In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. Archived: This report is greater than 3 years old. Whether or not to advise the use of an SMBP monitoring device for a patient with hypertension is a common clinical question for clinicians. This process is quick and painless. Internet Citation: Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. SMBP means you regularly use a personal blood pressure measurement device away from a doctor's office or hospitalusually at home. To address comparative effectiveness, we included prospective comparative studies of SMBP with or without additional support versus usual care or an alternative SMBP intervention. Taking Control of My Blood Pressure: DAngelos Story You will be subject to the destination website's privacy policy when you follow the link. government site. SMBP plus clinical support can improve access to care and quality of care for people with hypertension while making blood pressure control more convenient and accessible across the population. %%EOF 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 SMBP differs from clinic-based and ambulatory blood . 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)? 5600 Fishers Lane Rockville, MD 20857 National Library of Medicine Self-Measured Blood Pressure Monitoring: Action Steps for Public Health Practitioners. Why do I need to measure my blood pressure? Please confirm that you would like to log out of Medscape. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). No matter your age, you also can take steps each day to help keep your blood pressure in a healthy range. Self-measured blood pressure monitoring (SMBP), the regular measurement of blood pressure by a patient outside the clinical setting, plus additional support, is a proven, cost-effective but underutilized strategy to improve hypertension outcomes. You will receive email when new content is published. Several national and international hypertension guidelines endorse self-measured BP monitoring. The population of interest is the general population of people with hypertension, excluding pregnant women or those receiving dialysis. Background: Content last reviewed August 2018. Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. See the resources below for specific recommendations. 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. 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. 5600 Fishers Lane y ^]J[_tFe^~4:;:Cxbh jXd%SElY*Oi1h{_DsnL AHRQ Publication No. This 2020 AMA handout for Current Procedural Terminology (CPT) provides codes and descriptions for SMBP-related services. Take this form with you to your doctors office to record important blood pressure-related information. This resource from the Public Health Informatics Institute provides a checklist of helpful characteristics for SMBP telemonitoring software. The bold lines indicate the comparisons addressed in the Key Questions (see below). 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. Comparative Effectiveness Review No. 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. Bookshelf E-mail questions about the Forum toMillionHeartsSMBP@nachc.com. Introduction. Agency for Healthcare Research and Quality (US), Rockville (MD). Effective Health Care Program . 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. 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. https://effectivehealthcare.ahrq.gov/products/measuring-blood-pressure. 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. 8600 Rockville Pike These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. Would you like email updates of new search results? AHRQ Projects funded by the Patient-Centered Outcomes Research Trust Fund. This site needs JavaScript to work properly. hb```f`` & B,@Q+g~ 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. No trials compared different SMBP devices or provided evidence on the relationship between BP control and clinical or surrogate outcomes. HHSA 290-2007-10055-I.) Would you like email updates of new search results? 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. Rockville, MD: Agency for Healthcare Research and Quality. 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. Ambulatory BP monitoring requires a technologist to program the machine, fit it on the patient, remove it and download the results and a physician to interpret them. Many SMBP devices are commercially available. Research shows that SMBP: Can improve adherence and health outcomes for hypertensive patients1 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. 2011 Jan-Feb;46(1):99-102. doi: 10.4085/1062-6050-46.1.99. This 2020 joint policy statement from the American Heart Association (AHA) and the AMA addresses barriers to implementing SMBP monitoring. It predicted a rise by 24 percent in developed countries and 80 percent in developing countries by 2025.4 The World Health Report 2002 estimates that over 1 billion people have hypertension, which is estimated to cause 4.5 percent of the global disease burden.5 In addition, high BP directly results in 7 million deaths annually.6 Within the United States, about 76.4 million adults are affected.7 Data from the National Health and Nutrition Examination Surveys (NHANES) from 1999 to 2008 indicated that 30 percent of all adults in the U.S. 18 years and older were hypertensive, with a higher prevalence among African Americans and the elderly.8 The prevalence of verified hypertension in children is more than 3 percent.2 A study from 2002 reported a lifetime risk of developing hypertension among adults aged 55 to 65 years in the U.S. as greater than 90 percent.9 Despite improvements in the quality of health care and life expectancy, it is expected that the prevalence of hypertension will continue to rise as the population ages. Target: BP: Implement SMBP Talk with your health care team about regularly measuring your blood pressure at home, also called self-measured blood pressure (SMBP) monitoring. In a comparative effectiveness review supported by the Agency for . 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. National Library of Medicine Share this graphic with family and friends to show them the correct way to measure blood pressure. 8600 Rockville Pike Limitations: Agency for Healthcare Research and Quality, Rockville, MD. 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. 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. In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. 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. 5600 Fishers Lane This is an official U.S. government web site managed by the 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. For appropriate diagnosis and therapy, accurate BP measurement is of great importance. In: Daniel D, Prall M, editors. These blood pressure monitors are easy and safe to use. 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. 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. Talk with your health care team about regularly measuring your blood pressure at home, also called self-measured blood pressure (SMBP) monitoring. Unauthorized use of these marks is strictly prohibited. Resource description: This research summary of a systematic review compares the effectiveness of various methods and approaches to blood pressure measurement by patients or companions. in the management of hypertension, a systematic review of 49 studies examined the comparative effectiveness and adherence This video from NACHC, showcases several community health centers work to implement SMBP monitoring programs in their clinics. However, consistently attaining reliable BP measurements is problematic. Content last reviewed March 2020. government site. 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. Resource title: Effectiveness of Self-Measured Blood Pressure Monitoring in Adults With Hypertension. 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. You will be subject to the destination website's privacy policy when you follow the link. BP as recorded in the office or clinic setting at medical encounters is the most commonly used approach for measurement of BP. Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. . 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. 45. Collaborative Care Models for Improving Hypertension Control Through SMBP Monitoring in the management of hypertension, a systematic review of 49 studies examined the comparative effectiveness and adherence predictors of SMBP monitoring. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. The health care professional will slowly let air out of the cuff while listening to your pulse with a stethoscope and watching the gauge. Other factors that can improve accuracy include the use of an appropriately sized cuff and slow cuff deflation. Bethesda, MD 20894, Web Policies This list of resources from the Million Hearts Hypertension Control Change Package can help assign care team roles for an SMBP monitoring program and guide patients on selecting a home blood pressure monitor. MEDLINE, Cochrane Central Register of Controlled Trials, existing systematic and narrative reviews, recent conference proceedings, and the Food and Drug Administration. The https:// ensures that you are connecting to the 8. The review addressed SMBP monitoring performed by the patient or the patient's companion at home; it did not include monitoring done at the doctor's office, clinic, pharmacy, or health unit at work, nor did it include blood pressure (BP) monitoring done at home by nurses or other health care professionals. 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. There is insufficient evidence concerning predictors of SMBP adherence. Taking Control of My Blood Pressure: Natalias Story Hypertension often requires lifelong treatment. Use this tool to keep track of your blood pressure measurements at home. Tools to Establish a Self-Measured BP (SMBP) Monitoring Program [PDF 2 MB] Bethesda, MD 20894, Web Policies 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. Clinical support includes regular one-on-one counseling, web-based or telephonic support tools, and educational classes. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. 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. Agency for Healthcare Research and Quality (AHRQ) Self-Measured Blood Pressure Monitoring: Comparative Effectiveness [PDF 1.2 MB] 2013 Aug 6;159(3):185-94. doi: 10.7326/0003-4819-159-3-201308060-00008. 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. Accessibility 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. Regular BP measurement by visiting nurses or other health care professionals at home is not considered to be SMBP monitoring. Data Synthesis: Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. How does adherence with SMBP monitoring vary by patient factors? 2012 Feb 15. 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. official website and that any information you provide is encrypted 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. 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. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. This site needs JavaScript to work properly. No studies evaluated children. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness [Internet]. 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. hXio8EIbHr)_cBCq{(1KLL)}]IDb)Pb"VL *&DSK28ijMqXLG:a/^~ vs:?COe+Y1~504ye49ucTSQZGUI+'O+ {EQZu]`^.7t n\B^9~: 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 at Home: A Joint Policy Statement From the American Heart Association and American Medical Association Measurements can be read by a person or provided digitally by a device. : 14-05204-EF-1. Systematic Review: 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. Before 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 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. You and your health care team can take steps to control your blood pressureif it is too high. To determine predictors of adherence with SMBP monitoring. Progestogens for Prevention of Preterm Birth. 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. To accelerate SMBP use, the Centers for Disease Control and Prevention (CDC) funded the National . There are two BP monitoring strategies that can currently be used at home: Ambulatory and SMBP monitoring. Kallioinen N, Hill A, Horswill MS, Ward HE, Watson MO. 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. 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. 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. SMBP Health IT Checklist [PDF 136 KB] CER 45 Self-Measured Blood Pressure Monitoring Comparative Effectiveness Surveillance Final 4.7 AHRQ%Systematic%Review%% Surveillance%Program% CER$#45:$Self'Measured"Blood"Pressure"Monitoring:"$ Comparative"Effectiveness" Original$Release$Date:$nuary Ja "2012" Surveillance$Report: "vember"2012No " Surveillance$Report: "rchMa "2016"" For additional assistance, please contact us. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness [Internet]. SMBP means you regularly use a personal blood pressure measurement device away from a doctors office or hospitalusually at home. Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. Repeated measurements are needed to facilitate accurate classification of patients. PMC Possible comparisons between SMBP, SMBP plus additional support, support without SMBP, and usual care. 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. 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.
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