Technically, SMBP monitoring refers to regular measurement by the patient of his or her own BP. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. Read the full Million Hearts Hypertension Control Change Package. 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. 2012 Mar 19. This 1-hour continuing medical education (CME) course focuses on the appropriate use of SMBP monitoring in clinical practice and trains physicians, care teams, and other participants who are registered for Target: BP. Readings by a person can be affected by observer training, preference, and bias. Archived: This report is greater than 3 years old. This video from the NACHC features Natalia, a patient who explains how she has taken control of her blood pressure with SMBP monitoring. A reading that says your blood pressure is lower than it actually is may give you a false sense of security about your health. Data extraction Data on . 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. There is insufficient evidence concerning predictors of SMBP adherence. We also included longitudinal cohort studies in addressing adherence predictors. Effectiveness of Self-Measured Blood Pressure Monitoring in Adults With 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. You can review and change the way we collect information below. The https:// ensures that you are connecting to the 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. Cookies used to make website functionality more relevant to you. This video from NACHC features DAngelo, a patient who explains how he has taken control of his blood pressure with the help of SMBP monitoring. To increase nationwide implementation of SMBP plus clinical support, multiple issues must be addressed. hbbd```b``A$ug`rX|" o/XDLHp0{W$5)"30^` w That the mean number of BP measurements recorded per week for users who continued recording blood pressure at 6 weeks was 6 compared to 8 among those who continued for at least 14 weeks, demonstrates high levels of engagement with respect to self-measured BP monitoring. Project Timeline. Topline Findings: A National Analysis of Self-Measured Blood Pressure Monitoring Coverage and Reimbursement [PDF 1.7 MB] How do health care professionals measure my blood pressure? No matter your age, you also can take steps each day to help keep your blood pressure in a healthy range. 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. AHRQ Publication No. Internet Citation: Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. Rockville, MD 20857 These cookies may also be used for advertising purposes by these third parties. We standardized extraction by training on multiple articles, after which each study was extracted by one methodologist and the extraction reviewed by at least one other. 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. A recent CDC study found that 67 million adult Americans have hypertension, and of those, 36 million are uncontrolled. A BP cuff is placed around the upper arm and left in place for approximately 24 hours. Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Jan. Report No. Rockville, MD 20857 Methods - Self-Measured Blood Pressure Monitoring: Comparative This summary is provided to assist in clinical decisionmaking along with consideration of a patient's values and preferences. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness There is within-individual biological variability as well as measurement error. Talk with your health care team about how often you should have your blood pressure measured or when to measure it yourself. Page originally created December 2020. How do different devices for SMBP monitoring compare with each other (specifically semiautomatic or automatic versus manual) in their effects on clinical, surrogate, and intermediate outcomes (including SMBP monitoring adherence)? 5600 Fishers Lane Numerous health professional and government organizations have developed various guidelines for BP management. Take this form with you to your doctors office to record important blood pressure-related information. To sign up for updates or to access your subscriberpreferences, please enter your email address below. Division for Heart Disease and Stroke Prevention. Self-Measured Blood Pressure Monitoring at Home: A Joint Policy Statement From the American Heart Association and American Medical Association Self-Measured Blood Pressure Monitoring: Action Steps for Clinicians [PDF 947 KB] CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Allison Goldstein, MPH, MEDLINE, Cochrane Central Register of Controlled Trials, existing systematic and narrative reviews, recent conference proceedings, and the Food and Drug Administration. Many SMBP devices are commercially available. https://effectivehealthcare.ahrq.gov/products/measuring-blood-pressure. Findings may be used for research purposes, but should not be considered current. If you are concerned about your blood pressure numbers, talk to your health care team. Lozano P, Henrikson NB, Morrison CC, Dunn J, Nguyen M, Blasi P, Whitlock EP. 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 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. With training, additional support and treatment algorithms, patients may be able to self adjust medications based on SMBP results. While patient self-participation in chronic disease management appears promising, the sustainability and clinical impact of SMBP remains uncertain. This patient-friendly video from NACHC outlines clear instructions for using home blood pressure monitors. One study estimated that the global prevalence of hypertension in 2000 was 26 percent in the adult population. 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. The trials were greatly heterogeneous, varying in population, intervention, and outcome measures and definitions. 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. PDF Science-in-Brief Feature: Self-Measured Blood Pressure Monitoring - CDC Cite this: Self-Measured Blood Pressure Monitoring to Control Hypertension-Medscape-May06,2013. 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. How does SMBP monitoring compare with usual care or other interventions without SMBP in its effect on relevant clinical outcomes (cardiovascular events, mortality, patient satisfaction, quality of life, and adverse events related to antihypertensive agents)? Take this form [PDF 105 KB]with you on your first blood pressure visit to record important blood pressure-related information. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness Cookies used to make website functionality more relevant to you. (Prepared by the Tufts Evidence . 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. 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. The current report evaluates ambulatory BP monitoring only as an outcome measurement tool, not as an intervention of interest. The .gov means its official. Purpose: Bethesda, MD 20894, Web Policies FOIA This includes encouraging the purchase of fully automated, validated home blood pressure monitors with a properly sized arm cuff, training patients in SMBP techniques, checking patients' measurement techniques for accuracy, and interpreting and providing counseling based on shared blood pressure readings. Measurements may interfere with a patient's activity or sleep. Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Jan. (Comparative Effectiveness Reviews, No. This website also contains material copyrighted by 3rd parties. What should I do if my blood pressure numbers are high? pressure monitoring and refers to the regular use of a SMBP monitoring is also commonly referred to as home blood pressure monitoring. This one-page overview outlines the viability, costs, and returns for implementing an SMBP monitoring program based on Medicare reimbursement. This 2012 AHRQ review examined the comparative effectiveness of SMBP alone, of SMBP plus additional clinical support, and of usual care. 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. The actual BP measurement can be done either by the patient, or less frequently by a companion, who is usually not a medical professional. You and your health care team can take steps to control your blood pressureif it is too high. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). If you log out, you will be required to enter your username and password the next time you visit. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. government site. Self-measured blood pressure monitoring in the management of SMBP monitoring is the regular measurement of blood pressure by the patient outside the clinical setting, either at home or elsewhere. January 2012 As they were scoping their work for SMBP, they started by searching multiple databases 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. You can review and change the way we collect information below. 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 Collaborative Care Models for Improving Hypertension Control Through SMBP Monitoring 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. Figure 2. Data Sources: Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Self-Measured Blood Pressure Monitoring Program: Engaging Patients in Self-Measurement [PDF 1.5 MB] Please enable it to take advantage of the complete set of features! 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. 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. https://www.ahrq.gov/evidencenow/heart-health/blood-pressure/smbp-effectiveness.html. Measuring your blood pressure is the only way to know whether you have high blood pressure. 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. Whether or not to advise the use of an SMBP monitoring device for a patient with hypertension is a common clinical question for clinicians. First, a health care professional wraps an inflatable cuff around your arm. An official website of the United States government. 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. 8600 Rockville Pike 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. For additional assistance, please contact us. 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 2013 Aug 6;159(3):185-94. doi: 10.7326/0003-4819-159-3-201308060-00008. 8. Possible comparisons between SMBP, SMBP plus additional support, support without SMBP, and usual care, Agency for Healthcare Research and Quality (US). In response, providers offer customized support and advice, such as medication or lifestyle adjustments. John M Eisenberg Center for Clinical Decisions and Communications Science. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness [Internet]. Piper MA, Evans CV, Burda BU, Margolis KL, OConnor E, Smith N, Webber E, Perdue LA, Bigler KD, Whitlock EP. A connected monitor is preprogrammed to regularly record BP, usually every 15 to 20 minutes while awake and every 20 to 30 minutes while asleep. An official website of the Department of Health and Human Services, Latest available findings on quality of and access to health care. Empty your bladder and ensure at least 5 minutes of quiet rest before measurements. Target: BP: CME Course: Using SMBP to Diagnose and Manage High Blood Pressure Your feet should be flat on the floor and your legs . Don't smoke, drink caffeinated beverages or exercise within 30 minutes before measuring your blood pressure. Self-Blood Pressure Monitoring in an Urban, Ethnically Diverse [3] (Figure 1). 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. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Aug. Report No. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD. In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. Measurements can be read by a person or provided digitally by a device. Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. Progestogens for Prevention of Preterm Birth. They can help you make a plan to manage high blood pressure. 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. 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. The Community Preventive Services Task Force (CPSTF) Recommendations on Self-Measured Blood Pressure Monitoring Interventions 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. We take your privacy seriously. What you need to know about self-measured blood pressure monitoring Use this checklist: If you are keeping track of your blood pressure at home, use these additional tips. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD. Taking Control of My Blood Pressure: DAngelos Story Limitations: Reliable clinic measurements require an adequate rest period prior to measurement in order to enhance the consistency of BP readings. 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. Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. 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)? Share this graphic with family and friends to show them the correct way to measure blood pressure. Nonpharmacologic Interventions for Treatment-Resistant Depression in Adults. 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. SMBP means you regularly use a personal blood pressure measurement device away from a doctors office or hospitalusually at home. Where can I get my blood pressure checked? Uhlig K, Balk EM, Patel K, Ip S, Kitsios GD, Obadan NO, et al. These include ambulatory BP monitoring (ABPM), self monitoring (or self measurement or home based) BP which is usually done by the patient at home, at work, or in any conducive environment. In total, 49 studies met eligibility criteria. Several national and international hypertension guidelines endorse self-measured BP monitoring. Self-Measured Blood Pressure Monitoring | Million Hearts Murakami L, Rakotz M. Improving health outcomes: Blood pressure. Federal government websites often end in .gov or .mil. 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. 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. Screening for Cognitive Impairment in Older Adults: An Evidence Update for the U.S. Preventive Services Task Force [Internet]. Ann Intern Med. Out-of-Office Blood Pressure Monitoring: A Comparison of Ambulatory 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. CDCs 6|18 Initiative: Accelerating Evidence into Action A reading that says your blood pressure is higher than it actually is may lead to treatment you dont need. 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. Balk has over 125 publications on systematic reviews of a broad range of medical, surgical, health, and nutrition topics. To address comparative effectiveness, we included prospective comparative studies of SMBP with or without additional support versus usual care or an alternative SMBP intervention. The health care professional then inflates the cuff, which gently tightens on your arm. 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.) Centers for Disease Control and Prevention. Self-Measured Blood Pressure Monitoring: Action Steps for Public Health Practitioners [PDF 1 MB] 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. 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. How does adherence with SMBP monitoring vary by patient factors? These evidence-based action steps and resources, assembled by Million Hearts, can help practices implement SMBP monitoring.
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self measured blood pressure monitoring: comparative effectiveness