Regular home blood pressure monitoring is a cornerstone of hypertension management,yet new research indicates a significant gap between recommendation and practice. A recent study of over 3,300 individuals with hypertension revealed that less than a third consistently monitored their blood pressure at home as directed, despite the practice being linked to a 40% reduction in cardiovascular events and mortality. Published in JAMA Cardiology, the findings underscore the need for more accessible and convenient monitoring solutions to improve patient engagement and outcomes.
L’ESSENTIEL
- Home blood pressure monitoring is crucial for obtaining a more accurate picture of a patient’s true blood pressure.
- A study involving 3,390 people with hypertension found that only 1,181 were highly engaged in home blood pressure measurement, taking 24 to 28 readings per week.
- This consistent monitoring was associated with a reduction in blood pressure and a 40% lower risk of major cardiovascular events and all-cause mortality.
Regularly monitoring blood pressure at home, using a blood pressure monitor or an ambulatory blood pressure monitoring device, is a universally recommended practice for managing hypertension. This approach provides multiple blood pressure readings throughout the day, over several days, minimizing the “white coat effect”—a temporary increase in blood pressure when measured by a healthcare provider. According to l’Assurance Maladie, ambulatory blood pressure monitoring is used to detect blood pressure variations during daily activities. Home blood pressure measurement also helps assess the effectiveness of treatment.
Researchers at Mass General Brigham recently investigated patient engagement in home blood pressure monitoring. The study, conducted between September 2018 and June 2022, enrolled 3,390 individuals with an average age of 61 who were participating in a hypertension telehealth program. The average systolic blood pressure at the start of the study was 143 mmHg. Most participants had other health conditions, including 1,369 with atherosclerotic cardiovascular disease and 996 with diabetes.
Hypertension: Patients are Unlikely to Regularly Measure Blood Pressure at Home
Participants received training and a free blood pressure monitor for home use. They were asked to take 28 weekly measurements, automatically transmitted to their care coordinators, and received medication adjustments guided by an algorithm. The primary measure of the study was initial engagement, categorized as no engagement (0 measurements), low engagement (1 to 11 measurements per week), intermediate engagement (12 to 23 measurements per week), and high engagement (24 to 28 measurements per week).
The findings, published in JAMA Cardiology, revealed that 1,107 patients did not participate in the program, recording no blood pressure measurements. An additional 484 were low engagement, 618 were moderately engaged, and 1,181 were highly engaged. Adults who consistently measured their blood pressure at home and maintained that level of monitoring experienced a reduction in blood pressure, along with a 40% relative risk reduction in major cardiovascular events and all-cause mortality.
More Accessible and Less Restrictive Blood Pressure Monitoring Solutions Needed
The researchers emphasize the need for innovative, more convenient, and less burdensome monitoring methods for patients, similar to continuous glucose monitoring devices, to encourage optimal self-monitoring of blood pressure. Their next step is to identify and understand the specific barriers patients face when monitoring their blood pressure at home, which contribute to low engagement.
Home blood pressure measurement is best performed with an electronic upper arm monitor (with a cuff appropriately sized for your arm) due to its reliability. To take an accurate reading, sit in a quiet, comfortable room and rest for three to five minutes. Keep your legs uncrossed and your feet flat on the floor. Rest your bare arm on a table at heart level. Place the cuff on your bare arm, following the instructions on the device. Turn on the monitor. During the measurement, avoid talking, moving, or clenching your fist. The monitor will display two values in millimeters of mercury (mm Hg). The higher number is the systolic blood pressure (measured when the heart beats), and the lower number is the diastolic blood pressure (measured when the heart rests between beats). Carefully record these values on a blood pressure log.
