: 12-EHC002-EF. Agency for Healthcare Research and Quality (AHRQ) Self-Measured Blood Pressure Monitoring: Comparative Effectiveness [PDF 1.2 MB] 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. 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. Hypertension also imposes a heavy financial burden on society at large. 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. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness 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. Out-of-Office Blood Pressure Monitoring: A Comparison of Ambulatory For additional assistance, please contact us. 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]. Research Protocol . Internet Citation: Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. b W 35D43zi&J &lbP K 7X You will be subject to the destination website's privacy policy when you follow the link. %PDF-1.6 % 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. 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. SMBP Coverage Insights: Medicaid [PDF 232 KB] Content last reviewed August 2018. The cuff has a gauge on it that will measure your blood pressure. To address comparative effectiveness, we included prospective comparative studies of SMBP with or without additional support versus usual care or an alternative SMBP intervention. Measure your blood pressure regularly to help your health care team diagnose any health problems early. Regular BP measurement by visiting nurses or other health care professionals at home is not considered to be SMBP monitoring. Saving Lives, Protecting People. In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. 2012 Sep 21. Very few trials evaluated objective clinical outcomes. (Prepared by the Tufts Evidence-based Practice Center under Contract No. 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. 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. Choosing-a-Home-BP-Monitor At-a-Glance-Comparison [PDF 446 KB] Clipboard, Search History, and several other advanced features are temporarily unavailable. In that role, she provides scientific expertise to support research translation related to Million Hearts priority strategies. Measure Your Blood Pressure | cdc.gov Patients are instructed to keep an activity log throughout the testing period for evaluation of stress- and activity-related BP changes. SMBP differs from clinic-based and ambulatory blood . hXio8EIbHr)_cBCq{(1KLL)}]IDb)Pb"VL *&DSK28ijMqXLG:a/^~ vs:?COe+Y1~504ye49ucTSQZGUI+'O+ {EQZu]`^.7t n\B^9~: People using assistive technology may not be able to fully access information in these files. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD. The Forum convenes online quarterly. 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. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Limitations: Careers. Introduction. This website also contains material copyrighted by 3rd parties. This video from NACHC, showcases several community health centers work to implement SMBP monitoring programs in their clinics. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. 12-EHC002-EF. This 2021 recommendation from the USPSTF includes additional guidance for obtaining blood pressure measurements away from the clinical setting. Background: In brief, ambulatory BP monitoring is a noninvasive, fully automated technique in which BP is recorded over an extended period of time, typically 24 hours. Screening for Cognitive Impairment in Older Adults: An Evidence Update for the U.S. Preventive Services Task Force [Internet]. However, reviews of evidence should not be construed to represent clinical recommendations or guidelines. PMID: 23922064. An Opportunity to Better Address Hypertension in Women: Self-Measured Blood Pressure Monitoring This 2020 AMA handout for Current Procedural Terminology (CPT) provides codes and descriptions for SMBP-related services. Nonpharmacologic Interventions for Treatment-Resistant Depression in Adults. Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. For SMBP plus additional support versus usual care, the strength of evidence is high and supports a lower BP with SMBP use (SBP/DBP -3.4 to -8.9/-1.9 to -4.4 mmHg) up to 12 months. 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. No studies of SMBP monitoring in children were identified. SMBP means you regularly use a personal blood pressure measurement device away from a doctor's office or hospitalusually at home. Thank you for taking the time to confirm your preferences. Figure 2. 45.) 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. The health care professional will slowly let air out of the cuff while listening to your pulse with a stethoscope and watching the gauge. We take your privacy seriously. endstream endobj startxref 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. Apr 11, 2011. https://effectivehealthcare.ahrq.gov/products/measuring-blood-pressure/research. These evidence-based action steps and resources, assembled by Million Hearts, can help practices implement SMBP monitoring. ECG Challenge: What's Causing This Woman's Slow Pulse? This patient-friendly video from NACHC outlines clear instructions for using home blood pressure monitors. Uhlig K, Balk EM, Patel K, et al. These blood pressure monitors are easy and safe to use. Ann Intern Med. 2013 Aug 6;159(3):185-94. doi: 10.7326/0003-4819-159-3-201308060-00008. 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 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)? 8600 Rockville Pike CDCs 6|18 Initiative: Accelerating Evidence into Action 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. Purpose Purpose Generate prioritized topics for future research on SMBP, building on evidence gaps identified in a prior comparative effectiveness review and following an . Rockville, MD: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services; 2012. 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. E-mail questions about the Forum toMillionHeartsSMBP@nachc.com. Self-measured blood pressure (SMBP) has been used in the treatment of hypertension with three major aims: 1) to avoid undertreatment of hypertension 2) to enhance self-participation in disease management and to enhance adherence; and 3) to avoid overtreatment in those with lower BP out of the clinic compared with in the clinic 26 Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. 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. Before No studies of SMBP monitoring in children were identified. MeSH OF SELF-MEASURED BLOOD PRESSURE MONITORING INTERVENTIONS CENTERS FOR DISEASE CONTROL AND PREVENTION . Murakami L, Rakotz M. Improving health outcomes: Blood pressure. This 2020 joint policy statement from the American Heart Association (AHA) and the AMA addresses barriers to implementing SMBP monitoring. Why do I need to measure my blood pressure? This patient-friendly video from the Release the Pressure Coalition highlights the key steps people can take for accurate SMBP monitoring. Updated Hypertension Guidelines: Implications for Treatment? Topic Initiated. 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. 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. 5600 Fishers Lane The .gov means its official. 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. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Types of clinical support include one-on-one counseling, Web-based and telephone support, and educational classes. AHRQ Publication No. Many studies were of moderate to poor quality and had short followup periods. To determine predictors of adherence with SMBP monitoring. If using a digital or automatic blood pressure cuff, the health care professional will not need to use a stethoscope. Conclusions: Telephone: (301) 427-1364, Powered by the Evidence-based Practice Centers. In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. Regardless of the mode of support delivered, the patient-provider feedback loop is essential. To determine predictors of adherence with SMBP monitoring. Recommended management strategies for BP control include lifestyle and behavior modification (such as smoking cessation, moderation of alcohol consumption, salt restriction and other dietary modifications, regular exercise, and weight loss in obese persons), usually combined with the use of antihypertensive medication. 293 0 obj <> endobj Improving patient engagement in self-measured blood pressure monitoring The full report, listing all studies, is available at www.effectivehealthcare.ahrq.gov/selfmeasuredbp.cfm. In studies of SMBP monitoring, how does achieving BP control relate to clinical and surrogate outcomes? One study estimated that the global prevalence of hypertension in 2000 was 26 percent in the adult population. 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]. SMBP plus clinical support interventions should be delivered by a trained healthcare provider, such as a pharmacist or nurse, and include regular communication of patient SMBP readings to providers and a patient-provider feedback loop. 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. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. In studies of SMBP monitoring, how do clinical, surrogate, and intermediate outcomes (including SMBP monitoring adherence) vary by the type of additional support provided? Please confirm that you would like to log out of Medscape. 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). 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. 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. Take your blood pressure at the same time every day. These blood pressure monitors are easy and safe to use. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness Target: BP: Implement SMBP Please use this form to submit your questions or comments on how to make this article more useful to clinicians. 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.
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