26 March 2020
Hypertension is the most commonly diagnosed condition in outpatient office visits in the United States.1 According to the 2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults, 45.6% of American adults have high blood pressure.2 Out of those diagnosed with hypertension, 46% do not have their condition under control.3
Home blood pressure monitoring is one methodology used to confirm a hypertension diagnosis and manage the condition outside the clinic by helping patients reach their target blood pressure.
Out-of-office readings obtained through home blood pressure monitoring has numerous benefits. Home blood pressure monitoring allows the physician to obtain readings in the patient’s natural environment where blood pressure (BP) measurements tend to be lower than those taken in a clinical setting.4 The average of BP readings throughout the day is perceived to be a better representative of the patient’s true blood pressure than a single in-office reading. As a result, home blood pressure monitoring can help combat misclassification of hypertension in the clinic5 caused by the white-coat effect, clinician technique, equipment, patient health and activities the patient participated in prior to the exam.
Home blood pressure monitoring can also provide the physician with information on the patient’s response to medication allowing the care plan to be adjusted as necessary. Therefore, self-measurements can improve patient adherence to hypertension therapy resulting in the progression towards designated BP goals.
Home blood pressure monitoring may be a more feasible option than ambulatory blood pressure monitoring due to its convenience, affordability and availability.6 Unlike ambulatory blood pressure monitoring, home blood pressure monitoring does not necessitate clinical staff training, require the patient to wear the monitor for 24 hours or limit physical activity.
Many home blood pressure monitors are available for retail purchase. When shopping for a home blood pressure monitor, the patient should make sure their device meets the following criteria:
For example, Hillrom offers a clinician-connected home blood pressure monitor that allows the patient to take their blood pressure at home. Bluetooth® technology helps the patient make progress towards their goals by allowing them to store and track their BP readings and send data to their physician for review.
It is vital for the patient to use proper technique when measuring blood pressure at home to ensure accurate readings. 82% of physicians agree that most patients do not follow the correct steps to obtain accurate blood pressure readings when monitoring BP at home.8 Before recommending home blood pressure monitoring, the patient must be educated on home BP measurement techniques:
The patient should be instructed to take at least two readings one minute apart each morning, and each evening before dinner.4 Ideally, the patient should aim to obtain weekly readings two weeks after a treatment change and the week prior to an appointment with their physician.4
It is crucial the patient records all BP readings accurately. The patient can capture measurements via a blood pressure monitor with a built-in memory or by physically writing down readings, including numbers, date and time.9 The patient should either send readings to the physician electronically or bring their log of blood pressure readings to the appointment.9 For clinical decision making, the patient’s average blood pressure should be based on readings from two or more separate occasions.4
Lastly, the patient should use the same validated instrument when measuring blood pressure at home so the physician can accurately compare results.4
Although home blood pressure monitoring can provide physicians with great insights regarding a patient’s true BP, there are still some difficulties with this method. For example, home blood pressure monitoring is dependent on patient effort and engagement (i.e., proper technique, communication with their physician) to obtain high-quality data. Additionally, there may be data gaps with this method such as the lack of BP recordings during sleep.
To help confirm and manage hypertension, home blood pressure monitoring is considered a viable method. Its out-of-office BP readings provide physicians with critical data including the patient’s blood pressure in their natural environment and response to treatment.
2. American Heart Association. Heart Disease and Stroke Statistics 2018. https://www.heart.org/-/media/data-import/downloadables/heart-disease-and-stroke-statistics-2018---at-a-glance-ucm_498848.pdf. Accessed September 17, 2018.
5. Pickering TG, et al; American Heart Association; American Society of Hypertension; Preventative Cardiovascular Nurses Association. Call to action on use and reimbursement for home blood pressure monitoring: a joint scientific statement from the American Heart Association, American Society of Hypertension, and Preventative Cardiovascular Nurses Association. Hypertension. 2008 Jul:52(1):10-29.
10. National Institutes of Health. National Heart, Lung, and Blood Institute. JNC 7 Express. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.