Self-measured blood pressure (SMBP) monitoring at home is a validated approach to measure out-of-office BP that has the potential to improve the detection and control of hypertension, according to a joint policy statement from the American Heart Association (AHA) and American Medical Association (AMA).
"With fewer patients visiting medical offices during the COVID-19 pandemic, SMBP monitoring is more important than ever for people at risk for hypertension and uncontrolled BP," writing group chair Daichi Shimbo, MD, said in a statement.
"There should be investment in creating and supporting the infrastructure for expanding self-measured BP monitoring, as well as increasing coverage for patient- and provider-related costs," Shimbo, director, The Columbia Hypertension Center, Columbia University Irving Medical Center, New York City, told theheart.org | Medscape Cardiology.
The statement, Self-Measured Blood Pressure Monitoring at Home, was published June 22 in Circulation.
It provides "contemporary information" on the use, efficacy, and cost-effectiveness of SMBP at home for the diagnosis and management of hypertension.
The writing group notes that hypertension is one of the most important risk factors for cardiovascular disease. Several American and international guidelines support the use of SMBP.
"Indications include the diagnosis of white-coat hypertension and masked hypertension and the identification of white-coat effect and masked uncontrolled hypertension. Other indications include confirming the diagnosis of resistant hypertension and detecting morning hypertension," the group points out.
Use Validated Devices
Devices that are validated for clinical accuracy should be used for SMBP monitoring, the writing group advises. Validated devices that use the oscillometric method are preferred, and a standardized BP measurement (with appropriately sized cuffs) and monitoring protocol should be followed.
The group notes that meta-analyses of randomized trials indicate that SMBP monitoring is associated with a reduction in BP and improved BP control, and the benefits are greatest when used along with other interventions, such as education and counseling that can be delivered via phone or telehealth visits by nurses and care coordinators.
There are "sufficient data" to indicate that adding SMBP monitoring to office-based monitoring is cost-effective compared with office BP monitoring alone or usual care in patients with high office BP, the writing group says.
Potential cost savings associated with SMBP monitoring include a reduction in office visit follow-ups as a result of improved BP control, avoidance of possible overtreatment in patients with white-coat hypertension, and improvement in quality of life.
They note that randomized controlled trials assessing the impact of SMBP monitoring on cardiovascular outcomes are needed.
Barriers to Widespread Use
The use of SMBP monitoring is "essential" for the self-management of hypertension and has "great appeal" for expanding the benefits of cardiovascular prevention, the writing group says. They acknowledge, however, that transitioning from solely office-based BP management to a strategy that includes SMBP monitoring is not without actual and potential barriers.
The group recommends addressing these barriers by:
Educating patients and providers about the benefits of SMBP monitoring and the optimal approaches for SMBP monitoring
Establishing clinical core competency criteria to ensure high-quality SMBP monitoring is supported in clinical practice
Incorporating cointerventions that increase the effectiveness of SMBP monitoring, including behavioral change management and counseling, communication of treatment recommendations back to patients, medication management, and prescription and adherence monitoring
Creating systems for SMBP readings to be transferred from devices to electronic health records
Improving public and private health insurance coverage of validated SMBP monitoring devices prescribed by a healthcare provider
Reimbursing providers for costs associated with training patients, transmitting BP data, interpreting and reporting BP readings, and delivering cointerventions.
Increasing the use of SMBP monitoring is a major focus area of Target: BP — a national initiative of the AHA and AMA launched in response to the high prevalence of uncontrolled BP.
Target: BP helps healthcare organizations and care teams improve BP control rates through the evidence-based MAP BP Program.
MAP is an acronym that stands for Measure BP accurately every time it's measured, Act rapidly to manage uncontrolled BP, and Partner with patients to promote BP self-management.
This research had no commercial funding. Shimbo has disclosed no relevant conflicts of interest. A complete list of disclosures for the writing group is available with the original article.
Circulation. Published online June 22, 2020. Abstract
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Cite this: Self-Measured BP Monitoring at Home 'More Important Than Ever' - Medscape - Jul 01, 2020.