How does SMBP monitoring compare with usual care or other interventions without SMBP in its effect on relevant surrogate outcomes (cardiac measures: LVH [left ventricular hypertrophy], LVM [left ventricular mass], LVMI [left ventricular mass index]) and intermediate outcomes (BP control, BP treatment adherence, or health care process measures)? This program from the AMA and Johns Hopkins University School of Medicine is designed to help physician offices and health centers engage patients in SMBP monitoring. 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. Empty your bladder and ensure at least 5 minutes of quiet rest before measurements. Effective Health Care Program . %%EOF The direct and indirect cost of high BP and its complications has been estimated at more than $43.5 billion in 2007 in the U.S.7 Thus, it cannot be viewed simply as an individual health issue given the large public health impact and the potential for cost savings with effective prevention or treatment. Million Hearts Science team, Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GeorgiaDisclosure: Allison Goldstein, MPH, has disclosed no relevant financial relationships. Purpose Generate prioritized topics for future research on SMBP, building on evidence gaps identified in a prior comparative effectiveness review and following an . 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. Hypertension is a major risk factor for cardiovascular disease and mortality and accounts for an estimated 14 percent of cardiovascular deaths worldwide and 18 percent in developed countries.10 It is an important modifiable risk factor for coronary artery disease, stroke, chronic kidney disease, congestive heart failure, and peripheral vascular disease.1 The World Health Organization ranks high BP as the third highest risk factor for burden of disease, after underweight and unsafe sex, highlighting the contribution of hypertension directly and indirectly to the development of numerous diseases.5. Self-Measured Blood Pressure Monitoring Definition and Indications SMBP plus additional clinical support is one alternative to traditional oce care that could improve access to care and quality of care for individuals with hypertension while making blood pressure control more convenient and accessible across the population. Uhlig K, Balk EM, Patel K, et al. 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. Content last reviewed August 2018. No studies of SMBP monitoring in children were identified. This patient-friendly video from the Release the Pressure Coalition highlights the key steps people can take for accurate SMBP monitoring. A BP cuff is placed around the upper arm and left in place for approximately 24 hours. 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]. 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. 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 Read the full Million Hearts Hypertension Control Change Package. If using a digital or automatic blood pressure cuff, the health care professional will not need to use a stethoscope. (Prepared by the Tufts Evidence . Centers for Disease Control and Prevention. Click the topic below to receive emails when new articles are available. No studies evaluated children. Project Timeline. https://effectivehealthcare.ahrq.gov/products/measuring-blood-pressure. HHSA 290-2007-10055-I.) What is the correct way to measure blood pressure? 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. Self-Measured Blood Pressure Monitoring: Action Steps for Public Health Practitioners. How often should I measure my blood pressure? This SMBP coverage summary from the American Medical Association shows Medicaid coverage by state for automated SMBP blood pressure devices, standalone cuffs, and related clinical services. How to Measure Your Blood Pressure at Home [PDF 255 KB] Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. Balk has over 125 publications on systematic reviews of a broad range of medical, surgical, health, and nutrition topics. 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? 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. 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. hXio8EIbHr)_cBCq{(1KLL)}]IDb)Pb"VL *&DSK28ijMqXLG:a/^~ vs:?COe+Y1~504ye49ucTSQZGUI+'O+ {EQZu]`^.7t n\B^9~: 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. 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). 5600 Fishers Lane Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Introduction. Target: BP: CME Course: Using SMBP to Diagnose and Manage High Blood Pressure MeSH Patients are instructed to keep an activity log throughout the testing period for evaluation of stress- and activity-related BP changes. A reading that says your blood pressure is higher than it actually is may lead to treatment you dont need. Comparative Effectiveness Review No. Regardless of the mode of support delivered, the patient-provider feedback loop is essential. You've successfully added to your alerts. If you log out, you will be required to enter your username and password the next time you visit. 2013 Aug 6;159(3):185-94. doi: 10.7326/0003-4819-159-3-201308060-00008. Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Jan. Report No. This summary is provided to assist in clinical decisionmaking along with consideration of a patient's values and preferences. 7 HBPM is also known as self-measured BP. However, reviews of evidence should not be construed to represent clinical recommendations or guidelines. Self-Measured Blood Pressure Monitoring: Action Steps for Public Health Practitioners [PDF 1 MB] Possible comparisons between SMBP, SMBP plus additional support, support without SMBP, and usual care. 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. 0 Figure 1 shows possible comparisons between SMBP, SMBP plus additional support, support without SMBP, and usual care. Is immediate imaging important in managing low back pain? is a member of the Million Hearts Science team with the Centers for Disease Control and Prevention (CDC) Division for Heart Disease and Stroke Prevention. Oscillometric Blood Pressure Devices Validated for Accuracy During Pregnancy [PDF 441 KB] 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. MEDLINE, Cochrane Central Register of Controlled Trials, existing systematic and narrative reviews, recent conference proceedings, and the Food and Drug Administration. For example, terminal digit preference (i.e., preference for 0, 5, and even numbers) and single number preference (i.e., preference for specific values such as 130/80 or 140/90 mmHg) can lead to inaccuracies in measurement readings and variability across observers.17,18 This can be prevented when machines provide readings automatically. This AMAAHA joint initiative can help health care professionals launch an SMBP monitoring program. Bookshelf : 14-05204-EF-1. Division for Heart Disease and Stroke Prevention. 5600 Fishers Lane The Correct Way to Measure Blood Pressure The trials were greatly heterogeneous, varying in population, intervention, and outcome measures and definitions. 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. SMBP = self-measured BP; KQ = Key Question. Evidence shows that people with high blood pressure are more likely to lower their blood pressure if they use SMBP combined with support from their health care team than if they dont use SMBP.3. Findings may be used for research purposes, but should not be considered current. Bookshelf endstream endobj startxref High blood pressure (BP), or hypertension, is a common, long-term health condition, particularly among older adults. The Community Preventive Services Task Force (CPSTF) Recommendations on Self-Measured Blood Pressure Monitoring Interventions There is insufficient evidence concerning predictors of SMBP adherence. ECG Challenge: What's Causing This Woman's Slow Pulse? Using SMBP to guide you in diagnosing and treating hypertension likely will produce better outcomes than using office blood pressure readings alone. Accessibility The actual BP measurement can be done either by the patient, or less frequently by a companion, who is usually not a medical professional. An official website of the Department of Health and Human Services, Latest available findings on quality of and access to health care. 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. Many studies were of moderate to poor quality and had short followup periods. 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. Hypertension also imposes a heavy financial burden on society at large. See the resources below for specific recommendations. Nonpharmacologic Interventions for Treatment-Resistant Depression in Adults. As self-measurement requires patient participation, certain patient characteristics may affect compliance with SMBP monitoring, such as the willingness and ability to self-monitor BP and the technical literacy in operating the device or an interface for telemonitoring. The present Comparative Effectiveness Review (CER) evaluates the effects of self-measured blood pressure (SMBP) monitoring in hypertensive patients. Data Synthesis: Self-Measured Blood Pressure Monitoring at Home: A Joint Policy Statement From the American Heart Association and American Medical Association To address comparative effectiveness, we included prospective comparative studies of SMBP with or without additional support versus usual care or an alternative SMBP intervention. We also included longitudinal cohort studies in addressing adherence predictors. Screening for High Blood Pressure in Adults: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD. These evidence-based action steps and resources, assembled by Million Hearts, can help practices implement SMBP monitoring. Comparative Effectiveness Review No. SMBP differs from clinic-based and ambulatory blood . Careers. Talk with your health care team about regularly measuring your blood pressure at home, also called self-measured blood pressure (SMBP) monitoring. They help us to know which pages are the most and least popular and see how visitors move around the site. Talk with your health care team about how often you should have your blood pressure measured or when to measure it yourself. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. To review the role of self-measured blood pressure (SMBP) monitoring with or without additional support (interventions such as telemonitoring, counseling, education, Web support, behavioral interventions, home visits, etc.) Rockville, MD 20857 SMBP Health IT Checklist [PDF 136 KB] Several national and international hypertension guidelines endorse self-measured BP monitoring. In total, 49 studies met eligibility criteria. These blood pressure monitors are easy and safe to use. b W 35D43zi&J &lbP K 7X You can review and change the way we collect information below. 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. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. 45. 45. 8600 Rockville Pike This site needs JavaScript to work properly. FOIA Content last reviewed March 2021. Patient-provider feedback loop with clinical support for SMBP monitoring. Telephone: (301) 427-1364, Powered by the Evidence-based Practice Centers. 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. HHS Vulnerability Disclosure, Help [3] (Figure 2). The Evidence-based Practice Center (EPC) reviewed the existing body of evidence on the effects of SMBP on clinical, surrogate, and intermediate outcomes in the management of hypertension. Other factors that can improve accuracy include the use of an appropriately sized cuff and slow cuff deflation. Newer SMBP devices can automatically store readings and some are equipped to electronically transmit readings to a provider. Unable to load your collection due to an error, Unable to load your delegates due to an error, Self-Measured Blood Pressure Monitoring: Comparative Effectiveness [Internet]. Data Extraction: With training, additional support and treatment algorithms, patients may be able to self adjust medications based on SMBP results. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. An official website of the United States government. Purpose: 8600 Rockville Pike PMC In: Daniel D, Prall M, editors. Take this form [PDF 105 KB]with you on your first blood pressure visit to record important blood pressure-related information. 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. Apr 11, 2011. In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. 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. This video from the NACHC features Natalia, a patient who explains how she has taken control of her blood pressure with SMBP monitoring. Reliable clinic measurements require an adequate rest period prior to measurement in order to enhance the consistency of BP readings. AHRQ Publication No. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Details on design, patients, interventions, outcomes, and quality were extracted into standard forms. Uhlig K, Balk EM, Patel K, Ip S, Kitsios GD, Obadan NO, et al. Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. sharing sensitive information, make sure youre on a federal Self-Measured Blood Pressure Monitoring Program: Engaging Patients in Self-Measurement [PDF 1.5 MB] Past forum recordings, slides, and other resources can be found on the SMBP ForumConfluence page. Measure your blood pressure regularly to help your health care team diagnose any health problems early. Tools to Establish a Self-Measured BP (SMBP) Monitoring Program [PDF 2 MB] Would you like email updates of new search results? AHRQ Publication No. Types of clinical support include one-on-one counseling, Web-based and telephone support, and educational classes. Systematic Review: How does adherence with SMBP monitoring vary by patient factors? An official website of the United States government. I am Allison Goldstein from the Division for Heart Disease and Stroke Prevention at CDC. Please enter a Recipient Address and/or check the Send me a copy checkbox. AHRQ Projects funded by the Patient-Centered Outcomes Research Trust Fund. This feature requires the newest version of Flash. Take your blood pressure at the same time every day. Today, as part of the CDC Expert Commentary Series on Medscape, I would like to talk about self-measured blood pressure (SMBP) monitoring plus clinical support as a way to help patients manage their hypertension. 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. Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Jan. (Comparative Effectiveness Reviews, No. You will receive email when new content is published. Talk with your health care team about regularly measuring your blood pressure at home, also called self-measured blood pressure (SMBP) monitoring. To review the role of self-measured blood pressure (SMBP) monitoring with or without additional support (interventions such as telemonitoring, counseling, education, Web support, behavioral interventions, home visits, etc.) SMBP CPT Coding [PDF 1 MB] CDC twenty four seven. Comparative Effectiveness Review No. To increase nationwide implementation of SMBP plus clinical support, multiple issues must be addressed. 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. SMBP requires the use of a home blood pressure measurement device by the patient to measure blood pressure at different points in time. Hypertension often requires lifelong treatment. Rockville, MD 20857 2011 Aug 8. Use this list of questions to ask your health care team [PDF 173 KB]to help you manage your blood pressure. The health care professional will slowly let air out of the cuff while listening to your pulse with a stethoscope and watching the gauge. The https:// ensures that you are connecting to the In total, 49 studies met eligibility criteria. This table from a 2021 Current Atherosclerosis Reports journal article features oscillometric blood pressure devices validated for accuracy during pregnancy. How to Use Your Home Blood Pressure Monitor Piper MA, Evans CV, Burda BU, Margolis KL, OConnor E, Smith N, Webber E, Perdue LA, Bigler KD, Whitlock EP. 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. Centers for Disease Control and Prevention. [3] (Figure 1). 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. 5600 Fishers Lane Hello. Measurements may interfere with a patient's activity or sleep. Take this form with you to your doctors office to record important blood pressure-related information. 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. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2013. There is insufficient evidence concerning predictors of SMBP adherence. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness [Internet]. Archived: This report is greater than 3 years old. Document author(s)/institution of origin: Effective Health Care Program, Agency for Healthcare Research and . Clinic measurements may not reflect the usual BP outside of the clinic setting throughout a day. J Athl Train. 8. In addition, ambulatory BP monitoring is often used in research studies as an outcome, since many consider it to be more accurate than clinic-based BP measurement. 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. Self-Measured Blood Pressure Monitoring: Action Steps for Clinicians [PDF 947 KB] Research shows that SMBP: Can improve adherence and health outcomes for hypertensive patients1 In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. U.S. Preventive Services Task Force (USPSTF) Final Recommendation Statement: Hypertension in Adults: Screening >gL/?eEAV c,1t D~ 8-?x}0 KQUo~TJa&A6@sY(|x D G&pA32^Y|VLEcx 71HbFFhi3"9#+Z~GqESHm,Y-G1. Cookies used to make website functionality more relevant to you. Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. Please confirm that you would like to log out of Medscape. and transmitted securely. 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. Conclusions: and transmitted securely. To sign up for updates or to access your subscriberpreferences, please enter your email address below. Details on design, patients, interventions, outcomes, and quality were extracted into standard forms. Federal government websites often end in .gov or .mil. People who have high blood pressure may need to measure their blood pressure more often than people who do not have high blood pressure. Topline Findings: A National Analysis of Self-Measured Blood Pressure Monitoring Coverage and Reimbursement [PDF 1.7 MB] We take your privacy seriously. 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. Obtaining Adequate Fixation in a Periprosthetic Humerus Fracture Around a Shoulder Arthroplasty Stem in 81-Year-Old Man, ECG Challenge: Irregular Pulse During Cardiology Visit.
self measured blood pressure monitoring: comparative effectiveness
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