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. How to Use Your Home Blood Pressure Monitor 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. In: Daniel D, Prall M, editors. government site. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. 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. Take this form [PDF 105 KB]with you on your first blood pressure visit to record important blood pressure-related information. Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Jan. Report No. SMBP differs from clinic-based and ambulatory blood . In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. The goals of this report, therefore, are to inform physicians' decision whether to encourage the use of SMBP monitoring alone or along with additional support and to assist health care policymakers and payers with decisions regarding coverage and promotion of SMBP monitoring. 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). E-mail questions about the Forum [email protected]. 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. Progestogens for Prevention of Preterm Birth. Bethesda, MD 20894, Web Policies Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. 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. 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. Sit correctly. To sign up for updates or to access your subscriberpreferences, please enter your contact information below. The choice of treatment is largely dependent on the cause of hypertension, severity of the condition, as well as the presence or absence of existing comorbid states. 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. Saving Lives, Protecting People. 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. 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. Past forum recordings, slides, and other resources can be found on the SMBP ForumConfluence page. The HOME BP intervention for SMBP is an integrated patient-practitioner online digital tool. 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. In total, 49 studies met eligibility criteria. Agency for Healthcare Research and Quality (AHRQ) Self-Measured Blood Pressure Monitoring: Comparative Effectiveness [PDF 1.2 MB] See the resources below for specific recommendations. [3] (Figure 2). 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. 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. 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. Self-Measured Blood Pressure Monitoring . I am Allison Goldstein from the Division for Heart Disease and Stroke Prevention at CDC. sharing sensitive information, make sure youre on a federal : 12-EHC002-EF. We also included longitudinal cohort studies in addressing adherence predictors. Please enable it to take advantage of the complete set of features! Topic Initiated. Agency for Healthcare Research and Quality (US), Rockville (MD). 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. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. SMBP Health IT Checklist [PDF 136 KB] CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. HHSA 290-2007-10055-I.) [1] SMBP monitoring plus clinical support has been found to be effective in helping patients control their blood pressure.[2]. Centers for Disease Control and Prevention. They help us to know which pages are the most and least popular and see how visitors move around the site. Patient-provider feedback loop.Source:Centers for Disease Control and Prevention. Comparative Effectiveness Review No. Self-Measured Blood Pressure Monitoring: Action Steps for Public Health Practitioners [PDF 1 MB] Accessibility 2013 Aug 6;159(3):185-94. doi: 10.7326/0003-4819-159-3-201308060-00008. Numerous health professional and government organizations have developed various guidelines for BP management. Regular BP measurement by visiting nurses or other health care professionals at home is not considered to be SMBP monitoring. Hello. Many studies were of moderate to poor quality and had short followup periods. Before Self-blood pressure monitoring, by itself, has been shown to be an effective tool in predominantly white populations, but less studied in minority, urban communities. There are two BP monitoring strategies that can currently be used at home: Ambulatory and SMBP monitoring. Blood Pressure Validated Device Listing (VDL), Self-Measurement: How Patients and Care Teams Are Bringing Blood Pressure to Control, An Economic Case for Self-Measured Blood Pressure (SMBP) Monitoring [PDF - 156 KB], Choosing-a-Home-BP-Monitor At-a-Glance-Comparison, Self-Measured Blood Pressure Monitoring: Key Findings from a National Health Information Technology Landscape Analysis, Tools to Establish a Self-Measured BP (SMBP) Monitoring Program, Self-Measured Blood Pressure Monitoring Program: Engaging Patients in Self-Measurement, Oscillometric Blood Pressure Devices Validated for Accuracy During Pregnancy, Target: BP: CME Course: Using SMBP to Diagnose and Manage High Blood Pressure, Self-Measured Blood Pressure Monitoring: Action Steps for Clinicians, Collaborative Care Models for Improving Hypertension Control Through SMBP Monitoring, Accelerating Use of Self-measured Blood Pressure Monitoring (SMBP) Through Clinical-Community Care Models, Self-Measured Blood Pressure Monitoring: Action Steps for Public Health Practitioners, Topline Findings: A National Analysis of Self-Measured Blood Pressure Monitoring Coverage and Reimbursement, CDCs 6|18 Initiative: Accelerating Evidence into Action, Release the Pressure Self-Measured Blood Pressure (SMBP) Training Video, How to Use Your Home Blood Pressure Monitor, Taking Control of My Blood Pressure: DAngelos Story, Taking Control of My Blood Pressure: Natalias Story, How to Measure Your Blood Pressure at Home, The Correct Way to Measure Blood Pressure, How Do We Jump-Start Self-measured Blood Pressure Monitoring in the United States? Tools to Establish a Self-Measured BP (SMBP) Monitoring Program [PDF 2 MB] 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 2012 Feb 15. official website and that any information you provide is encrypted This AMAAHA joint initiative can help health care professionals launch an SMBP monitoring program. 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. If you log out, you will be required to enter your username and password the next time you visit. PMC You will be subject to the destination website's privacy policy when you follow the link. Rockville, MD 20857 This site needs JavaScript to work properly. Addressing Barriers Beyond the Published Literature There is growing evidence that selfmonitoring of blood pressure (SMBP) with guided support beyond usual primary care improves BP control. 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. AHRQ Publication No. 2011 Jan-Feb;46(1):99-102. doi: 10.4085/1062-6050-46.1.99. 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. 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. Hypertension Medication for Specific Comorbidities, Individualized Weight Monitoring Using the Heartphone, Home Blood Pressure Monitoring in Patients With Hypertension. MeSH Many SMBP devices are commercially available. Limitations: 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. For appropriate diagnosis and therapy, accurate BP measurement is of great importance. Purpose Would you like email updates of new search results? You will be subject to the destination website's privacy policy when you follow the link. An official website of the Department of Health and Human Services, Latest available findings on quality of and access to health care. Providers can help with SMBP implementation by promoting SMBP to their hypertensive patients and establishing clinical feedback systems. Cite this: Self-Measured Blood Pressure Monitoring to Control Hypertension-Medscape-May06,2013. 2011 Aug 8. To summarize evidence about the effectiveness of self-measured blood pressure (SMBP) monitoring in adults with hypertension. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Self-Measured Blood Pressure Monitoring: Key Findings from a National Health Information Technology Landscape Analysis[PDF 1.3 MB] Effective BP control has been shown to decrease incidence for stroke by 35 to 40 percent, myocardial infarction by 20 to 25 percent, and heart failure more than 50 percent.11,12 Systematic reviews have also shown the beneficial effects of lowering BP on reducing fatal and nonfatal stroke, cardiac events, and total among individuals with severe hypertension or at increased risk (such as of older age or with other comorbid risk factors).11,13,14 A decrease of 5 mmHg in systolic BP has been estimated to result in a 14 percent overall reduction in mortality due to stroke, 9 percent reduction in mortality due to chronic heart disease and 7 percent reduction in all-cause mortality.1,15,16 However, long-term adherence to lifestyle modification and medication remains a challenge in the management of hypertension, which is usually a lifelong condition. Unauthorized use of these marks is strictly prohibited. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. (Prepared by the Tufts Evidence-based Practice Center under Contract No. Patient-provider feedback loop with clinical support for SMBP monitoring. 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. 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. Page originally created December 2020. Measuring your blood pressure is the only way to know whether you have high blood pressure. 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. 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. 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. Very few trials evaluated objective clinical outcomes. This website also contains material copyrighted by 3rd parties. HHS Vulnerability Disclosure, Help The present Comparative Effectiveness Review (CER) evaluates the effects of self-measured blood pressure (SMBP) monitoring in hypertensive patients. All information these cookies collect is aggregated and therefore anonymous. Federal government websites often end in .gov or .mil. If you are concerned about your blood pressure numbers, talk to your health care team. Systematic Review: A BP cuff is placed around the upper arm and left in place for approximately 24 hours. SMBP requires the use of a home blood pressure measurement device by the patient to measure blood pressure at different points in time. If using a digital or automatic blood pressure cuff, the health care professional will not need to use a stethoscope. in the management of hypertension, a systematic review of 49 studies examined the comparative effectiveness and adherence predictors of SMBP monitoring. We take your privacy seriously. Balk has over 125 publications on systematic reviews of a broad range of medical, surgical, health, and nutrition topics. Possible comparisons between SMBP, SMBP plus additional support, support without SMBP, and usual care. Source:Centers for Disease Control and Prevention. FOIA Your feet should be flat on the floor and your legs . Choosing-a-Home-BP-Monitor At-a-Glance-Comparison [PDF 446 KB] To sign up for updates or to access your subscriberpreferences, please enter your email address below. First, a health care professional wraps an inflatable cuff around your arm. Very few trials evaluated objective clinical outcomes. Newer SMBP devices can automatically store readings and some are equipped to electronically transmit readings to a provider. Ann Intern Med. These evidence-based action steps and resources, assembled by Million Hearts, can help practices implement SMBP monitoring. Sit with your back straight and supported (on a dining chair, rather than a sofa). 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: Action Steps for Public Health Practitioners. Public Information from the CDC and Medscape. Self-Measured Blood Pressure Monitoring Program: Engaging Patients in Self-Measurement [PDF 1.5 MB] 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). Document author(s)/institution of origin: Effective Health Care Program, Agency for Healthcare Research and . High blood pressure usually has no warning signs or symptoms, and many people do not know they have it. : 14-05204-EF-1. The actual BP measurement can be done either by the patient, or less frequently by a companion, who is usually not a medical professional. This patient-friendly video from the Release the Pressure Coalition highlights the key steps people can take for accurate SMBP monitoring. Piper MA, Evans CV, Burda BU, Margolis KL, OConnor E, Smith N, Webber E, Perdue LA, Bigler KD, Whitlock EP. Federal government websites often end in .gov or .mil. Accessibility Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Aug. Report No. FOIA While patient self-participation in chronic disease management appears promising, the sustainability and clinical impact of SMBP remains uncertain. Please enable it to take advantage of the complete set of features! In studies of SMBP monitoring, how do clinical, surrogate, and intermediate outcomes (including SMBP monitoring adherence) vary by the type of additional support provided? : 13-05194-EF-1. Take this form with you to your doctors office to record important blood pressure-related information. Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. 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. Target: BP: Implement SMBP Empty your bladder and ensure at least 5 minutes of quiet rest before measurements. 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. This patient-friendly video from NACHC outlines clear instructions for using home blood pressure monitors. People using assistive technology may not be able to fully access information in these files. 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. Murakami L, Rakotz M. Improving health outcomes: Blood pressure. (Prepared by the Tufts Evidence . Content last reviewed March 2021. 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. Release the Pressure Self-Measured Blood Pressure (SMBP) Training Video 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. Show details Contents < Prev Next > Key Informants Susan Booth Project Leader, Personal Care & Wellness Consumer Reports Yonkers, NY Hayden Bosworth, Ph.D. 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. Finally, SMBP may be useful in preventing overtreatment in individuals with white coat syndrome, orthostatic BP changes, or hypotensive episodes from medication. 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. To sign up for updates or to access your subscriberpreferences, please enter your contact information below. 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. Effective Health Care Program . hbbd```b``A$ug`rX|" o/XDLHp0{W$5)"30^` w This report can help policymakers learn more about which payers have programs that cover and reimburse for SMBP monitoring. The https:// ensures that you are connecting to the There were 24 comparisons of SMBP alone versus usual care, 24 of SMBP plus additional support versus usual care, 12 of SMBP plus additional support versus SMBP without additional support or with less intense additional support, and 1 study evaluating predictors of adherence to SMBP. Patient-provider feedback loops may involve patients reporting blood pressure readings for a given time period, concerns about medications, and progress on lifestyle changes to their providers. The health care professional then inflates the cuff, which gently tightens on your arm. That the mean number of BP measurements recorded per week for users who continued recording blood pressure at 6 weeks was 6 compared to 8 among those who continued for at least 14 weeks, demonstrates high levels of engagement with respect to self-measured BP monitoring. How do different devices for SMBP monitoring compare with each other (specifically semiautomatic or automatic versus manual) in their effects on clinical, surrogate, and intermediate outcomes (including SMBP monitoring adherence)? European Associations Review Dietary Therapies for Obesity, AHA Statement Ranks 10 Popular Diets for Heart Health. More broadly, though, it is the regular use of a BP measurement device that is owned by (or lent to) the patient to be used outside the office/clinic setting. CER 45 Self-Measured Blood Pressure Monitoring Comparative Effectiveness Surveillance Final 4.7 AHRQ%Systematic%Review%% Surveillance%Program% CER$#45:$Self'Measured"Blood"Pressure"Monitoring:"$ Comparative"Effectiveness" Original$Release$Date:$nuary Ja "2012" Surveillance$Report: "vember"2012No " Surveillance$Report: "rchMa "2016"" 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. Reliable clinic measurements require an adequate rest period prior to measurement in order to enhance the consistency of BP readings. Figure 1 shows possible comparisons between SMBP, SMBP plus additional support, support without SMBP, and usual care. 2013 Aug 6;159(3):185-94. doi: 10.7326/0003-4819-159-3-201308060-00008. 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. 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. Where can I get my blood pressure checked? Hypertension often requires lifelong treatment. 5600 Fishers Lane : 14-05198-EF-1. Clinical support includes regular one-on-one counseling, web-based or telephonic support tools, and educational classes. 0 In addition, SMBP may carry the risk of unreliable BP readings if not obtained in a standard fashion, inappropriate self adjustments of antihypertensive medications, as well as increased anxiety in susceptible patients. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Use this checklist: If you are keeping track of your blood pressure at home, use these additional tips. In studies of SMBP monitoring, how does achieving BP control relate to clinical and surrogate outcomes? Self-Measured Blood Pressure Monitoring at Home: A Joint Policy Statement From the American Heart Association and American Medical Association include self-measured blood pressure monitoring (SMBP) plus additional clinical support and empowerment of non-physician clinicians (e.g. SMBP Coverage Insights: Medicaid [PDF 232 KB] This tool was developed by the National Association of Community Health Centers to help health care professionals compare blood pressure measurement devices from the U.S. Validated Device Listing across device features including cost, available cuff sizes, and data/technology capabilities. Archived: This report is greater than 3 years old. Don't smoke, drink caffeinated beverages or exercise within 30 minutes before measuring your blood pressure. An official website of the Department of Health & Human Services, Internet Citation: This review does not explore the validity, reproducibility, or comparability of BP measurements across devices or techniques (which was addressed by the 2002 EPC report25), or the use of SMBP as a diagnostic tool.