self measured blood pressure monitoring: comparative effectiveness
MEDLINE, Cochrane Central Register of Controlled Trials, existing systematic and narrative reviews, recent conference proceedings, and the Food and Drug Administration. No studies evaluated children. A reading that says your blood pressure is lower than it actually is may give you a false sense of security about your health. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. However, even when measured according to established guidelines, clinic BP measurements have several limitations. An official website of the Department of Health and Human Services, Latest available findings on quality of and access to health care. Thank you for taking the time to confirm your preferences. Document author(s)/institution of origin: Effective Health Care Program, Agency for Healthcare Research and . Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. 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. High blood pressure (BP), or hypertension, is a common, long-term health condition, particularly among older adults. Lin JS, O'Connor E, Rossom RC, Perdue LA, Burda BU, Thompson M, Eckstrom E. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013 Nov. Report No. The actual BP measurement can be done either by the patient, or less frequently by a companion, who is usually not a medical professional. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unable to load your collection due to an error, Unable to load your delegates due to an error, Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. No studies evaluated children. In response, providers offer customized support and advice, such as medication or lifestyle adjustments. Finally, SMBP may be useful in preventing overtreatment in individuals with white coat syndrome, orthostatic BP changes, or hypotensive episodes from medication. Archived: This report is greater than 3 years old. This article outlines high-level SMBP barriers that federal/national partners have encountered and offers potential solutions to achieve widespread SMBP implementation. Providers can help with SMBP implementation by promoting SMBP to their hypertensive patients and establishing clinical feedback systems. In a comparative effectiveness review supported by the Agency for . This report can help policymakers learn more about which payers have programs that cover and reimburse for SMBP monitoring. 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. Several national and international hypertension guidelines endorse self-measured BP monitoring. Learn the correct way to have your blood pressure taken, whether youre getting it checked at the doctors office or checking it yourself at home. 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. Please confirm that you would like to log out of Medscape. In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. Many studies were of moderate to poor quality and had short followup periods. All information these cookies collect is aggregated and therefore anonymous. SMBP differs from clinic-based and ambulatory blood . Is immediate imaging important in managing low back pain? Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. Telephone: (301) 427-1364, Powered by the Evidence-based Practice Centers. Self Measured Blood Pressure Monitoring (SMBP), the self measurement of blood pressure (BP) outside of the health care setting may be an effective tool to facilitate BP control. An official website of the Department of Health & Human Services. The .gov means its official. 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. Piper MA, Evans CV, Burda BU, Margolis KL, OConnor E, Smith N, Webber E, Perdue LA, Bigler KD, Whitlock EP. Systematic Review: Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. How can I measure my blood pressure at home? Internet Citation: Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. Read the full Million Hearts Hypertension Control Change Package. government site. Rockville (MD): Agency for Healthcare Research and Quality (US); 2014 Dec. Report No. Regular BP measurement by visiting nurses or other health care professionals at home is not considered to be SMBP monitoring. To address comparative effectiveness, we included prospective comparative studies of SMBP with or without additional support versus usual care or an alternative SMBP intervention. 45. 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. 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. An official website of the United States government. This site needs JavaScript to work properly. Document author(s)/institution of origin: Effective Health Care Program, Agency for Healthcare Research and Quality, Internet Citation: Effectiveness of Self-Measured Blood Pressure Monitoring in Adults With Hypertension. This video from NACHC, showcases several community health centers work to implement SMBP monitoring programs in their clinics. Unauthorized use of these marks is strictly prohibited. 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. In people with hypertension (adults and children), does self-measured blood pressure (SMBP) monitoring, compared with usual care or other interventions without SMBP, have an effect on clinically important outcomes? How Do We Jump-Start Self-measured Blood Pressure Monitoring in the United States? Strong scientific evidence shows that self-measured blood pressure (SMBP) monitoring, also known as home blood pressure monitoring, plus clinical support helps people with hypertension lower their blood pressure. 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. Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. Untreated or ineffectively treated hypertension leads to increased cardiovascular . 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. This website also contains material copyrighted by 3rd parties. HHSA 290-2007-10055-I.) Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. Clinical support includes regular one-on-one counseling, web-based or telephonic support tools, and educational classes. %%EOF No studies of SMBP monitoring in children were identified. 12-EHC002-EF. 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. By using the site you are agreeing to this as outlined in our privacy notice and cookie policy. Regardless of the mode of support delivered, the patient-provider feedback loop is essential. Introduction. hXio8EIbHr)_cBCq{(1KLL)}]IDb)Pb"VL *&DSK28ijMqXLG:a/^~ vs:?COe+Y1~504ye49ucTSQZGUI+'O+ {EQZu]`^.7t n\B^9~: Addressing Barriers Beyond the Published Literature Show details Contents < Prev Next > Key Informants Susan Booth Project Leader, Personal Care & Wellness Consumer Reports Yonkers, NY Hayden Bosworth, Ph.D. Research Protocol . 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. 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. Past forum recordings, slides, and other resources can be found on the SMBP ForumConfluence page. SMBP monitoring is the regular measurement of blood pressure by the patient outside the clinical setting, either at home or elsewhere. Updated Hypertension Guidelines: Implications for Treatment? Ann Intern Med. [1] SMBP monitoring plus clinical support has been found to be effective in helping patients control their blood pressure.[2]. However, there is uncertainty about the appropriate home BP targets for guiding treatment decisions and whether these should be based on the same cut-points from clinic BP or from ABPM for defining hypertension.32. Content last reviewed March 2020. 45. 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. 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. This article presents strategies for strengthening the United States ability to address hypertension in women focusing on pregnancy-related considerations for self-measured blood pressure monitoring. 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. Self-Measured Blood Pressure Monitoring: Key Findings from a National Health Information Technology Landscape Analysis[PDF 1.3 MB] This 2020 AMA handout for Current Procedural Terminology (CPT) provides codes and descriptions for SMBP-related services. SMBP monitoring may not be suitable in certain patients, such as those with arrhythmias and ectopic beats, large arm circumferences (as a too-small cuff size may give falsely elevated BP readings), with physical or mental disabilities that interfere with device operation. Use this tool to keep track of your blood pressure measurements at home. What is the correct way to measure blood pressure? This is an official U.S. government web site managed by the Research shows that SMBP: Can improve adherence and health outcomes for hypertensive patients1 Topic Initiated. Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Jan. Report No. 2012 Mar 19. Other factors that can improve accuracy include the use of an appropriately sized cuff and slow cuff deflation. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness [Internet]. Bookshelf The Correct Way to Measure Blood Pressure 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. Many studies were of moderate to poor quality and had short followup periods. Apr 11, 2011. 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. Disclaimer. Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Jan. (Comparative Effectiveness Reviews, No. Numerous health professional and government organizations have developed various guidelines for BP management. Comparative Effectiveness Review No. No trials compared different SMBP devices or provided evidence on the relationship between BP control and clinical or surrogate outcomes. John M. Eisenberg Center for Clinical Decisions and Communications Science. Strong scientific evidence shows that self-measured blood pressure (SMBP) monitoring, also known as home blood pressure monitoring, plus clinical support helps people with hypertension lower their blood pressure. If you have high blood pressure, talk to your health care team about steps to take to control your blood pressureto lower your risk for heart disease and stroke. This document provides action steps for public health practitioners to facilitate the implementation of SMBP monitoring plus additional support in five key areas: Understanding the environment; Working with payers and purchasers; Working with health care providers; Spreading the word to the public; and Monitoring/assessment of SMBP, plus additional support implementation. Why do I need to measure my blood pressure? 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. 5600 Fishers Lane Please enable it to take advantage of the complete set of features! Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD. SMBP means you regularly use a personal blood pressure measurement device away from a doctors office or hospitalusually at home. 2011 Jan-Feb;46(1):99-102. doi: 10.4085/1062-6050-46.1.99. Rockville, MD: Agency for Healthcare Research and Quality. Hello. Before This video from the NACHC features Natalia, a patient who explains how she has taken control of her blood pressure with SMBP monitoring. hbbd```b``A$ug`rX|" o/XDLHp0{W$5)"30^` w Take at least two readings, 1 or 2 minutes apart. In total, 49 studies met eligibility criteria. https://www.ahrq.gov/evidencenow/heart-health/blood-pressure/smbp-effectiveness.html. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. pressure monitoring and refers to the regular use of a SMBP means you regularly use a personal blood pressure measurement device away from a doctor's office or hospitalusually at home. 52 prospective comparative studies of SMBP monitoring with or without additional support versus usual care or an alternative SMBP monitoring intervention in persons with hypertension. No trials compared different SMBP devices or provided evidence on the relationship between BP control and clinical or surrogate outcomes. We included studies that used arm (not wrist) monitors for at least 8 weeks and excluded studies of pregnant women or people on hemodialysis. Ann Intern Med. 1, 2 The TASMINH (Telemonitoring And SelfManagement in the Control of Hypertension) trials demonstrated that SMBP plus support, including telemonitoring (remotely monitoring patients using communication SMBP monitoring is also commonly referred to as home blood pressure monitoring. For example it is unclear whether simply providing a device for SMBP will improve BP control or whether this needs to be combined with additional support such as the telemetric transmission of readings to a provider to allow more frequent titration of drugs, regular nursing contact, or other types of interactions with a provider regarding hypertension management. Findings may be used for research purposes, but should not be considered current. : 13-05194-EF-1. 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. Take this form with you to your doctors office to record important blood pressure-related information. Cookies used to make website functionality more relevant to you. January 2012 As they were scoping their work for SMBP, they started by searching multiple databases Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2013. 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 site needs JavaScript to work properly. This patient-friendly video from NACHC outlines clear instructions for using home blood pressure monitors. Register for the Million HeartsSMBP Forum, an opportunity for clinical, public health, and community-based partners to exchange best and promising practices, identify solutions to common obstacles, and share resources to accelerate SMBP monitoring uptake. government site. 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. 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. 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. Rockville, MD 20857 sX Ndb`T~ 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. Repeated measurements are needed to facilitate accurate classification of patients. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Aug. Report No. 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. The cuff has a gauge on it that will measure your blood pressure. 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. 2013 Aug 6;159(3):185-94. doi: 10.7326/0003-4819-159-3-201308060-00008. Self-Measured Blood Pressure Monitoring: Action Steps for Public Health Practitioners. Purpose: 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. A reading that says your blood pressure is higher than it actually is may lead to treatment you dont need. These evidence-based action steps and resources, assembled by Million Hearts, can help practices implement SMBP monitoring. Centers for Disease Control and Prevention. Taking Control of My Blood Pressure: Natalias Story 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. 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. Reliable clinic measurements require an adequate rest period prior to measurement in order to enhance the consistency of BP readings. Balk has over 125 publications on systematic reviews of a broad range of medical, surgical, health, and nutrition topics. Comparative Effectiveness of Diagnosis and Treatment of Obstructive Sleep Apnea in Adults. He has led the Evidence Review Teams for numerous guidelines for management of kidney disease, gynecological surgery, orthopedic surgery, and triaging in resource-poor countries. 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. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. 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. AHRQ Projects funded by the Patient-Centered Outcomes Research Trust Fund. [3] (Figure 2). You will be subject to the destination website's privacy policy when you follow the link. There is within-individual biological variability as well as measurement error. How does adherence with SMBP monitoring vary by patient factors? 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. This may facilitate direct communication with a provider via phone call or email and result in shorter turn-around times in responding to a BP reading and thus ultimately to better BP control. (Prepared by the Tufts Evidence-based Practice Center under Contract No. 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. Self-Measured Blood Pressure Monitoring . Telephone: (301) 427-1364, Effectiveness of Self-Measured Blood Pressure Monitoring in Adults With Hypertension, https://www.ahrq.gov/evidencenow/heart-health/blood-pressure/smbp-effectiveness.html, AHRQ Publishing and Communications Guidelines, Evidence-based Practice Center (EPC) Reports, Healthcare Cost and Utilization Project (HCUP), AHRQ Quality Indicator Tools for Data Analytics, United States Health Information Knowledgebase (USHIK), AHRQ Informed Consent & Authorization Toolkit for Minimal Risk Research, Grant Application, Review & Award Process, Study Sections for Scientific Peer Review, Getting Recognition for Your AHRQ-Funded Study, AHRQ Research Summit on Diagnostic Safety, AHRQ Research Summit on Learning Health Systems, National Action Alliance To Advance Patient Safety, Blood Pressure Control Evidence and Resources, Cholesterol Management Evidence and Resources, Advancing Heart Health Research and Results, U.S. Department of Health & Human Services. Rockville, MD 20857 Strategies aimed at the control of high BP as well as adherence to medication continue to be of foremost concern to providers and patients, health care payers, policymakers, and governments worldwide. Target: BP: CME Course: Using SMBP to Diagnose and Manage High Blood Pressure Project Timeline. Page originally created December 2020. Tools to Establish a Self-Measured BP (SMBP) Monitoring Program [PDF 2 MB] Details on design, patients, interventions, outcomes, and quality were extracted into standard forms. This patient-friendly video from the Release the Pressure Coalition highlights the key steps people can take for accurate SMBP monitoring. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. 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. An official website of the Department of Health & Human Services, Internet Citation: Talk with your health care team about regularly measuring your blood pressure at home, also called self-measured blood pressure (SMBP) monitoring. No studies of SMBP monitoring in children were identified. 8600 Rockville Pike 8. Accessibility In total, 49 studies met eligibility criteria. CDCs 6|18 Initiative: Accelerating Evidence into Action Taking Control of My Blood Pressure: DAngelos Story High blood pressure usually has no warning signs or symptoms, and many people do not know they have it. Together we can empower patients to take control of their hypertension, thereby reducing their risk for heart attack and stroke. and transmitted securely. Screening for High Blood Pressure in Adults: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]. HHS Vulnerability Disclosure, Help Empty your bladder and ensure at least 5 minutes of quiet rest before measurements. This 2021 recommendation from the USPSTF includes additional guidance for obtaining blood pressure measurements away from the clinical setting. y ^]J[_tFe^~4:;:Cxbh jXd%SElY*Oi1h{_DsnL Self-Measured Blood Pressure Monitoring: Comparative Effectiveness [Internet]. 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. Source:Centers for Disease Control and Prevention. May 28, 2010. Topline Findings: A National Analysis of Self-Measured Blood Pressure Monitoring Coverage and Reimbursement [PDF 1.7 MB] Types of clinical support include one-on-one counseling, Web-based and telephone support, and educational classes.
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