self measured blood pressure monitoring: comparative effectiveness self measured blood pressure monitoring: comparative effectiveness
An official website of the Department of Health & Human Services. 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. 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. Whether or not to advise the use of an SMBP monitoring device for a patient with hypertension is a common clinical question for clinicians. In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. Careers. This one-page overview outlines the viability, costs, and returns for implementing an SMBP monitoring program based on Medicare reimbursement. 5600 Fishers Lane 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. include self-measured blood pressure monitoring (SMBP) plus additional clinical support and empowerment of non-physician clinicians (e.g. This article presents strategies for strengthening the United States ability to address hypertension in women focusing on pregnancy-related considerations for self-measured blood pressure monitoring. Would you like email updates of new search results? This resource from the Public Health Informatics Institute provides a checklist of helpful characteristics for SMBP telemonitoring software. 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. 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. Self-Measured Blood Pressure Monitoring: Action Steps for Public Health Practitioners. You will be subject to the destination website's privacy policy when you follow the link. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. endstream endobj 294 0 obj <>/Metadata 50 0 R/Names 317 0 R/Outlines 332 0 R/PageMode/UseOutlines/Pages 291 0 R/StructTreeRoot 110 0 R/Type/Catalog/ViewerPreferences<>>> endobj 295 0 obj <>/Font<>/ProcSet[/PDF/Text]/Properties<>>>/Rotate 0/StructParents 0/Tabs/S/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 296 0 obj <>stream Measuring your blood pressure is the only way to know whether you have high blood pressure. Comparative Effectiveness Review No. Together we can empower patients to take control of their hypertension, thereby reducing their risk for heart attack and stroke. Project Timeline. 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 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. 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. Rockville, MD 20857 Technically, SMBP monitoring refers to regular measurement by the patient of his or her own BP. Brown Affiliations 45. This article outlines high-level SMBP barriers that federal/national partners have encountered and offers potential solutions to achieve widespread SMBP implementation. A reading that says your blood pressure is lower than it actually is may give you a false sense of security about your health. Content last reviewed March 2021. The population of interest is the general population of people with hypertension, excluding pregnant women or those receiving dialysis. 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. The bold lines indicate the comparisons addressed in the Key Questions (see below). John M Eisenberg Center for Clinical Decisions and Communications Science. Why do I need to measure my blood pressure? Sit with your back straight and supported (on a dining chair, rather than a sofa). 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. 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. sharing sensitive information, make sure youre on a federal Division for Heart Disease and Stroke Prevention. 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. An official website of the United States government. The direct and indirect cost of high BP and its complications has been estimated at more than $43.5 billion in 2007 in the U.S.7 Thus, it cannot be viewed simply as an individual health issue given the large public health impact and the potential for cost savings with effective prevention or treatment. Click the topic below to receive emails when new articles are available. John M. Eisenberg Center for Clinical Decisions and Communications Science. CER 45 Self-Measured Blood Pressure Monitoring Comparative Effectiveness Surveillance Final 4.7 AHRQ%Systematic%Review%% Surveillance%Program% CER$#45:$Self'Measured"Blood"Pressure"Monitoring:"$ Comparative"Effectiveness" Original$Release$Date:$nuary Ja "2012" Surveillance$Report: "vember"2012No " Surveillance$Report: "rchMa "2016"" In total, 49 studies met eligibility criteria. In studies of SMBP monitoring, how does achieving BP control relate to clinical and surrogate outcomes? government site. Hypertension also imposes a heavy financial burden on society at large. No studies of SMBP monitoring in children were identified. Progestogens for Prevention of Preterm Birth. This 2012 AHRQ review examined the comparative effectiveness of SMBP alone, of SMBP plus additional clinical support, and of usual care. May 28, 2010. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness [Internet]. Prior to joining CDC, Allison worked on the Global Polio Eradication Initiative at CARE International where she designed curricula for health workers and conducted evaluation field research on global polio eradication efforts. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. Findings may be used for research purposes, but should not be considered current. 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. 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. Allison is trained as an emergency medical technician and received a bachelor of science degree in biology and anthropology from the University of Michigan and a master of public health degree, with a focus in behavioral science and education, from Emory University. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. 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. Cite this: Self-Measured Blood Pressure Monitoring to Control Hypertension-Medscape-May06,2013. 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. Use this printable and shareable list of questions to ask your health care team to help you manage your blood pressure. 12-EHC002-EF. Archived: This report is greater than 3 years old. SMBP = self-measured BP; KQ = Key Question. 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.) [3] (Figure 2). The figure shows a schematic of possible comparisons between SMBP, SMBP plus additional, support without SMBP, and usual care. The https:// ensures that you are connecting to the To address comparative effectiveness, we included prospective comparative studies of SMBP with or without additional support versus usual care or an alternative SMBP intervention. 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. in the management of hypertension, a systematic review of 49 studies examined the comparative effectiveness and adherence predictors of SMBP monitoring. 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. endstream endobj startxref 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. The current report evaluates ambulatory BP monitoring only as an outcome measurement tool, not as an intervention of interest. The health care professional then inflates the cuff, which gently tightens on your arm. Patients in the intervention group and their providers, received feedback on self-monitored blood pressure results and optional lifestyle advice and motivational support. . Rockville, MD: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services; 2012. SMBP means you regularly use a personal blood pressure measurement device away from a doctors office or hospitalusually at home. 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. This summary is provided to assist in clinical decisionmaking along with consideration of a patient's values and preferences. Resource title: Effectiveness of Self-Measured Blood Pressure Monitoring in Adults With Hypertension. Many SMBP devices are commercially available. BP as recorded in the office or clinic setting at medical encounters is the most commonly used approach for measurement of BP. Target: BP: CME Course: Using SMBP to Diagnose and Manage High Blood Pressure Internet Citation: Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. Several national and international hypertension guidelines endorse self-measured BP monitoring. 5600 Fishers Lane 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. 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. Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. 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. 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. We also included longitudinal cohort studies in addressing adherence predictors. 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)? 2012 Sep 21. To address comparative effectiveness, we included prospective comparative studies of SMBP with or without additional support versus usual care or an alternative SMBP intervention. They can help you make a plan to manage high blood pressure. A recent CDC study found that 67 million adult Americans have hypertension, and of those, 36 million are uncontrolled. Lipid Screening in Childhood for Detection of Multifactorial Dyslipidemia: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]. official website and that any information you provide is encrypted Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Jan. Report No. FOIA 2013 Aug 6;159(3):185-94. doi: 10.7326/0003-4819-159-3-201308060-00008. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2013. Self-Measured Blood Pressure Monitoring: Action Steps for Public Health Practitioners. Your feet should be flat on the floor and your legs . Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. Screening for High Blood Pressure in Adults: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]. This patient-friendly video from the Release the Pressure Coalition highlights the key steps people can take for accurate SMBP monitoring. You can review and change the way we collect information below. The primary objective of this review is to evaluate whether the use of SMBP monitoring influences outcomes in adults and children with hypertension and to what extent these changes in outcomes can be attributable to the use of self monitoring devices alone or the use of SMBP with additional support or attention provided. 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. These blood pressure monitors are easy and safe to use. Repeated measurements are needed to facilitate accurate classification of patients. SMBP Coverage Insights: Medicaid [PDF 232 KB] However, even when measured according to established guidelines, clinic BP measurements have several limitations. HHSA 290-2007-10055-I.) To determine predictors of adherence with SMBP monitoring. 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. How Do We Jump-Start Self-measured Blood Pressure Monitoring in the United States? Unauthorized use of these marks is strictly prohibited. (Prepared by the Tufts Evidence-based Practice Center under Contract No. Conclusions: MeSH Past forum recordings, slides, and other resources can be found on the SMBP ForumConfluence page. 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. 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. 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. 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. Introduction. The actual BP measurement can be done either by the patient, or less frequently by a companion, who is usually not a medical professional. Federal government websites often end in .gov or .mil.
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