb"VL *&DSK28ijMqXLG:a/^~ vs:?COe+Y1~504ye49ucTSQZGUI+'O+ {EQZu]`^.7t n\B^9~: Use this checklist: If you are keeping track of your blood pressure at home, use these additional tips. To increase nationwide implementation of SMBP plus clinical support, multiple issues must be addressed. This easy-to-read graphic from CDC shows patients the correct way to measure blood pressure and can be shared on your social channels and patient websites. Purpose Addressing Barriers Beyond the Published Literature, Self-Measured Blood Pressure Monitoring at Home: A Joint Policy Statement From the American Heart Association and American Medical Association, An Opportunity to Better Address Hypertension in Women: Self-Measured Blood Pressure Monitoring, Agency for Healthcare Research and Quality (AHRQ) Self-Measured Blood Pressure Monitoring: Comparative Effectiveness, U.S. Preventive Services Task Force (USPSTF) Final Recommendation Statement: Hypertension in Adults: Screening, Division for Heart Disease and Stroke Prevention, Live to the Beat Campaign Partner Toolkit. There were 24 comparisons of SMBP alone versus usual care, 24 of SMBP plus additional support versus usual care, 12 of SMBP plus additional support versus SMBP without additional support or with less intense additional support, and 1 study evaluating predictors of adherence to SMBP. With training, additional support and treatment algorithms, patients may be able to self adjust medications based on SMBP results. Hypertension often requires lifelong treatment. 343 0 obj <>stream Self-Measured Blood Pressure Monitoring: Action Steps for Public Health Practitioners [PDF 1 MB] These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. 5600 Fishers Lane Finally, SMBP may be useful in preventing overtreatment in individuals with white coat syndrome, orthostatic BP changes, or hypotensive episodes from medication. This report can help policymakers learn more about which payers have programs that cover and reimburse for SMBP monitoring. Ambulatory BP monitoring requires a technologist to program the machine, fit it on the patient, remove it and download the results and a physician to interpret them. The site is secure. AHRQ Publication No. The site is secure. Centers for Disease Control and Prevention. Untreated or ineffectively treated hypertension leads to increased cardiovascular morbidity and mortality in individuals, increased consumption of health care resources, high financial and human costs to society. Document author(s)/institution of origin: Effective Health Care Program, Agency for Healthcare Research and Quality, Internet Citation: Effectiveness of Self-Measured Blood Pressure Monitoring in Adults With Hypertension. Talk with your health care team about how often you should have your blood pressure measured or when to measure it yourself. : 14-05198-EF-1. This patient-friendly video from the Release the Pressure Coalition highlights the key steps people can take for accurate SMBP monitoring. To determine predictors of adherence with SMBP monitoring. SMBP with or without additional support may confer a small benefit in BP control compared with usual care, but the BP effect beyond 12 months and the attendant long-term clinical consequences remain unclear. In that role, she provides scientific expertise to support research translation related to Million Hearts priority strategies. This website requires cookies, and the limited processing of your personal data in order to function. In studies of SMBP monitoring, how do clinical, surrogate, and intermediate outcomes (including SMBP monitoring adherence) vary by the type of additional support provided? Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. Federal government websites often end in .gov or .mil. All information these cookies collect is aggregated and therefore anonymous. Archived: This report is greater than 3 years old. MeSH A 2012 comparative-effectiveness review by the Agency for Healthcare Research and Quality found strong evidence that SMBP plus clinical support was more effective than usual care in improving blood pressure control among patients with hypertension. Please enable it to take advantage of the complete set of features! How can I measure my blood pressure at home? Unauthorized use of these marks is strictly prohibited. Other factors that can improve accuracy include the use of an appropriately sized cuff and slow cuff deflation. To determine predictors of adherence with SMBP monitoring. Bethesda, MD 20894, Web Policies Many studies were of moderate to poor quality and had short followup periods. Talk with your health care team about regularly measuring your blood pressure at home, also called self-measured blood pressure (SMBP) monitoring. We take your privacy seriously. Taking Control of My Blood Pressure: Natalias Story For SMBP plus additional support versus usual care, the strength of evidence is high and supports a lower BP with SMBP use (SBP/DBP -3.4 to -8.9/-1.9 to -4.4 mmHg) up to 12 months. Click the topic below to receive emails when new articles are available. These blood pressure monitors are easy and safe to use. This process is quick and painless. Thus an alternative term for SMBP monitoring which better captures the application of self measurement for this report is the term home BP monitoring; however since the term is relatively rarely used in the literature, we will continue to use SMBP. For SMBP plus additional support versus SMBP alone or with less intense additional support, the strength of evidence is low, failing to support a difference in BP. If using a digital or automatic blood pressure cuff, the health care professional will not need to use a stethoscope. dabl Educational Trust: Sphygmomanometers for Self-measurement of Blood Pressure, British Hypertension Society: Blood Pressure Monitors Validated for Home Use, AHRQ Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. Kallioinen N, Hill A, Horswill MS, Ward HE, Watson MO. However, even when measured according to established guidelines, clinic BP measurements have several limitations. 8600 Rockville Pike An official website of the United States government. Use this printable and shareable list of questions to ask your health care team to help you manage your blood pressure. He has led the Evidence Review Teams for numerous guidelines for management of kidney disease, gynecological surgery, orthopedic surgery, and triaging in resource-poor countries. No studies evaluated children. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD. The health care professional will slowly let air out of the cuff while listening to your pulse with a stethoscope and watching the gauge. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. Resource title: Effectiveness of Self-Measured Blood Pressure Monitoring in Adults With Hypertension Resource description: This research summary of a systematic review compares the effectiveness of various methods and approaches to blood pressure measurement by patients or companions. A connected monitor is preprogrammed to regularly record BP, usually every 15 to 20 minutes while awake and every 20 to 30 minutes while asleep. This 2020 joint policy statement from the American Heart Association (AHA) and the AMA addresses barriers to implementing SMBP monitoring. The actual BP measurement can be done either by the patient, or less frequently by a companion, who is usually not a medical professional. In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. May 28, 2010. Federal government websites often end in .gov or .mil. This 2020 AMA handout for Current Procedural Terminology (CPT) provides codes and descriptions for SMBP-related services. To systematically review the trial evidence on the comparative effectiveness of hypertension management with versus without SMBP monitoring, and of different additional support interventions with SMBP. This article presents strategies for strengthening the United States ability to address hypertension in women focusing on pregnancy-related considerations for self-measured blood pressure monitoring. Hypertension often requires lifelong treatment. Self-Measured Blood Pressure Monitoring Definition and Indications SMBP plus additional clinical support is one alternative to traditional oce care that could improve access to care and quality of care for individuals with hypertension while making blood pressure control more convenient and accessible across the population. The population of interest is the general population of people with hypertension, excluding pregnant women or those receiving dialysis. An official website of the Department of Health and Human Services, Latest available findings on quality of and access to health care. Possible comparisons between SMBP, SMBP plus additional support, support without SMBP, and usual care, Agency for Healthcare Research and Quality (US). The current report evaluates ambulatory BP monitoring only as an outcome measurement tool, not as an intervention of interest. Figure 1 shows possible comparisons between SMBP, SMBP plus additional support, support without SMBP, and usual care. Bookshelf Why do I need to measure my blood pressure? Ann Intern Med. These evidence-based action steps and resources, assembled by Million Hearts, can help practices implement SMBP monitoring. >gL/?eEAV c,1t D~ 8-?x}0 KQUo~TJa&A6@sY(|x D G&pA32^Y|VLEcx 71HbFFhi3"9#+Z~GqESHm,Y-G1. Disclaimer. official website and that any information you provide is encrypted Resource description: This research summary of a systematic review compares the effectiveness of various methods and approaches to blood pressure measurement by patients or companions. If you have high blood pressure, talk to your health care team about steps to take to control your blood pressureto lower your risk for heart disease and stroke. Careers. Self-measured blood pressure monitoring (SMBP), the regular measurement of blood pressure by a patient outside the clinical setting, plus additional support, is a proven, cost-effective but underutilized strategy to improve hypertension outcomes. Purpose Generate prioritized topics for future research on SMBP, building on evidence gaps identified in a prior comparative effectiveness review and following an . We standardized extraction by training on multiple articles, after which each study was extracted by one methodologist and the extraction reviewed by at least one other. Obtaining Adequate Fixation in a Periprosthetic Humerus Fracture Around a Shoulder Arthroplasty Stem in 81-Year-Old Man, ECG Challenge: Irregular Pulse During Cardiology Visit. Technically, SMBP monitoring refers to regular measurement by the patient of his or her own BP. The gauge uses a unit of measurement called millimeters of mercury (mmHg) to measure the pressure in your blood vessels. Cookies used to make website functionality more relevant to you. Collaborative Care Models for Improving Hypertension Control Through SMBP Monitoring Your feet should be flat on the floor and your legs . 2013 Aug 6;159(3):185-94. doi: 10.7326/0003-4819-159-3-201308060-00008. If you are concerned about your blood pressure numbers, talk to your health care team. Strong scientific evidence shows that self-measured blood pressure (SMBP) monitoring, also known as home blood pressure monitoring, plus clinical support helps people with hypertension lower their blood pressure. The HOME BP intervention for SMBP is an integrated patient-practitioner online digital tool. Unable to load your collection due to an error, Unable to load your delegates due to an error, Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. In response, providers offer customized support and advice, such as medication or lifestyle adjustments. Lin JS, O'Connor E, Rossom RC, Perdue LA, Burda BU, Thompson M, Eckstrom E. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013 Nov. Report No. PMC In studies of SMBP monitoring, how does achieving BP control relate to clinical and surrogate outcomes? To sign up for updates or to access your subscriberpreferences, please enter your contact information below. This video from the NACHC features Natalia, a patient who explains how she has taken control of her blood pressure with SMBP monitoring. %%EOF However, reviews of evidence should not be construed to represent clinical recommendations or guidelines. Evidence shows that people with high blood pressure are more likely to lower their blood pressure if they use SMBP combined with support from their health care team than if they dont use SMBP.3. To review the role of self-measured blood pressure (SMBP) monitoring with or without additional support (interventions such as telemonitoring, counseling, education, Web support, behavioral interventions, home visits, etc.) There is no consensus on the precise protocol for SMBP monitoring in the management of hypertension regarding timing, frequency and duration. This report focuses on SMBP monitoring as a strategy to help patients and clinicians to better manage and control hypertension while avoiding under- or overtreatment or treatment-related hypotension. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. U.S. Preventive Services Task Force (USPSTF) Final Recommendation Statement: Hypertension in Adults: Screening Take your blood pressure at the same time every day. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. 7 HBPM is also known as self-measured BP. SMBP differs from clinic-based and ambulatory blood . There were 24 comparisons of SMBP alone versus usual care, 24 of SMBP plus additional support versus usual care, 12 of SMBP plus additional support versus SMBP without additional support or with less intense additional support, and 1 study evaluating predictors of adherence to SMBP.

self measured blood pressure monitoring: comparative effectiveness