Experts Call for Home Blood Pressure Monitoring

Eileen Koutnik-FotopoulosStaff Writer

Routine home blood pressuremonitoring (HBPM) may helpthe 73 million individuals withhypertension better manage the disease,according to a new joint scientific statementfrom 3 health care organizations.

Hypertension increases the risk ofheart attack and stroke, which can beprevented by patients controlling theirblood pressure (BP) to reduce the risk.Statistics indicate that hypertensionkills 50,000 individuals in the UnitedStates each year, according to theAmerican Heart Association (AHA)—oneof the organizations that coauthoredthe statement. The American Societyof Hypertension and the PreventiveCardiovascularNurses Association alsoauthored the call to action.

The target HBPM goal for treatmentis <135/85 mm Hg or <130/80 mmHg in high-risk patients. Home monitoringis useful in the elderly&#8212;in whomboth BP variability and the white-coateffect are increased&#8212;patients with diabetes,patients with kidney disease, andin pregnant women, according to thestatement.

"Blood pressure measurement andtracking could be improved with homemonitoring by the patients themselves,in much the way people with diabetesmonitor their blood sugar levels withhome glucose monitors," said ThomasG. Pickering, MD, PhD, chair of the statementwriting group.

Studies have pointed out that thetraditional way of measuring BP inadults can be misleading. Researchhas shown that between 10% and 20%of patients diagnosed with high BP inthe physician's office actually have thewhite-coat effect, meaning that theirpressures are within normal rangeunder other conditions, but spike inthe medical setting.

Because BP changes throughout theday, taking one reading at a physiciansoffice every few months does not givean accurate assessment of an individual'scondition. Dr. Pickering noted severalbenefits of home monitor use. Homemonitors can take multiple measurementsduring each session, can be usedat different times of the day, and willhelp to involve patients in the managementof their own BP. Many home monitorsare equipped to store average BPreadings over time, providing key datafor patients to take to their physicians sothey can work together to diagnose andtreat the condition. As for cost, manymonitors retail for under $100.

As for the current use of HBPM,the researchers highlighted several keyresultsfrom a Gallup poll of patientswith hypertension conducted in 2005.The number of patients monitoringtheir BP at home has rose steadily overthe past 5 years, being 38% in 2000 and55% in 2005. The proportion of patientsowning a monitor has increased from49% in 2000 to 64% in 2005. In 2000,35% of patients reported that a physicianrecommended the use of a homemonitor, and rose to 47% in 2005.

Pharmacists are considered themost accessible health care provider.Because home BP monitors are typicallysold at community pharmacies, andpatients visit their pharmacy monthlyto pick up their antihypertensive medication,pharmacists can play a key rolein recommending HBPM and how toproperly use the machine.

Although earlier AHA guidelines haveincluded home monitors, this is the firststatement to have detailed recommendationson their use. They include:

• Patients should purchase oscillometricmonitors with cuffs thatfit on the upper arm. They shoulduse a proper fitting cuff, and aska health care provider the properway to use the monitors. Wristmonitors are not recommended.
• Patients should take 2 or 3 readingsat a time, 1 minute apart,while resting in a seated position.The arm should be supported, withthe upper arm at heart level, andfeet on the floor (back supported,legs uncrossed). It is important totake the readings at the same timeeach day, such as morning andevening, or as a health care professionalrecommends.
• Use of a home monitor can confirmsuspected or newly diagnosedhypertension and rule out diagnosisfor patients whose readings atthe physician's office do not reflecttheir actual pressures over time
• Home monitoring can be used toevaluate the response to any typeof antihypertensive treatment, andto motivate patients to take theirmedications regularly

The statement was published recentlyonline in Hypertension, the Journal ofthe American Society of Hypertension,the Journal of Clinical Hypertension, andin the June 2008 issue of the Journal ofCardiovascular Nursing.