Having patients measure their own blood pressure at home can improve diagnosis of hypertension, and for those patients who have it, can help get their hypertension under control. Learn the facts about self-measured blood pressure monitoring, including how you can get a self-measured blood pressure monitoring program started in your practice. What is self-measured blood pressure monitoring? Sometimes called “home blood pressure monitoring,” this patient self-measurement occurs outside of a clinical setting. Research shows this process can improve adherence and health outcomes for patients with hypertension. Why would I want patients to self-measure their blood pressure at home? Randomized controlled trials have shown that self-measured blood pressure predicts cardiovascular morbidity and mortality better than office blood pressure measurements, so using it to guide you in diagnosing and treating hypertension likely will produce better outcomes than using office blood pressure readings alone. Self-measurements provide more blood pressure readings over a longer period of time, which better represents what a patient’s true blood pressure is. By having more reliable blood pressure readings to work with, you are less likely to misdiagnose a patient as having sustained hypertension when they really have isolated office blood pressure elevations (known as “white coat hypertension”). This concept also applies to assessing the blood pressure control of a patient with hypertension. Having more accurate and reliable readings allows clinicians to assess whether a patient’s anti-hypertensive treatment is sufficiently controlling their blood pressure. If it is not controlled, a clinician can act more rapidly, being confident that the multiple readings taken over the course of several days are more reliable than a few blood pressure measurements taken during a single office visit. How do my patients get a home blood pressure monitor? Your patients can buy a monitor at their local drug store. Many public and private health insurance plans don’t cover the cost of self-monitoring devices, unfortunately. Prices for a typical high-quality device can range from $50 to $150. Another option is to purchase monitors for your practice and loan them out to patients. How can I help my patients determine which monitor to buy? Most of the methods of monitoring patients’ blood pressure that are shown to improve patient outcomes use automated (oscillometric) devices. With this type, the patient wraps a cuff around his or her arm and presses a button to get a digital blood pressure reading. When recommending an automated device, tell the patient to make sure the device meets these four criteria: • Valid. Automatic devices should be certified by the Association for the Advancement of Medical Instrumentation, the British Hypertension Society or the European Society of Hypertension. • Meant for the upper arm. Only upper arm monitors produce reliable measures. Monitors for the wrist do not produce accurate results. • Easy to use. Devices come in a range of models with varying features, so the patient should choose a device that is easiest for him or her to use. • Able to share data. Some devices can store readings and report back at a later time, calculate an average measure and transmit to other devices, such as your electronic health record system. How should my patient use a home blood pressure monitor? Have your patient use this infographic to get in an appropriate position before they take the reading. (See below for additional free resources your practice can download and use.) Your patient should take two readings at one- to two-minute intervals, both in the morning and evening for seven consecutive days. This will provide four measurements a day, 28 for a week, which is ideal. Make sure the patient knows to record each measurement. Offer additional support when using this process, such as a one-time training session when you or someone on your staff can watch the patient obtain his or her blood pressure measurement. This way you make sure the patients understands how to do so correctly. How do I use the data from my patient’s measurements? When you receive the patient’s measurements, calculate the average value of all the systolic and diastolic blood pressures. Use this single average to determine whether your patient has hypertension or your patient’s blood pressure is controlled. Research shows this process improves blood pressure control when physicians provide personalized support and advice based on the patient’s data. Do I need to give the patient any warnings? Make sure your patient knows what to do if he or she has a measurement that is outside your pre-determined acceptable range, or if he or she experiences any symptoms with a high or low blood pressure measurement. This could mean seeking emergency treatment, if appropriate. Source
