self measured blood pressure monitoring: comparative effectiveness self measured blood pressure monitoring: comparative effectiveness

HHSA 290-2007-10055-I.) A 2012 comparative-effectiveness review by the Agency for Healthcare Research and Quality found strong evidence that SMBP plus clinical support was . 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. Talk with your health care team about regularly measuring your blood pressure at home, also called self-measured blood pressure (SMBP) monitoring. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness [Internet]. However, reviews of evidence should not be construed to represent clinical recommendations or guidelines. For appropriate diagnosis and therapy, accurate BP measurement is of great importance. Hypertension also imposes a heavy financial burden on society at large. Unauthorized use of these marks is strictly prohibited. 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. 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. Figure 2. How does adherence with SMBP monitoring vary by patient factors? A BP cuff is placed around the upper arm and left in place for approximately 24 hours. Europe PMC is an archive of life sciences journal literature. Together we can empower patients to take control of their hypertension, thereby reducing their risk for heart attack and stroke. The health care professional will slowly let air out of the cuff while listening to your pulse with a stethoscope and watching the gauge. and transmitted securely. Further debate focuses on the role of additional support needed to enhance adherence with SMBP monitoring and, possibly, achieve the clinical benefit from it. SMBP Health IT Checklist [PDF 136 KB] Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. 8. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Thank you for taking the time to confirm your preferences. 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. 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. European Associations Review Dietary Therapies for Obesity, AHA Statement Ranks 10 Popular Diets for Heart Health. Disclaimer. 0 Measuring your blood pressure is the only way to know whether you have high blood pressure. This 2012 AHRQ review examined the comparative effectiveness of SMBP alone, of SMBP plus additional clinical support, and of usual care. https://www.ahrq.gov/evidencenow/heart-health/blood-pressure/smbp-effectiveness.html. Possible comparisons between SMBP, SMBP plus additional support, support without SMBP, and usual care, Agency for Healthcare Research and Quality (US). This patient-friendly video from the Release the Pressure Coalition highlights the key steps people can take for accurate SMBP monitoring. Self-Measured Blood Pressure Monitoring: Action Steps for Public Health Practitioners. [3] (Figure 2). SMBP Coverage Insights: Medicaid [PDF 232 KB] The figure shows a schematic of possible comparisons between SMBP, SMBP plus additional, support without SMBP, and usual care. Document author(s)/institution of origin: Effective Health Care Program, Agency for Healthcare Research and . 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. Clinic measurements may not reflect the usual BP outside of the clinic setting throughout a day. Data Extraction: You will be subject to the destination website's privacy policy when you follow the link. 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. 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. 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. 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. There is growing evidence that selfmonitoring of blood pressure (SMBP) with guided support beyond usual primary care improves BP control. Apr 11, 2011. No studies evaluated children. Share this graphic with family and friends to show them the correct way to measure blood pressure. This process is quick and painless. and transmitted securely. 12-EHC002-EF. 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. The https:// ensures that you are connecting to the They can help you make a plan to manage high blood pressure. Patient-provider feedback loop.Source:Centers for Disease Control and Prevention. The full report, listing all studies, is available at www.effectivehealthcare.ahrq.gov/selfmeasuredbp.cfm. They help us to know which pages are the most and least popular and see how visitors move around the site. You will receive email when new content is published. For additional assistance, please contact us. AHRQ Projects funded by the Patient-Centered Outcomes Research Trust Fund. This site needs JavaScript to work properly. 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. 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. No studies of SMBP monitoring in children were identified. Take at least two readings, 1 or 2 minutes apart. Please enable it to take advantage of the complete set of features! Hypertension Medication for Specific Comorbidities, Individualized Weight Monitoring Using the Heartphone, Home Blood Pressure Monitoring in Patients With Hypertension. Cite this: Self-Measured Blood Pressure Monitoring to Control Hypertension-Medscape-May06,2013. https://effectivehealthcare.ahrq.gov/products/measuring-blood-pressure/research. Before This program from the AMA and Johns Hopkins University School of Medicine is designed to help physician offices and health centers engage patients in SMBP monitoring. CDCs 6|18 Initiative: Accelerating Evidence into Action 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. Centers for Disease Control and Prevention. 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 CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Sit with your back straight and supported (on a dining chair, rather than a sofa). 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. : 14-05198-EF-1. Background Hypertension often requires lifelong treatment. An official website of the United States government. Content last reviewed March 2021. If you log out, you will be required to enter your username and password the next time you visit. 45. 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 make website functionality more relevant to you. 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. Thank you for taking the time to confirm your preferences. 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. The site is secure. Rockville, MD: Agency for Healthcare Research and Quality. 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. 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. May 28, 2010. %%EOF Regular BP measurement by visiting nurses or other health care professionals at home is not considered to be SMBP monitoring. 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. In: Daniel D, Prall M, editors. 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. i` V04s7.w`t32Cc( L4M\ES}*vWe+= 4a)\5O)si8hQ[^}.L01>#t7On,c7g K>=}NrMo4;Zj:97MgN1m#6+U6i The .gov means its official. SMBP monitoring is also commonly referred to as home blood pressure monitoring. This video summarizes results from Accelerating Use of Self-measured Blood Pressure Monitoring (SMBP) Through Clinical-Community Care Models article, which discusses a pilot project in nine community health centers across three states to increase the use of SMBP using a collaborative model with health centers, community organizations, and health departments. You will be subject to the destination website's privacy policy when you follow the link. Topline Findings: A National Analysis of Self-Measured Blood Pressure Monitoring Coverage and Reimbursement [PDF 1.7 MB] government site. Patients are instructed to keep an activity log throughout the testing period for evaluation of stress- and activity-related BP changes. This 2021 recommendation from the USPSTF includes additional guidance for obtaining blood pressure measurements away from the clinical setting. 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. 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.) 5600 Fishers Lane 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 clinic26, SMBP is being used to avoid undertreatment of hypertension. 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. Centers for Disease Control and Prevention. 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)? HHS Vulnerability Disclosure, Help 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. Patient-provider feedback loop with clinical support for SMBP monitoring. This AMAAHA joint initiative can help health care professionals launch an SMBP monitoring program. Self-Measured Blood Pressure Monitoring: Action Steps for Clinicians [PDF 947 KB] Balk has over 125 publications on systematic reviews of a broad range of medical, surgical, health, and nutrition topics. Collaborative Care Models for Improving Hypertension Control Through SMBP Monitoring 7 HBPM is also known as self-measured BP. This video from NACHC, showcases several community health centers work to implement SMBP monitoring programs in their clinics. Disclaimer. This is an official U.S. government web site managed by the 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. Talk with your health care team about how often you should have your blood pressure measured or when to measure it yourself. To accelerate SMBP use, the Centers for Disease Control and Prevention (CDC) funded the National . Taking Control of My Blood Pressure: Natalias Story 45.) Untreated or ineffectively treated hypertension leads to increased cardiovascular . The trials were greatly heterogeneous, varying in population, intervention, and outcome measures and definitions. 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 video from the NACHC features Natalia, a patient who explains how she has taken control of her blood pressure with SMBP monitoring. To address comparative effectiveness, we included prospective comparative studies of SMBP with or without additional support versus usual care or an alternative SMBP intervention. How Do We Jump-Start Self-measured Blood Pressure Monitoring in the United States? In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. 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. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Federal government websites often end in .gov or .mil. This one-page overview outlines the viability, costs, and returns for implementing an SMBP monitoring program based on Medicare reimbursement. 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. These types of minimally intensive approaches are important to test in all populations, especially those experiencing related health disparities, for broad implementation with . National Library of Medicine Why do I need to measure my blood pressure? If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. 8600 Rockville Pike 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. Updated Hypertension Guidelines: Implications for Treatment? 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. Self-Measured Blood Pressure Monitoring: Action Steps for Public Health Practitioners [PDF 1 MB] No matter your age, you also can take steps each day to help keep your blood pressure in a healthy range. Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. government site. Screening for Cognitive Impairment in Older Adults: An Evidence Update for the U.S. Preventive Services Task Force [Internet]. 343 0 obj <>stream Thank you. How can I measure my blood pressure at home? 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. Measurements can be read by a person or provided digitally by a device. 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. 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. Study Selection: 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. Patients may require some instruction on how to use SMBP devices.30,31. No trials compared different SMBP devices or provided evidence on the relationship between BP control and clinical or surrogate outcomes. b W 35D43zi&J &lbP K 7X SMBP requires the use of a home blood pressure measurement device by the patient to measure blood pressure at different points in time. Current insurance coverage for SMBP plus clinical support is limited and improvements are planned or are under way. Accessibility Would you like email updates of new search results? These blood pressure monitors are easy and safe to use. 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. 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. Cookies used to make website functionality more relevant to you. 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. 5600 Fishers Lane In studies of SMBP monitoring, how does achieving BP control relate to clinical and surrogate outcomes? 2012 Sep 21. While patient self-participation in chronic disease management appears promising, the sustainability and clinical impact of SMBP remains uncertain. 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 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. Target: BP: Implement SMBP Hypertension is a major risk factor for cardiovascular disease and mortality and accounts for an estimated 14 percent of cardiovascular deaths worldwide and 18 percent in developed countries.10 It is an important modifiable risk factor for coronary artery disease, stroke, chronic kidney disease, congestive heart failure, and peripheral vascular disease.1 The World Health Organization ranks high BP as the third highest risk factor for burden of disease, after underweight and unsafe sex, highlighting the contribution of hypertension directly and indirectly to the development of numerous diseases.5.