: 14-05198-EF-1. Associate Director, Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center Murakami L, Rakotz M. Improving health outcomes: Blood pressure. For additional assistance, please contact us. Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. in the management of hypertension, a systematic review of 49 studies examined the comparative effectiveness and adherence predictors of SMBP monitoring. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. Thus an alternative term for SMBP monitoring which better captures the application of self measurement for this report is the term home BP monitoring; however since the term is relatively rarely used in the literature, we will continue to use SMBP. 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. Patient-provider feedback loop.Source:Centers for Disease Control and Prevention. Target: BP: Implement SMBP Where can I get my blood pressure checked? Rockville, MD 20857 hXio8EIbHr)_cBCq{(1KLL)}]IDb)Pb"VL *&DSK28ijMqXLG:a/^~ vs:?COe+Y1~504ye49ucTSQZGUI+'O+ {EQZu]`^.7t n\B^9~: Neither is there consensus on how many serial measurements should be taken and which ones should be used or averaged to derive an accurate reading. official website and that any information you provide is encrypted Release the Pressure Self-Measured Blood Pressure (SMBP) Training Video Cookies used to make website functionality more relevant to you. To sign up for updates or to access your subscriberpreferences, please enter your contact information below. 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. The site is secure. This report addresses questions regarding the clinical value of SMBP monitoring with or without additional support and what factors may predict adherence with SMBP monitoring. There is no consensus on the precise protocol for SMBP monitoring in the management of hypertension regarding timing, frequency and duration. Disclaimer. Collaborative Care Models for Improving Hypertension Control Through SMBP Monitoring 5600 Fishers Lane Use this printable and shareable list of questions to ask your health care team to help you manage your blood pressure. Patient-provider feedback loop with clinical support for SMBP monitoring. PMC Archived: This report is greater than 3 years old. Together we can empower patients to take control of their hypertension, thereby reducing their risk for heart attack and stroke. How does adherence with SMBP monitoring vary by patient factors? MeSH However, reviews of evidence should not be construed to represent clinical recommendations or guidelines. 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. Would you like email updates of new search results? Given the inconvenience and expense of setting up and using the device, ambulatory BP monitoring is predominantly used to diagnose white coat or masked hypertension, to identify people with abnormal daily BP patters, or to help with management of hard to control or highly variable BP. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. To determine predictors of adherence with SMBP monitoring. 0 i` V04s7.w`t32Cc( L4M\ES}*vWe+= 4a)\5O)si8hQ[^}.L01>#t7On,c7g K>=}NrMo4;Zj:97MgN1m#6+U6i Is immediate imaging important in managing low back pain? (Prepared by the Tufts Evidence . The .gov means its official. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Jan. (Comparative Effectiveness Reviews, No. This one-page overview outlines the viability, costs, and returns for implementing an SMBP monitoring program based on Medicare reimbursement. Saving Lives, Protecting People. 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. To address comparative effectiveness, we included prospective comparative studies of SMBP with or without additional support versus usual care or an alternative SMBP intervention. Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. SMBP means you regularly use a personal blood pressure measurement device away from a doctor's office or hospitalusually at home. The actual BP measurement can be done either by the patient, or less frequently by a companion, who is usually not a medical professional. pharmacists and nurse practitioners) to manage patients' HBP (Figure 1). https://effectivehealthcare.ahrq.gov/products/measuring-blood-pressure/research. No matter your age, you also can take steps each day to help keep your blood pressure in a healthy range. The full report, listing all studies, is available at www.effectivehealthcare.ahrq.gov/selfmeasuredbp.cfm. Current settings for BP measurement include BP measurement in a healthcare setting, or BP measurement in a patient's usual environment with either ambulatory BP monitoring, or self-measured BP (SMBP) monitoring. 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. 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)? National Library of Medicine This report can help policymakers learn more about which payers have programs that cover and reimburse for SMBP monitoring. Take at least two readings, 1 or 2 minutes apart. PMC Source:Centers for Disease Control and Prevention. Progestogens for Prevention of Preterm Birth. Please confirm that you would like to log out of Medscape. 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. In studies of SMBP monitoring, how do clinical, surrogate, and intermediate outcomes (including SMBP monitoring adherence) vary by the type of additional support provided? 293 0 obj <> endobj Very few trials evaluated objective clinical outcomes. Untreated or ineffectively treated hypertension leads to increased cardiovascular . How Do We Jump-Start Self-measured Blood Pressure Monitoring in the United States? Please enter a Recipient Address and/or check the Send me a copy checkbox. 2013 Aug 6;159(3):185-94. doi: 10.7326/0003-4819-159-3-201308060-00008. 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. 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. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness Addressing Barriers Beyond the Published Literature Nonpharmacologic Interventions for Treatment-Resistant Depression in Adults. PDF Self-Measured Blood Pressure Monitoring - Centers for Disease Control 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. HHS Vulnerability Disclosure, Help European Associations Review Dietary Therapies for Obesity, AHA Statement Ranks 10 Popular Diets for Heart Health. You will receive email when new content is published. Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. This 2021 recommendation from the USPSTF includes additional guidance for obtaining blood pressure measurements away from the clinical setting. The health care professional will slowly let air out of the cuff while listening to your pulse with a stethoscope and watching the gauge. This resource from the Public Health Informatics Institute provides a checklist of helpful characteristics for SMBP telemonitoring software. In studies of SMBP monitoring, how does achieving BP control relate to clinical and surrogate outcomes? Measuring your blood pressure is the only way to know whether you have high blood pressure. Talk with your health care team about how often you should have your blood pressure measured or when to measure it yourself. To summarize evidence about the effectiveness of self-measured blood pressure (SMBP) monitoring in adults with hypertension. Centers for Disease Control and Prevention. 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. How do health care professionals measure my blood pressure? A reading that says your blood pressure is lower than it actually is may give you a false sense of security about your health. John M Eisenberg Center for Clinical Decisions and Communications Science. 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. Using SMBP to guide you in diagnosing and treating hypertension likely will produce better outcomes than using office blood pressure readings alone. Please enable it to take advantage of the complete set of features! May 28, 2010. Repeated measurements are needed to facilitate accurate classification of patients. Show details Contents < Prev Next > Key Informants Susan Booth Project Leader, Personal Care & Wellness Consumer Reports Yonkers, NY Hayden Bosworth, Ph.D. The site is secure. The .gov means its official. [1] SMBP monitoring plus clinical support has been found to be effective in helping patients control their blood pressure.[2]. Agency for Healthcare Research and Quality (AHRQ) Self-Measured Blood Pressure Monitoring: Comparative Effectiveness [PDF 1.2 MB] This 2015 CPSTF systematic review evaluates the effectiveness of using SMBP with additional clinical support to manage high blood pressure and SMBP alone. Patients are instructed to keep an activity log throughout the testing period for evaluation of stress- and activity-related BP changes. Figure 1. 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. HHSA 290-2007-10055-I.) CDC twenty four seven. 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. You will be subject to the destination website's privacy policy when you follow the link. High blood pressure usually has no warning signs or symptoms, and many people do not know they have it. While patient self-participation in chronic disease management appears promising, the sustainability and clinical impact of SMBP remains uncertain. Newer SMBP devices can automatically store readings and some are equipped to electronically transmit readings to a provider. Self-measured BP monitoring, the measurement of BP by an individual outside of the office at home, is a validated approach for out-of-office BP measurement. dabl Educational Trust: Sphygmomanometers for Self-measurement of Blood Pressure, British Hypertension Society: Blood Pressure Monitors Validated for Home Use, AHRQ Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. Ann Intern Med. Content last reviewed March 2021. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2013. HHS Vulnerability Disclosure, Help In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. A 2012 comparative-effectiveness review by the Agency for Healthcare Research and Quality found strong evidence that SMBP plus clinical support was . government site. We also included longitudinal cohort studies in addressing adherence predictors. 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. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Aug. Report No. 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. Systematic Review: A health care team member can show you how to use one if you need help. Details on design, patients, interventions, outcomes, and quality were extracted into standard forms. SMBP means you regularly use a personal blood pressure measurement device away from a doctors office or hospitalusually at home. include self-measured blood pressure monitoring (SMBP) plus additional clinical support and empowerment of non-physician clinicians (e.g. AHRQ Projects funded by the Patient-Centered Outcomes Research Trust Fund. 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 2012 AHRQ review examined the comparative effectiveness of SMBP alone, of SMBP plus additional clinical support, and of usual care. An official website of the United States government. 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. SMBP monitoring is the regular measurement of blood pressure by the patient outside the clinical setting, either at home or elsewhere. I am Allison Goldstein from the Division for Heart Disease and Stroke Prevention at CDC. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD. 45. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2013. No studies evaluated children. Impact of SelfMonitoring of Blood Pressure on Processes of sharing sensitive information, make sure youre on a federal These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. Possible comparisons between SMBP, SMBP plus additional support, support without SMBP, and usual care, Agency for Healthcare Research and Quality (US). Self-Measured Blood Pressure Monitoring at Home: A Joint Policy One study estimated that the global prevalence of hypertension in 2000 was 26 percent in the adult population. 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. 2013 Aug 6;159(3):185-94. doi: 10.7326/0003-4819-159-3-201308060-00008. Hypertension often requires lifelong treatment. Conclusions: Self-Measured Blood Pressure Monitoring: Key Findings from a National Health Information Technology Landscape Analysis[PDF 1.3 MB] The health care professional then inflates the cuff, which gently tightens on your arm. Target: BP: CME Course: Using SMBP to Diagnose and Manage High Blood Pressure Bethesda, MD 20894, Web Policies No studies of SMBP monitoring in children were identified. 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. Purpose Generate prioritized topics for future research on SMBP, building on evidence gaps identified in a prior comparative effectiveness review and following an . Research shows that SMBP: Can improve adherence and health outcomes for hypertensive patients1 This graphic from Target: BP demonstrates how to prepare for a blood pressure reading, the correct position to take your own blood pressure, and how to measure it. 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. We included studies that used arm (not wrist) monitors for at least 8 weeks and excluded studies of pregnant women or people on hemodialysis. 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. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. Types of clinical support include one-on-one counseling, Web-based and telephone support, and educational classes. MEDLINE, Cochrane Central Register of Controlled Trials, existing systematic and narrative reviews, recent conference proceedings, and the Food and Drug Administration. SMBP requires the use of a home blood pressure measurement device by the patient to measure blood pressure at different points in time. Current insurance coverage for SMBP plus clinical support is limited and improvements are planned or are under way. Lozano P, Henrikson NB, Morrison CC, Dunn J, Nguyen M, Blasi P, Whitlock EP. 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. Screening for High Blood Pressure in Adults: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]. 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 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. Unauthorized use of these marks is strictly prohibited. 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]. 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. This 2020 AMA handout for Current Procedural Terminology (CPT) provides codes and descriptions for SMBP-related services. Measure your blood pressure regularly to help your health care team diagnose any health problems early. 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. Please enable it to take advantage of the complete set of features! Agency for Healthcare Research and Quality (US), Rockville (MD). Comparative Effectiveness of Diagnosis and Treatment of Obstructive Sleep Apnea in Adults. Talk with your health care team about regularly measuring your blood pressure at home, also called self-measured blood pressure (SMBP) monitoring. We take your privacy seriously. 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. People using assistive technology may not be able to fully access information in these files. See the resources below for specific recommendations. 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. 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. J Athl Train. Why do I need to measure my blood pressure? Self-Measured Blood Pressure Monitoring . Rockville, MD 20857 Oscillometric Blood Pressure Devices Validated for Accuracy During Pregnancy [PDF 441 KB] and transmitted securely. We also included longitudinal cohort studies in addressing adherence predictors. 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 toolkit, developed by the National Association of Community Health Centers (NACHC) for Million Hearts, can help organizations successfully integrate SMBP monitoring into care processes and workflows. Many SMBP devices are commercially available. Self-Measured Blood Pressure Monitoring: Action Steps for Clinicians [PDF 947 KB] Taking Control of My Blood Pressure: Natalias Story 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. 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. 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.)
