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. Comparative Effectiveness of Diagnosis and Treatment of Obstructive Sleep Apnea in Adults. Comparative Effectiveness Review No. I am Allison Goldstein from the Division for Heart Disease and Stroke Prevention at CDC. [3] (Figure 1). 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). Hello. 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. No trials compared different SMBP devices or provided evidence on the relationship between BP control and clinical or surrogate outcomes. What is the correct way to measure blood pressure? The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. 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. Release the Pressure Self-Measured Blood Pressure (SMBP) Training Video Ann Intern Med. 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. Shareable Handouts and Tools in English and Spanish, steps to take to control your blood pressure, this list of questions to ask your health care team, take steps each day to help keep your blood pressure in a healthy range, Heart disease and stroke statistics-2020 update: a report from the American Heart Association, Sources of inaccuracy in the measurement of adult patients resting blood pressure in clinical settings: A systematic review, National Center for Chronic Disease Prevention and Health Promotion, 5 Surprising Facts About High Blood Pressure, Hypertension Statistical Reports for Health Professionals, Morbidity and Mortality Weekly Reports About Hypertension, Hypertension Resources for Health Professionals, U.S. Department of Health & Human Services. This list of resources from the Million Hearts Hypertension Control Change Package can help assign care team roles for an SMBP monitoring program and guide patients on selecting a home blood pressure monitor. The present Comparative Effectiveness Review (CER) evaluates the effects of self-measured blood pressure (SMBP) monitoring in hypertensive patients. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. Choosing-a-Home-BP-Monitor At-a-Glance-Comparison [PDF 446 KB] A 2012 comparative-effectiveness review by the Agency for Healthcare Research and Quality found strong evidence that SMBP plus clinical support was . HHS Vulnerability Disclosure, Help In that role, she provides scientific expertise to support research translation related to Million Hearts priority strategies. Tools to Establish a Self-Measured BP (SMBP) Monitoring Program [PDF 2 MB] Systematic Review: Lozano P, Henrikson NB, Morrison CC, Dunn J, Nguyen M, Blasi P, Whitlock EP. Centers for Disease Control and Prevention. MeSH Generally, individuals with hypertension would use such devices at home to measure their own BP and provide written lists of readings to their provider at office visits. Content last reviewed August 2018. Ann Intern Med. You can review and change the way we collect information below. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD. Newer SMBP devices can automatically store readings and some are equipped to electronically transmit readings to a provider. This video from the NACHC features Natalia, a patient who explains how she has taken control of her blood pressure with SMBP monitoring. PMC These blood pressure monitors are easy and safe to use. Measure Your Blood Pressure | cdc.gov These cookies may also be used for advertising purposes by these third parties. official website and that any information you provide is encrypted 45. Self-Measured Blood Pressure Monitoring: Action Steps for Clinicians [PDF 947 KB] Thank you for taking the time to confirm your preferences. 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. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. The site is secure. Prior to joining CDC, Allison worked on the Global Polio Eradication Initiative at CARE International where she designed curricula for health workers and conducted evaluation field research on global polio eradication efforts. However, there is uncertainty about the appropriate home BP targets for guiding treatment decisions and whether these should be based on the same cut-points from clinic BP or from ABPM for defining hypertension.32. This resource from the Public Health Informatics Institute provides a checklist of helpful characteristics for SMBP telemonitoring software. 2013 Aug 6;159(3):185-94. doi: 10.7326/0003-4819-159-3-201308060-00008. Whether or not to advise the use of an SMBP monitoring device for a patient with hypertension is a common clinical question for clinicians. Background: Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. pharmacists and nurse practitioners) to manage patients' HBP (Figure 1). Unauthorized use of these marks is strictly prohibited. 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. Rockville (MD): Agency for Healthcare Research and Quality (US); 2014 Dec. Report No. To address comparative effectiveness, we included prospective comparative studies of SMBP with or without additional support versus usual care or an alternative SMBP intervention. Agency for Healthcare Research and Quality (AHRQ) Self-Measured Blood Pressure Monitoring: Comparative Effectiveness [PDF 1.2 MB] Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. To summarize evidence about the effectiveness of self-measured blood pressure (SMBP) monitoring in adults with hypertension. What you need to know about self-measured blood pressure monitoring Page originally created December 2020. SMBP = self-measured BP; KQ = Key Question. Unable to load your collection due to an error, Unable to load your delegates due to an error, Self-Measured Blood Pressure Monitoring: Comparative Effectiveness [Internet]. Further debate focuses on the role of additional support needed to enhance adherence with SMBP monitoring and, possibly, achieve the clinical benefit from it. There is growing evidence that selfmonitoring of blood pressure (SMBP) with guided support beyond usual primary care improves BP control. Please enable it to take advantage of the complete set of features! SMBP means you regularly use a personal blood pressure measurement device away from a doctor's office or hospitalusually at home. 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. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness [Internet]. 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. Target: BP: CME Course: Using SMBP to Diagnose and Manage High Blood Pressure 45.) Recommended management strategies for BP control include lifestyle and behavior modification (such as smoking cessation, moderation of alcohol consumption, salt restriction and other dietary modifications, regular exercise, and weight loss in obese persons), usually combined with the use of antihypertensive medication. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness 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. Europe PMC is an archive of life sciences journal literature. 2012 Sep 21. >gL/?eEAV c,1t D~ 8-?x}0 KQUo~TJa&A6@sY(|x D G&pA32^Y|VLEcx 71HbFFhi3"9#+Z~GqESHm,Y-G1. This process is quick and painless. Register for the Million HeartsSMBP Forum, an opportunity for clinical, public health, and community-based partners to exchange best and promising practices, identify solutions to common obstacles, and share resources to accelerate SMBP monitoring uptake. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness Uhlig K, Balk EM, Patel K, et al. PDF Science In Brief: Home and Online Management and Evaluation of Blood 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. Addressing Barriers Beyond the Published Literature Read the full Million Hearts Hypertension Control Change Package. Effectiveness of Self-Measured Blood Pressure Monitoring in Adults With Would you like email updates of new search results? Details on design, patients, interventions, outcomes, and quality were extracted into standard forms. SMBP monitoring is also commonly referred to as home blood pressure monitoring. There is no consensus on the precise protocol for SMBP monitoring in the management of hypertension regarding timing, frequency and duration. Together we can empower patients to take control of their hypertension, thereby reducing their risk for heart attack and stroke. . In addition, ambulatory BP monitoring is often used in research studies as an outcome, since many consider it to be more accurate than clinic-based BP measurement. Self-Measured Blood Pressure Monitoring | Million Hearts One study estimated that the global prevalence of hypertension in 2000 was 26 percent in the adult population. Regardless of the mode of support delivered, the patient-provider feedback loop is essential. Cite this: Self-Measured Blood Pressure Monitoring to Control Hypertension-Medscape-May06,2013. 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. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness 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. We take your privacy seriously. An official website of the Department of Health and Human Services, Latest available findings on quality of and access to health care. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. 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. This patient-friendly video from NACHC outlines clear instructions for using home blood pressure monitors. Data extraction Data on . : 13-05194-EF-1. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. If you are concerned about your blood pressure numbers, talk to your health care team. Rockville, MD 20857 Source:Centers for Disease Control and Prevention. Strategies aimed at the control of high BP as well as adherence to medication continue to be of foremost concern to providers and patients, health care payers, policymakers, and governments worldwide. National Library of Medicine SMBP requires the use of a home blood pressure measurement device by the patient to measure blood pressure at different points in time. High blood pressure (BP), or hypertension, is a common, long-term health condition, particularly among older adults. 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. 5600 Fishers Lane Internet Citation: You can review and change the way we collect information below. Patient-provider feedback loop with clinical support for SMBP monitoring. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness Before i` V04s7.w`t32Cc( L4M\ES}*vWe+= 4a)\5O)si8hQ[^}.L01>#t7On,c7g K>=}NrMo4;Zj:97MgN1m#6+U6i BP as recorded in the office or clinic setting at medical encounters is the most commonly used approach for measurement of BP. PDF Background Effective Health Care Program - Agency for Healthcare and transmitted securely. Taking Control of My Blood Pressure: DAngelos Story In: Daniel D, Prall M, editors. 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 figure shows a schematic of possible comparisons between SMBP, SMBP plus additional, support without SMBP, and usual care. 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 There is within-individual biological variability as well as measurement error. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness hXio8EIbHr)_cBCq{(1KLL)}]IDb)Pb"VL *&DSK28ijMqXLG:a/^~ vs:?COe+Y1~504ye49ucTSQZGUI+'O+ {EQZu]`^.7t n\B^9~: 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. If you log out, you will be required to enter your username and password the next time you visit. This table from a 2021 Current Atherosclerosis Reports journal article features oscillometric blood pressure devices validated for accuracy during pregnancy. 1, 2 The TASMINH (Telemonitoring And SelfManagement in the Control of Hypertension) trials demonstrated that SMBP plus support, including telemonitoring (remotely monitoring patients using communication This 2020 AMA handout for Current Procedural Terminology (CPT) provides codes and descriptions for SMBP-related services. Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. Cookies used to make website functionality more relevant to you. No studies evaluated children. The .gov means its official. 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. Oscillometric Blood Pressure Devices Validated for Accuracy During Pregnancy [PDF 441 KB] 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. However, reviews of evidence should not be construed to represent clinical recommendations or guidelines. Document author(s)/institution of origin: Effective Health Care Program, Agency for Healthcare Research and . Purpose: 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. 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. Repeated measurements are needed to facilitate accurate classification of patients. Careers. Sit correctly. endstream endobj startxref Why do I need to measure my blood pressure? Rockville, MD 20857 and transmitted securely. Study Selection: 12-EHC002-EF. Out-of-Office Blood Pressure Monitoring: A Comparison of Ambulatory Allison is trained as an emergency medical technician and received a bachelor of science degree in biology and anthropology from the University of Michigan and a master of public health degree, with a focus in behavioral science and education, from Emory University. The HOME BP intervention for SMBP is an integrated patient-practitioner online digital tool. 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. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. You will be subject to the destination website's privacy policy when you follow the link. 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 (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 The Evidence-based Practice Center (EPC) reviewed the existing body of evidence on the effects of SMBP on clinical, surrogate, and intermediate outcomes in the management of hypertension. Content last reviewed March 2020. Telephone: (301) 427-1364, Powered by the Evidence-based Practice Centers. Would you like email updates of new search results? Effectiveness of Self-Measured Blood Pressure Monitoring in - PubMed Take this form with you to your doctors office to record important blood pressure-related information. These blood pressure monitors are easy and safe to use. 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. 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. How Do We Jump-Start Self-measured Blood Pressure Monitoring in the United States? 2013 Aug 6;159(3):185-94. doi: 10.7326/0003-4819-159-3-201308060-00008. Hypertension often requires lifelong treatment. It predicted a rise by 24 percent in developed countries and 80 percent in developing countries by 2025.4 The World Health Report 2002 estimates that over 1 billion people have hypertension, which is estimated to cause 4.5 percent of the global disease burden.5 In addition, high BP directly results in 7 million deaths annually.6 Within the United States, about 76.4 million adults are affected.7 Data from the National Health and Nutrition Examination Surveys (NHANES) from 1999 to 2008 indicated that 30 percent of all adults in the U.S. 18 years and older were hypertensive, with a higher prevalence among African Americans and the elderly.8 The prevalence of verified hypertension in children is more than 3 percent.2 A study from 2002 reported a lifetime risk of developing hypertension among adults aged 55 to 65 years in the U.S. as greater than 90 percent.9 Despite improvements in the quality of health care and life expectancy, it is expected that the prevalence of hypertension will continue to rise as the population ages. 2011 Aug 8. Many studies were of moderate to poor quality and had short followup periods. This is an official U.S. government web site managed by the J Athl Train. High blood pressure usually has no warning signs or symptoms, and many people do not know they have it. This AMAAHA joint initiative can help health care professionals launch an SMBP monitoring program. How can I measure my blood pressure at home? Self-measured blood pressure monitoring in the management of The trials were greatly heterogeneous, varying in population, intervention, and outcome measures and definitions. Current settings for BP measurement include BP measurement in a healthcare setting, or BP measurement in a patient's usual environment with either ambulatory BP monitoring, or self-measured BP (SMBP) monitoring. Hypertension also imposes a heavy financial burden on society at large. 8600 Rockville Pike hb```f`` & B,@Q+g~ Piper MA, Evans CV, Burda BU, Margolis KL, OConnor E, Smith N, Webber E, Perdue LA, Bigler KD, Whitlock EP. For the purpose of this report, BP measurement by the patient in the office/clinic/pharmacy or a health unit at work is not included under SMBP monitoring since it does not reliably overcome the problem of white coat hypertension nor provide the privacy and opportunity for more frequent measurements of home self measurement. In a comparative effectiveness review supported by the Agency for . The goals of this report, therefore, are to inform physicians' decision whether to encourage the use of SMBP monitoring alone or along with additional support and to assist health care policymakers and payers with decisions regarding coverage and promotion of SMBP monitoring. 8. 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. Federal government websites often end in .gov or .mil. Providers can help with SMBP implementation by promoting SMBP to their hypertensive patients and establishing clinical feedback systems. An official website of the Department of Health & Human Services, Internet Citation: In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. They can help you make a plan to manage high blood pressure. For SMBP alone versus usual care, the strength of evidence is moderate and supports a lower BP with SMBP (SBP/DBP -3.1/-2.0 mmHg at 6 months). SMBP monitoring is the regular measurement of blood pressure by the patient outside the clinical setting, either at home or elsewhere. An official website of the Department of Health & Human Services. Accelerating Use of Self-measured Blood Pressure Monitoring (SMBP Kallioinen N, Hill A, Horswill MS, Ward HE, Watson MO. Given the inconvenience and expense of setting up and using the device, ambulatory BP monitoring is predominantly used to diagnose white coat or masked hypertension, to identify people with abnormal daily BP patters, or to help with management of hard to control or highly variable BP. For example, terminal digit preference (i.e., preference for 0, 5, and even numbers) and single number preference (i.e., preference for specific values such as 130/80 or 140/90 mmHg) can lead to inaccuracies in measurement readings and variability across observers.17,18 This can be prevented when machines provide readings automatically. PMC 315 0 obj <>/Filter/FlateDecode/ID[]/Index[293 51]/Info 292 0 R/Length 113/Prev 421311/Root 294 0 R/Size 344/Type/XRef/W[1 3 1]>>stream A BP cuff is placed around the upper arm and left in place for approximately 24 hours. Using SMBP to guide you in diagnosing and treating hypertension likely will produce better outcomes than using office blood pressure readings alone. To determine predictors of adherence with SMBP monitoring. 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. Limitations: Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2013. European Associations Review Dietary Therapies for Obesity, AHA Statement Ranks 10 Popular Diets for Heart Health. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. MEDLINE, Cochrane Central Register of Controlled Trials, existing systematic and narrative reviews, recent conference proceedings, and the Food and Drug Administration. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness sharing sensitive information, make sure youre on a federal 7 HBPM is also known as self-measured BP. John M Eisenberg Center for Clinical Decisions and Communications Science. How does adherence with SMBP monitoring vary by patient factors? Support interventions can be delivered outside of a normal office visit -- for example via telephone, email, or Internet portal -- thereby reducing the necessary frequency of face-to-face visits. The full report, listing all studies, is available at www.effectivehealthcare.ahrq.gov/selfmeasuredbp.cfm. Data Extraction: To determine predictors of adherence with SMBP monitoring. Self-Measured Blood Pressure Monitoring Program: Engaging Patients in Self-Measurement [PDF 1.5 MB] Self-Measured Blood Pressure Monitoring - Medscape Hypertension often requires lifelong treatment. 2013 Aug 6;159(3):185-94. doi: 10.7326/0003-4819-159-3-201308060-00008. This review does not explore the validity, reproducibility, or comparability of BP measurements across devices or techniques (which was addressed by the 2002 EPC report25), or the use of SMBP as a diagnostic tool. Click the topic below to receive emails when new articles are available. Where can I get my blood pressure checked? While patient self-participation in chronic disease management appears promising, the sustainability and clinical impact of SMBP remains uncertain. In response, providers offer customized support and advice, such as medication or lifestyle adjustments. AHRQ Publication No. https://www.ahrq.gov/evidencenow/heart-health/blood-pressure/smbp-effectiveness.html. How does SMBP monitoring compare with usual care or other interventions without SMBP in its effect on relevant surrogate outcomes (cardiac measures: LVH [left ventricular hypertrophy], LVM [left ventricular mass], LVMI [left ventricular mass index]) and intermediate outcomes (BP control, BP treatment adherence, or health care process measures)? The current report evaluates ambulatory BP monitoring only as an outcome measurement tool, not as an intervention of interest.