self measured blood pressure monitoring: comparative effectiveness

This patient-friendly video from the Release the Pressure Coalition highlights the key steps people can take for accurate SMBP monitoring. By using the site you are agreeing to this as outlined in our privacy notice and cookie policy. Lipid Screening in Childhood for Detection of Multifactorial Dyslipidemia: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]. 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. 8600 Rockville Pike These cookies may also be used for advertising purposes by these third parties. 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. 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. Conclusions: The .gov means its official. Tools to Establish a Self-Measured BP (SMBP) Monitoring Program [PDF 2 MB] HHS Vulnerability Disclosure, Help The HOME BP intervention for SMBP is an integrated patient-practitioner online digital tool. This website requires cookies, and the limited processing of your personal data in order to function. 8600 Rockville Pike Patient-provider feedback loop with clinical support for SMBP monitoring. How to Use Your Home Blood Pressure Monitor https://effectivehealthcare.ahrq.gov/products/measuring-blood-pressure/research. Agency for Healthcare Research and Quality, Rockville, MD. They can help you make a plan to manage high blood pressure. SMBP monitoring is also commonly referred to as home blood pressure monitoring. It has been the subject of a 2002 Evidence Practice Center (EPC) Evidence Report.25 A fuller description of ambulatory BP monitoring can be found there. 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. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. This feature requires the newest version of Flash. Accessibility 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. Rockville, MD: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services; 2012. sX Ndb`T~ %%EOF In that role, she provides scientific expertise to support research translation related to Million Hearts priority strategies. Oscillometric Blood Pressure Devices Validated for Accuracy During Pregnancy [PDF 441 KB] Unauthorized use of these marks is strictly prohibited. Rockville, MD 20857 Many things can affect a blood pressure reading, including: Its important to get an accurate blood pressure reading so that you have a clearer picture of your risk for heart disease and stroke. 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. 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. Source:Centers for Disease Control and Prevention. 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). The cuff has a gauge on it that will measure your blood pressure. 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. Types of clinical support include one-on-one counseling, Web-based and telephone support, and educational classes. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. You've successfully added to your alerts. Allison Goldstein, MPH, SMBP plus clinical support can improve access to care and quality of care for people with hypertension while making blood pressure control more convenient and accessible across the population. Kallioinen N, Hill A, Horswill MS, Ward HE, Watson MO. Agency for Healthcare Research and Quality (US), Rockville (MD). 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. 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. John M. Eisenberg Center for Clinical Decisions and Communications Science. Talk with your health care team about how often you should have your blood pressure measured or when to measure it yourself. High blood pressure usually has no warning signs or symptoms, and many people do not know they have it. No studies evaluated children. This 2020 AMA handout for Current Procedural Terminology (CPT) provides codes and descriptions for SMBP-related services. b W 35D43zi&J &lbP K 7X 45.) Hello. hbbd```b``A$ug`rX|" o/XDLHp0{W$5)"30^` w is a member of the Million Hearts Science team with the Centers for Disease Control and Prevention (CDC) Division for Heart Disease and Stroke Prevention. 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. Patients are instructed to keep an activity log throughout the testing period for evaluation of stress- and activity-related BP changes. Bookshelf Measuring your blood pressure is the only way to know whether you have high blood pressure. You and your health care team can take steps to control your blood pressureif it is too high. 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. 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 Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. MeSH 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. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Why do I need to measure my blood pressure? 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. . : 14-05204-EF-1. The present Comparative Effectiveness Review (CER) evaluates the effects of self-measured blood pressure (SMBP) monitoring in hypertensive patients. Background: 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. Learn the correct way to have your blood pressure taken, whether youre getting it checked at the doctors office or checking it yourself at home. MeSH Progestogens for Prevention of Preterm Birth. 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. Very few trials evaluated objective clinical outcomes. hXio8EIbHr)_cBCq{(1KLL)}]IDb)Pb"VL *&DSK28ijMqXLG:a/^~ vs:?COe+Y1~504ye49ucTSQZGUI+'O+ {EQZu]`^.7t n\B^9~: Self-Measured Blood Pressure Monitoring: Key Findings from a National Health Information Technology Landscape Analysis[PDF 1.3 MB] To determine predictors of adherence with SMBP monitoring. This table from a 2021 Current Atherosclerosis Reports journal article features oscillometric blood pressure devices validated for accuracy during pregnancy. 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 SMBP means you regularly use a personal blood pressure measurement device away from a doctor's office or hospitalusually at home. [3] (Figure 1). This one-page overview outlines the viability, costs, and returns for implementing an SMBP monitoring program based on Medicare reimbursement. This AMAAHA joint initiative can help health care professionals launch an SMBP monitoring program. Patients may require some instruction on how to use SMBP devices.30,31. Today, as part of the CDC Expert Commentary Series on Medscape, I would like to talk about self-measured blood pressure (SMBP) monitoring plus clinical support as a way to help patients manage their hypertension. 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.) Please confirm that you would like to log out of Medscape. include self-measured blood pressure monitoring (SMBP) plus additional clinical support and empowerment of non-physician clinicians (e.g. Talk with your health care team about regularly measuring your blood pressure at home, also called self-measured blood pressure (SMBP) monitoring. 2013 Aug 6;159(3):185-94. doi: 10.7326/0003-4819-159-3-201308060-00008. Hypertension Medication for Specific Comorbidities, Individualized Weight Monitoring Using the Heartphone, Home Blood Pressure Monitoring in Patients With Hypertension. Effective Health Care Program . 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. E-mail questions about the Forum toMillionHeartsSMBP@nachc.com. OF SELF-MEASURED BLOOD PRESSURE MONITORING INTERVENTIONS CENTERS FOR DISEASE CONTROL AND PREVENTION . There is within-individual biological variability as well as measurement error. This patient-friendly video from NACHC outlines clear instructions for using home blood pressure monitors. 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. 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. An official website of the Department of Health and Human Services, Latest available findings on quality of and access to health care. Screening for High Blood Pressure in Adults: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. J Athl Train. 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. Rockville, MD: Agency for Healthcare Research and Quality. Ann Intern Med. SMBP monitoring is the regular measurement of blood pressure by the patient outside the clinical setting, either at home or elsewhere. Topic Initiated. Use this tool to keep track of your blood pressure measurements at home. This video from NACHC features DAngelo, a patient who explains how he has taken control of his blood pressure with the help of SMBP monitoring. The full report, listing all studies, is available at www.effectivehealthcare.ahrq.gov/selfmeasuredbp.cfm. National Library of Medicine PMC In people with hypertension (adults and children), does self-measured blood pressure (SMBP) monitoring, compared with usual care or other interventions without SMBP, have an effect on clinically important outcomes? FOIA https://effectivehealthcare.ahrq.gov/products/measuring-blood-pressure. Reliable clinic measurements require an adequate rest period prior to measurement in order to enhance the consistency of BP readings. No studies of SMBP monitoring in children were identified. To sign up for updates or to access your subscriberpreferences, please enter your email address below. Several national and international hypertension guidelines endorse self-measured BP monitoring. You will be subject to the destination website's privacy policy when you follow the link. An Opportunity to Better Address Hypertension in Women: Self-Measured Blood Pressure Monitoring Very few trials evaluated objective clinical outcomes. In total, 49 studies met eligibility criteria. 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. 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. A reading that says your blood pressure is higher than it actually is may lead to treatment you dont need. There is growing evidence that selfmonitoring of blood pressure (SMBP) with guided support beyond usual primary care improves BP control. 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. AHRQ Publication No. 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. People who have high blood pressure may need to measure their blood pressure more often than people who do not have high blood pressure. Project Timeline. These blood pressure monitors are easy and safe to use. SMBP differs from clinic-based and ambulatory blood . Disclaimer. The Correct Way to Measure Blood Pressure For additional assistance, please contact us. Empty your bladder and ensure at least 5 minutes of quiet rest before measurements. Would you like email updates of new search results? SMBP Health IT Checklist [PDF 136 KB] There is no consensus on the precise protocol for SMBP monitoring in the management of hypertension regarding timing, frequency and duration. Measurements may interfere with a patient's activity or sleep. This toolkit, developed by the National Association of Community Health Centers (NACHC) for Million Hearts, can help organizations successfully integrate SMBP monitoring into care processes and workflows. Finally, SMBP may be useful in preventing overtreatment in individuals with white coat syndrome, orthostatic BP changes, or hypotensive episodes from medication. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. Apr 11, 2011. Federal government websites often end in .gov or .mil. Self-Measured Blood Pressure Monitoring Program: Engaging Patients in Self-Measurement [PDF 1.5 MB] To determine predictors of adherence with SMBP monitoring. PMC U.S. Preventive Services Task Force (USPSTF) Final Recommendation Statement: Hypertension in Adults: Screening Take this form with you to your doctors office to record important blood pressure-related information. FOIA Agency for Healthcare Research and Quality (AHRQ) Self-Measured Blood Pressure Monitoring: Comparative Effectiveness [PDF 1.2 MB] Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Jan. Report No. This report from the Public Health Informatic Institute provides key findings from a national health information technology assessment on SMBP and identifies gaps, barriers, and recommendations to advance the collection, transfer, and use of patient-generated SMBP data to improve hypertension management. 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 Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD. Details on design, patients, interventions, outcomes, and quality were extracted into standard forms. HHS Vulnerability Disclosure, Help SMBP CPT Coding [PDF 1 MB] In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. However, reviews of evidence should not be construed to represent clinical recommendations or guidelines. Thank you for taking the time to confirm your preferences. Collaborative Care Models for Improving Hypertension Control Through SMBP Monitoring Sit correctly. 5600 Fishers Lane Cookies used to make website functionality more relevant to you. Rockville (MD): Agency for Healthcare Research and Quality (US); 2014 Dec. Report No. Archived: This report is greater than 3 years old. Research shows that SMBP: Can improve adherence and health outcomes for hypertensive patients1 Use this list of questions to ask your health care team [PDF 173 KB]to help you manage your blood pressure. You can review and change the way we collect information below. 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. Newer SMBP devices can automatically store readings and some are equipped to electronically transmit readings to a provider. 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. The Community Preventive Services Task Force (CPSTF) Recommendations on Self-Measured Blood Pressure Monitoring Interventions More broadly, though, it is the regular use of a BP measurement device that is owned by (or lent to) the patient to be used outside the office/clinic setting. National Library of Medicine 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. government site. 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. In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. While patient self-participation in chronic disease management appears promising, the sustainability and clinical impact of SMBP remains uncertain. Whether or not to advise the use of an SMBP monitoring device for a patient with hypertension is a common clinical question for clinicians. To address comparative effectiveness, we included prospective comparative studies of SMBP with or without additional support versus usual care or an alternative SMBP intervention. Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. 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. 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. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness [Internet]. The gauge uses a unit of measurement called millimeters of mercury (mmHg) to measure the pressure in your blood vessels. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. CDC twenty four seven. Uhlig K, Balk EM, Patel K, et al. Associate Director, Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center Page originally created December 2020. To address comparative effectiveness, we included prospective comparative studies of SMBP with or without additional support versus usual care or an alternative SMBP intervention. Technically, SMBP monitoring refers to regular measurement by the patient of his or her own BP. The primary objective of this review is to evaluate whether the use of SMBP monitoring influences outcomes in adults and children with hypertension and to what extent these changes in outcomes can be attributable to the use of self monitoring devices alone or the use of SMBP with additional support or attention provided. Click the topic below to receive emails when new articles are available. In otherwise healthy adults, hypertension is defined as a persistently elevated BP equal to or greater than 140/90 mmHg.1 The recommended BP measurement technique is to average two readings taken in a person after 5 minutes quietly seated in chair.1 In children, the diagnosis is made from an average of three or more BP readings greater than the 95th percentile for age, sex, and height.2,3 The Seventh Joint National Committee (JNC 7) guideline recommends a BP goal of 140/90 mmHg or less in the general population and a lower goal of 130/80 mmHg or less in patients with diabetes mellitus or chronic kidney disease.1. 5600 Fishers Lane 2011 Aug 8. endstream endobj 294 0 obj <>/Metadata 50 0 R/Names 317 0 R/Outlines 332 0 R/PageMode/UseOutlines/Pages 291 0 R/StructTreeRoot 110 0 R/Type/Catalog/ViewerPreferences<>>> endobj 295 0 obj <>/Font<>/ProcSet[/PDF/Text]/Properties<>>>/Rotate 0/StructParents 0/Tabs/S/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 296 0 obj <>stream The direct and indirect cost of high BP and its complications has been estimated at more than $43.5 billion in 2007 in the U.S.7 Thus, it cannot be viewed simply as an individual health issue given the large public health impact and the potential for cost savings with effective prevention or treatment. The site is secure. Choosing-a-Home-BP-Monitor At-a-Glance-Comparison [PDF 446 KB] 52 prospective comparative studies of SMBP monitoring with or without additional support versus usual care or an alternative SMBP monitoring intervention in persons with hypertension. 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. Data Synthesis: 343 0 obj <>stream Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. The Forum convenes online quarterly. The bold lines indicate the comparisons addressed in the Key Questions (see below). The cost of a home BP monitor ranges between $40 to $150, and the insurance coverage and approval for these devices vary across states.33 However, provision of the device could be cost-saving if it resulted in a reduced number of office visits for BP measurement or management or resulted in improved BP, which could translate into reduced morbidity and health care utilization. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2013. This 2021 recommendation from the USPSTF includes additional guidance for obtaining blood pressure measurements away from the clinical setting. 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. Thank you for taking the time to confirm your preferences. 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