Self-Monitoring Blood Pressure to Improve Hypertension
Hypertension is a major risk factor for heart disease, stroke, and kidney disease. Even a small elevation in blood pressure can increase the risk for cardiovascular disease and mortality. The risk of death from ischemic heart disease and stroke doubles for every 20 mmHg increase in systolic blood pressure or 10 mmHg increase in diastolic blood pressure. Self-monitoring of blood pressure (SMBP), when combined with additional clinical support, is one strategy that can reduce the risk of disability or death due to high blood pressure, and has been shown to lead to better overall control.
SMBP is the regular measurement of blood pressure by a patient at home or somewhere outside of the healthcare setting, using a personal measurement device. A recent article on the effectiveness of SMBP, stated that self-monitoring was associated with reduced clinic systolic blood pressure (sBP) compared to usual care at 12 months, and was most effective in those with fewer anti-hypertensive medications and higher baseline sBP up to 170 mmHg.
When engaging your patients in self-monitoring activities, it is important to make sure that your patients feel comfortable with the process and that they know what steps to take, including seeking emergency treatment, if they have a blood pressure reading that is outside the pre-determined acceptable range, or if they experience symptoms with a high or low blood pressure reading. This guidance to your patient should be individualized by the clinician and reinforced by clinical staff at the initiation of any SMBP. Your patients should also be communicating the home measurements with their provider’s office to be most effective. This can be done using the telephone, patient portal, or an in person follow-up visit.
The Centers for Disease Control and Prevention (CDC) and Million Hearts have provided a guide detailing Action Steps for Clinicians to facilitate the implementation of SMBP including how to prepare care teams to implement SMBP with patients, how to empower patients, and additional clinical and educational support.
Million Hearts/ CDC Action Steps for Clinicians
Uhlig K, Balk EM, Patel K, et al. Self-measured blood pressure monitoring: comparative effectiveness. Comparative effectiveness review no. 45 (prepared by the Tufts Evidence-based Practice Center under Contract No. HHSA 290-2007- 10055-I.) AHRQ Publication No. 12-EHC002-EF. Rockville, MD: Agency for Healthcare Research and Quality. January 2012. http://www.effectivehealthcare.ahrq.gov/reports/final.cfm
Blood Pressure. Murakami L and Rakotz M. Self-measured Blood Pressure Monitoring Program: Engaging Patients in Self-measurement. 1st ed. Daniel D and Prall M, eds. American Medical Association and the Johns Hopkins University School of Medicine; February 2015.