Use this checklist: If you are keeping track of your blood pressure at home, use these additional tips. Research shows that SMBP: Can improve adherence and health outcomes for hypertensive patients1 SMBP requires the use of a home blood pressure measurement device by the patient to measure blood pressure at different points in time. . Choosing-a-Home-BP-Monitor At-a-Glance-Comparison [PDF 446 KB] Federal government websites often end in .gov or .mil. 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. 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. 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. If you are concerned about your blood pressure numbers, talk to your health care team. : 12-EHC002-EF. 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. 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. In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. This article outlines high-level SMBP barriers that federal/national partners have encountered and offers potential solutions to achieve widespread SMBP implementation. There is insufficient evidence concerning predictors of SMBP adherence. 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 website requires cookies, and the limited processing of your personal data in order to function. SMBP means you regularly use a personal blood pressure measurement device away from a doctor's office or hospitalusually at home. https://www.ahrq.gov/evidencenow/heart-health/blood-pressure/smbp-effectiveness.html. How does adherence with SMBP monitoring vary by patient factors? Finally, SMBP may be useful in preventing overtreatment in individuals with white coat syndrome, orthostatic BP changes, or hypotensive episodes from medication. Reliable clinic measurements require an adequate rest period prior to measurement in order to enhance the consistency of BP readings. The bold lines correspond to the comparisons covered in this report: SMBP versus usual care (Key Question 1, part 1); SMBP plus additional support versus support without SMBP (also Key Question 1, part 1); SMBP plus additional support versus usual care (Key Question 1, part 2); SMBP plus additional support versus SMBP (Key Question 2). Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. Very few trials evaluated objective clinical outcomes. Take at least two readings, 1 or 2 minutes apart. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. 45. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. 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. Bethesda, MD 20894, Web Policies 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. 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)? Whether or not to advise the use of an SMBP monitoring device for a patient with hypertension is a common clinical question for clinicians. Further debate focuses on the role of additional support needed to enhance adherence with SMBP monitoring and, possibly, achieve the clinical benefit from it. The gauge uses a unit of measurement called millimeters of mercury (mmHg) to measure the pressure in your blood vessels. 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. SMBP = self-measured BP; KQ = Key Question The figure shows a schematic of possible comparisons between SMBP, SMBP plus additional, support without (more), In light of the potential health care benefits and knowledge gaps highlighted above, a topic titled Self Blood Pressure Monitoring was developed through the processes of topic identification, selection, and refinement for Comparative Effectiveness Review (CER) within the Agency for Healthcare Research and Quality (AHRQ) Effective Health Care program.34. Content last reviewed August 2018. Content last reviewed March 2021. Self-measured blood pressure (SMBP) monitoring, sometimes called home blood pressure monitoring, is a patient- performed measurement of their own blood pressure outside of a clinical setting. Regardless of the mode of support delivered, the patient-provider feedback loop is essential. Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Jan. Report No. SMBP monitoring can provide more frequent BP readings and if these are transmitted back to the provider, they can be used for more rapid and frequent adjustments in blood pressure medication to ensure adequate BP control. Careers. Agency for Healthcare Research and Quality (US), Rockville (MD). If using a digital or automatic blood pressure cuff, the health care professional will not need to use a stethoscope. 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. 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. To sign up for updates or to access your subscriberpreferences, please enter your email address below. Unauthorized use of these marks is strictly prohibited. CDCs 6|18 Initiative: Accelerating Evidence into Action 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. government site. Document author(s)/institution of origin: Effective Health Care Program, Agency for Healthcare Research and . 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. John M. Eisenberg Center for Clinical Decisions and Communications Science. What is the correct way to measure blood pressure? People using assistive technology may not be able to fully access information in these files. Rockville (MD): Agency for Healthcare Research and Quality (US); 2014 Dec. Report No. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD. Comparative Effectiveness of Diagnosis and Treatment of Obstructive Sleep Apnea in Adults. This video from NACHC, showcases several community health centers work to implement SMBP monitoring programs in their clinics. Apr 11, 2011. MEDLINE, Cochrane Central Register of Controlled Trials, existing systematic and narrative reviews, recent conference proceedings, and the Food and Drug Administration. 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. 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]. An official website of the United States government. 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. How do health care professionals measure my blood pressure? These evidence-based action steps and resources, assembled by Million Hearts, can help practices implement SMBP monitoring. 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). Self-Measured Blood Pressure Monitoring Program: Engaging Patients in Self-Measurement [PDF 1.5 MB] 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. The cuff has a gauge on it that will measure your blood pressure. This report can help policymakers learn more about which payers have programs that cover and reimburse for SMBP monitoring. 45.) Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. An official website of the United States government. You've successfully added to your alerts. Oscillometric Blood Pressure Devices Validated for Accuracy During Pregnancy [PDF 441 KB] 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. 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. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. We take your privacy seriously. All information these cookies collect is aggregated and therefore anonymous. 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. Balk has over 125 publications on systematic reviews of a broad range of medical, surgical, health, and nutrition topics. 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. Would you like email updates of new search results? These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. You and your health care team can take steps to control your blood pressureif it is too high. 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. 2012 Sep 21. 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. 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. 8600 Rockville Pike In response, providers offer customized support and advice, such as medication or lifestyle adjustments. This site needs JavaScript to work properly. Cookies used to make website functionality more relevant to you. Technically, SMBP monitoring refers to regular measurement by the patient of his or her own BP. 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. Self-measured BP monitoring, the measurement of BP by an individual outside of the office at home, is a validated approach for out-of-office BP measurement. 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. 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. While patient self-participation in chronic disease management appears promising, the sustainability and clinical impact of SMBP remains uncertain. The Correct Way to Measure Blood Pressure For additional assistance, please contact us. Patient-provider feedback loop with clinical support for SMBP monitoring. PMID: 23922064. Please enable it to take advantage of the complete set of features! This feature requires the newest version of Flash. Self-Measured Blood Pressure Monitoring: Action Steps for Clinicians [PDF 947 KB] 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. Readings by a person can be affected by observer training, preference, and bias. 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. What should I do if my blood pressure numbers are high? Comparative Effectiveness Review No. Measurements may interfere with a patient's activity or sleep. hb```f`` & B,@Q+g~ 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. How often should I measure my blood pressure? Brown Affiliations Talk with your health care team about regularly measuring your blood pressure at home, also called self-measured blood pressure (SMBP) monitoring. Tools to Establish a Self-Measured BP (SMBP) Monitoring Program [PDF 2 MB] Resources for Public Health Professionals, Improving Medication Adherence Among Patients with Hypertension, Hypertension Control Challenge Rules and Eligibility, Hypertension Control Champions Success Stories, Hospitals & Health Systems Recognition Program, Spotlight: NYC Health + Hospitals/Metropolitan, Spotlight: The Ohio State University and Wexner Medical Center, Spotlight: New Hanover Regional Medical Center, COVID-19 and Cardiovascular Disease Partner Toolkit, Heart-Healthy Steps Campaign Partner Toolkit, "Live to the Beat" Campaign Partner Toolkit, Self-Measured Blood Pressure (SMBP) Monitoring Implementation Toolkit [PDF - 2 MB], U.S. Murakami L, Rakotz M. Improving health outcomes: Blood pressure. This is an official U.S. government web site managed by the This 2020 joint policy statement from the American Heart Association (AHA) and the AMA addresses barriers to implementing SMBP monitoring. Hypertension also imposes a heavy financial burden on society at large. pressure monitoring and refers to the regular use of a Addressing Barriers Beyond the Published Literature Comparative Effectiveness Review Number 45 Self-Measured Blood Pressure Monitoring: Comparative Effectiveness Executive Summary Background High blood pressure (BP), or hypertension, is a common, long-term health condition, particularly among older adults. (Prepared by the Tufts Evidence-based Practice Center under Contract No. A reading that says your blood pressure is lower than it actually is may give you a false sense of security about your health. Thank you for taking the time to confirm your preferences. 12-EHC002-EF. Bookshelf 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. There is within-individual biological variability as well as measurement error. Effective Health Care Program . 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. There are two BP monitoring strategies that can currently be used at home: Ambulatory and SMBP monitoring. Resource title: Effectiveness of Self-Measured Blood Pressure Monitoring in Adults With Hypertension. A health care team member can show you how to use one if you need help. HHS Vulnerability Disclosure, Help You will be subject to the destination website's privacy policy when you follow the link. The trials were greatly heterogeneous, varying in population, intervention, and outcome measures and definitions. Types of clinical support include one-on-one counseling, Web-based and telephone support, and educational classes. Other factors that can improve accuracy include the use of an appropriately sized cuff and slow cuff deflation. How Do We Jump-Start Self-measured Blood Pressure Monitoring in the United States? >gL/?eEAV c,1t D~ 8-?x}0 KQUo~TJa&A6@sY(|x D G&pA32^Y|VLEcx 71HbFFhi3"9#+Z~GqESHm,Y-G1. 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. Telephone: (301) 427-1364, Powered by the Evidence-based Practice Centers. For appropriate diagnosis and therapy, accurate BP measurement is of great importance. Topic Initiated. Self-Measured Blood Pressure Monitoring: Action Steps for Public Health Practitioners. This 2015 CPSTF systematic review evaluates the effectiveness of using SMBP with additional clinical support to manage high blood pressure and SMBP alone. The site is secure. endstream endobj startxref 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 .gov means its official. 12-EHC002-EF. Clinic measurements may not reflect the usual BP outside of the clinic setting throughout a day. These include ambulatory BP monitoring (ABPM), self monitoring (or self measurement or home based) BP which is usually done by the patient at home, at work, or in any conducive environment. Is immediate imaging important in managing low back pain? A 2012 comparative-effectiveness review by the Agency for Healthcare Research and Quality found strong evidence that SMBP plus clinical support was more effective than usual care in improving blood pressure control among patients with hypertension. Lozano P, Henrikson NB, Morrison CC, Dunn J, Nguyen M, Blasi P, Whitlock EP. Agency for Healthcare Research and Quality, Rockville, MD. and transmitted securely. Comparative Effectiveness Review No. Hypertension often requires lifelong treatment. No matter your age, you also can take steps each day to help keep your blood pressure in a healthy range. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Conclusions: Please enter a Recipient Address and/or check the Send me a copy checkbox. John M Eisenberg Center for Clinical Decisions and Communications Science. 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. In: Daniel D, Prall M, editors. Target: BP: Implement SMBP However, consistently attaining reliable BP measurements is problematic. Purpose Generate prioritized topics for future research on SMBP, building on evidence gaps identified in a prior comparative effectiveness review and following an . To accelerate SMBP use, the Centers for Disease Control and Prevention (CDC) funded the National . 8. No studies evaluated children. 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. 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. FOIA Bookshelf Topline Findings: A National Analysis of Self-Measured Blood Pressure Monitoring Coverage and Reimbursement [PDF 1.7 MB] The bold lines indicate the comparisons addressed in the Key Questions (see below). 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. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness.
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