For all comparisons, evidence for clinical outcomes was insufficient; for all other outcomes (surrogate and intermediate outcomes, and health care encounters) strength of evidence was low, thus failing to support a difference. Introduction. Clinic measurements may not reflect the usual BP outside of the clinic setting throughout a day. January 2012 As they were scoping their work for SMBP, they started by searching multiple databases In total, 49 studies met eligibility criteria. A recent CDC study found that 67 million adult Americans have hypertension, and of those, 36 million are uncontrolled. Kallioinen N, Hill A, Horswill MS, Ward HE, Watson MO. 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. Self-measured blood pressure (SMBP) monitoring, the regular measurement of blood pressure (BP) by the patient at home, has been proposed as a means of improving treatment adherence and BP control. On the other hand, if more frequent home BP measurements lead to more encounters for counseling, modification of lifestyle behaviors, drug treatments along with management of adverse effects, SMBP may actually increase cost, at least in the short term, since it takes several years for improved BP control to improve clinical outcomes. National Library of Medicine In brief, ambulatory BP monitoring is a noninvasive, fully automated technique in which BP is recorded over an extended period of time, typically 24 hours. To accelerate SMBP use, the Centers for Disease Control and Prevention (CDC) funded the National . Patients may require some instruction on how to use SMBP devices.30,31. Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. Purpose: Self-Measured Blood Pressure Monitoring at Home: A Joint Policy Statement From the American Heart Association and American Medical Association Research shows that SMBP: Can improve adherence and health outcomes for hypertensive patients1 Self-Measured Blood Pressure Monitoring: Comparative Effectiveness [Internet]. A 2012 comparative-effectiveness review by the Agency for Healthcare Research and Quality found strong evidence that SMBP plus clinical support was . Cookies used to make website functionality more relevant to you. Telephone: (301) 427-1364, Powered by the Evidence-based Practice Centers, Self-Measured Blood Pressure Monitoring: Comparative Effectiveness, https://effectivehealthcare.ahrq.gov/products/measuring-blood-pressure, Comment on Key Questions and Draft Reports, 25 Years of the AHRQ Evidence-based Practice Center Program, U.S. Department of Health & Human Services. Centers for Disease Control and Prevention. Neither is there consensus on how many serial measurements should be taken and which ones should be used or averaged to derive an accurate reading. SMBP Coverage Insights: Medicaid [PDF 232 KB] Agency for Healthcare Research and Quality, Rockville, MD. Careers. Patients are instructed to keep an activity log throughout the testing period for evaluation of stress- and activity-related BP changes. 7 HBPM is also known as self-measured BP. in the management of hypertension, a systematic review of 49 studies examined the comparative effectiveness and adherence See the resources below for specific recommendations. A health care team member can show you how to use one if you need help. 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. sX Ndb`T~ https://effectivehealthcare.ahrq.gov/products/measuring-blood-pressure. Background Hypertension often requires lifelong treatment. How can I measure my blood pressure at home? What should I do if my blood pressure numbers are high? This resource from the Public Health Informatics Institute provides a checklist of helpful characteristics for SMBP telemonitoring software. in the management of hypertension, a systematic review of 49 studies examined the comparative effectiveness and adherence predictors of SMBP monitoring. Brown Affiliations Hypertension often requires lifelong treatment. Your feet should be flat on the floor and your legs . There is insufficient evidence concerning predictors of SMBP adherence. Measurements may interfere with a patient's activity or sleep. PMC National Library of Medicine Accessibility Regardless of the mode of support delivered, the patient-provider feedback loop is essential. 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. 2013 Aug 6;159(3):185-94. doi: 10.7326/0003-4819-159-3-201308060-00008. No studies evaluated children. Systematic Review: : 13-05194-EF-1. How does adherence with SMBP monitoring vary by patient factors? Several national and international hypertension guidelines endorse self-measured BP monitoring. Europe PMC is an archive of life sciences journal literature. This 2020 AMA handout for Current Procedural Terminology (CPT) provides codes and descriptions for SMBP-related services. Million Hearts Science team, Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GeorgiaDisclosure: Allison Goldstein, MPH, has disclosed no relevant financial relationships. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. 2012 Sep 21. Please enter a Recipient Address and/or check the Send me a copy checkbox. 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. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. 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. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. Technically, SMBP monitoring refers to regular measurement by the patient of his or her own BP. Topline Findings: A National Analysis of Self-Measured Blood Pressure Monitoring Coverage and Reimbursement [PDF 1.7 MB] Self-Measured Blood Pressure Monitoring: Comparative Effectiveness [Internet]. John M Eisenberg Center for Clinical Decisions and Communications Science. Very few trials evaluated objective clinical outcomes. CDCs 6|18 Initiative: Accelerating Evidence into Action Data extraction Data on . 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. : 14-05198-EF-1. 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. That the mean number of BP measurements recorded per week for users who continued recording blood pressure at 6 weeks was 6 compared to 8 among those who continued for at least 14 weeks, demonstrates high levels of engagement with respect to self-measured BP monitoring. Please enable it to take advantage of the complete set of features! hXio8EIbHr)_cBCq{(1KLL)}]IDb)Pb"VL *&DSK28ijMqXLG:a/^~ vs:?COe+Y1~504ye49ucTSQZGUI+'O+ {EQZu]`^.7t n\B^9~: 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. The review addressed SMBP monitoring performed by the patient or the patient's companion at home; it did not include monitoring done at the doctor's office, clinic, pharmacy, or health unit at work, nor did it include blood pressure (BP) monitoring done at home by nurses or other health care professionals. SMBP measurements can be obtained from the upper arm, wrist, or fingers (or, if necessary, the lower extremity); however, experts recommend the use of upper arm devices due to the lack of validation and the high number of inaccurate measurements from the wrist and finger devices.26-28 Models for SMBP devices range from mechanical aneroid gauges (sphygmomanometers), which require self-inflation and auscultation (manual devices), to manually-inflated sphygmomanometers with automatic displays (semiautomated devices), to fully automated configurations that automatically inflate the sphygmomanometer and measure the BP (automated devices). Many have undergone validation according to the recommendations of the American Association of Medical Instrumentation, the European Society of Hypertension or the British Hypertension Society.25,29 Generally, the use of validated devices is preferred. Self-measured blood pressure (SMBP) has been used in the treatment of hypertension with three major aims: 1) to avoid undertreatment of hypertension 2) to enhance self-participation in disease management and to enhance adherence; and 3) to avoid overtreatment in those with lower BP out of the clinic compared with in the clinic 26 To determine predictors of adherence with SMBP monitoring. 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. 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. Finally, SMBP may be useful in preventing overtreatment in individuals with white coat syndrome, orthostatic BP changes, or hypotensive episodes from medication. Cite this: Self-Measured Blood Pressure Monitoring to Control Hypertension-Medscape-May06,2013. 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. 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. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2013. For all comparisons, evidence for clinical outcomes was insufficient; for all other outcomes (surrogate and intermediate outcomes, and health care encounters) strength of evidence was low, thus failing to support a difference. 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. The HOME BP intervention for SMBP is an integrated patient-practitioner online digital tool. Comparative Effectiveness Review No. People using assistive technology may not be able to fully access information in these files. All information these cookies collect is aggregated and therefore anonymous. How do health care professionals measure my blood pressure? 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. This article outlines high-level SMBP barriers that federal/national partners have encountered and offers potential solutions to achieve widespread SMBP implementation. (Prepared by the Tufts Evidence-based Practice Center under Contract No. Bethesda, MD 20894, Web Policies An official website of the Department of Health and Human Services, Latest available findings on quality of and access to health care. The https:// ensures that you are connecting to the ECG Challenge: What's Causing This Woman's Slow Pulse? The CDC 6|18 Initiative supports providing access for SMBP monitoring for home use and creating individual, provider, and health system incentives for compliance and meeting goals. Careers. The choice of treatment is largely dependent on the cause of hypertension, severity of the condition, as well as the presence or absence of existing comorbid states. SMBP monitoring is the regular measurement of blood pressure by the patient outside the clinical setting, either at home or elsewhere.
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