sharing sensitive information, make sure youre on a federal 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. Screening for Cognitive Impairment in Older Adults: An Evidence Update for the U.S. Preventive Services Task Force [Internet]. Figure 2. Types of clinical support include one-on-one counseling, Web-based and telephone support, and educational classes. Hypertension often requires lifelong treatment. Document author(s)/institution of origin: Effective Health Care Program, Agency for Healthcare Research and . This patient-friendly video from the Release the Pressure Coalition highlights the key steps people can take for accurate SMBP monitoring. Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. 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. HHS Vulnerability Disclosure, Help Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2013. Take your blood pressure at the same time every day. 2012 Feb 15. 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. ECG Challenge: What's Causing This Woman's Slow Pulse? 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. AHRQ Publication No. People using assistive technology may not be able to fully access information in these files. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD. Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. 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. There is insufficient evidence concerning predictors of SMBP adherence. Updated Hypertension Guidelines: Implications for Treatment? 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. High blood pressure usually has no warning signs or symptoms, and many people do not know they have it. An official website of the United States government. To determine predictors of adherence with SMBP monitoring. Click the topic below to receive emails when new articles are available. %%EOF The bold lines correspond to the comparisons covered in this report: SMBP versus usual care (Key Question 1, part 1); SMBP plus additional support versus support without SMBP (also Key Question 1, part 1); SMBP plus additional support versus usual care (Key Question 1, part 2); SMBP plus additional support versus SMBP (Key Question 2). 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. The .gov means its official. These blood pressure monitors are easy and safe to use. 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. The Community Preventive Services Task Force (CPSTF) Recommendations on Self-Measured Blood Pressure Monitoring Interventions (Prepared by the Tufts Evidence . government site. For SMBP plus additional support versus usual care, the strength of evidence is high and supports a lower BP with SMBP use (SBP/DBP -3.4 to -8.9/-1.9 to -4.4 mmHg) up to 12 months. Disclaimer. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. Talk with your health care team about regularly measuring your blood pressure at home, also called self-measured blood pressure (SMBP) monitoring. [3] (Figure 2). High blood pressure (BP), or hypertension, is a common, long-term health condition, particularly among older adults. Purpose: 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. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2013. (Prepared by the Tufts Evidence-based Practice Center under Contract No. Regular BP measurement by visiting nurses or other health care professionals at home is not considered to be SMBP monitoring. Unauthorized use of these marks is strictly prohibited. Research Protocol . AHRQ Projects funded by the Patient-Centered Outcomes Research Trust Fund. MEDLINE, Cochrane Central Register of Controlled Trials, existing systematic and narrative reviews, recent conference proceedings, and the Food and Drug Administration. Hypertension Medication for Specific Comorbidities, Individualized Weight Monitoring Using the Heartphone, Home Blood Pressure Monitoring in Patients With Hypertension. To address comparative effectiveness, we included prospective comparative studies of SMBP with or without additional support versus usual care or an alternative SMBP intervention. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. This patient-friendly video from NACHC outlines clear instructions for using home blood pressure monitors. is a member of the Million Hearts Science team with the Centers for Disease Control and Prevention (CDC) Division for Heart Disease and Stroke Prevention. : 14-05204-EF-1. Archived: This report is greater than 3 years old. These types of minimally intensive approaches are important to test in all populations, especially those experiencing related health disparities, for broad implementation with . CDCs 6|18 Initiative: Accelerating Evidence into Action Figure 1. Cookies used to make website functionality more relevant to you. 5600 Fishers Lane Project Timeline. This site needs JavaScript to work properly. in the management of hypertension, a systematic review of 49 studies examined the comparative effectiveness and adherence You can review and change the way we collect information below. 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. PMID: 23922064. Data Sources: However, reviews of evidence should not be construed to represent clinical recommendations or guidelines. 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.) Findings may be used for research purposes, but should not be considered current. 45. official website and that any information you provide is encrypted . 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. and transmitted securely. Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. sharing sensitive information, make sure youre on a federal pressure monitoring and refers to the regular use of a In people with hypertension (adults and children), does self-measured blood pressure (SMBP) monitoring, compared with usual care or other interventions without SMBP, have an effect on clinically important outcomes? This table from a 2021 Current Atherosclerosis Reports journal article features oscillometric blood pressure devices validated for accuracy during pregnancy. 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. Further debate focuses on the role of additional support needed to enhance adherence with SMBP monitoring and, possibly, achieve the clinical benefit from it. Rockville, MD 20857 Use this tool to keep track of your blood pressure measurements at home. 12-EHC002-EF. Self-Measured Blood Pressure Monitoring: Key Findings from a National Health Information Technology Landscape Analysis[PDF 1.3 MB] 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. Agency for Healthcare Research and Quality, Rockville, MD. Patients in the intervention group and their providers, received feedback on self-monitored blood pressure results and optional lifestyle advice and motivational support. How to Use Your Home Blood Pressure Monitor Use this checklist: If you are keeping track of your blood pressure at home, use these additional tips. Regardless of the mode of support delivered, the patient-provider feedback loop is essential. The https:// ensures that you are connecting to the The population of interest is the general population of people with hypertension, excluding pregnant women or those receiving dialysis. The site is secure. Lipid Screening in Childhood for Detection of Multifactorial Dyslipidemia: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]. Use this list of questions to ask your health care team [PDF 173 KB]to help you manage your blood pressure. Would you like email updates of new search results? No matter your age, you also can take steps each day to help keep your blood pressure in a healthy range. 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. Measurements can be read by a person or provided digitally by a device. https://effectivehealthcare.ahrq.gov/products/measuring-blood-pressure/research. SMBP CPT Coding [PDF 1 MB] Possible comparisons between SMBP, SMBP plus additional support, support without SMBP, and usual care, Agency for Healthcare Research and Quality (US). Thank you. Self-Measured Blood Pressure Monitoring: Action Steps for Clinicians [PDF 947 KB] Reliable clinic measurements require an adequate rest period prior to measurement in order to enhance the consistency of BP readings. 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. 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. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. Europe PMC is an archive of life sciences journal literature. 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. Federal government websites often end in .gov or .mil. 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. The current report evaluates ambulatory BP monitoring only as an outcome measurement tool, not as an intervention of interest. Shareable Handouts and Tools in English and Spanish, steps to take to control your blood pressure, this list of questions to ask your health care team, take steps each day to help keep your blood pressure in a healthy range, Heart disease and stroke statistics-2020 update: a report from the American Heart Association, Sources of inaccuracy in the measurement of adult patients resting blood pressure in clinical settings: A systematic review, National Center for Chronic Disease Prevention and Health Promotion, 5 Surprising Facts About High Blood Pressure, Hypertension Statistical Reports for Health Professionals, Morbidity and Mortality Weekly Reports About Hypertension, Hypertension Resources for Health Professionals, U.S. Department of Health & Human Services. Accessibility Clinical support includes regular one-on-one counseling, web-based or telephonic support tools, and educational classes. To accelerate SMBP use, the Centers for Disease Control and Prevention (CDC) funded the National . Self-Measured Blood Pressure Monitoring: Comparative Effectiveness [Internet]. Before To determine predictors of adherence with SMBP monitoring. 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)? Allison Goldstein, MPH, Self-Measured Blood Pressure Monitoring . Cookies used to make website functionality more relevant to you. To address comparative effectiveness, we included prospective comparative studies of SMBP with or without additional support versus usual care or an alternative SMBP intervention. 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. 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. U.S. Preventive Services Task Force (USPSTF) Final Recommendation Statement: Hypertension in Adults: Screening Finally, SMBP may be useful in preventing overtreatment in individuals with white coat syndrome, orthostatic BP changes, or hypotensive episodes from medication. 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 The Evidence-based Practice Center (EPC) reviewed the existing body of evidence on the effects of SMBP on clinical, surrogate, and intermediate outcomes in the management of hypertension. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Use this printable and shareable list of questions to ask your health care team to help you manage your blood pressure. sX Ndb`T~ Why do I need to measure my blood pressure? Your feet should be flat on the floor and your legs . Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. FOIA Comparative Effectiveness Review No. 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)? Topline Findings: A National Analysis of Self-Measured Blood Pressure Monitoring Coverage and Reimbursement [PDF 1.7 MB] Thank you for taking the time to confirm your preferences. There is no consensus on the precise protocol for SMBP monitoring in the management of hypertension regarding timing, frequency and duration. Content last reviewed March 2021. Division for Heart Disease and Stroke Prevention. No studies of SMBP monitoring in children were identified. Accessibility 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 (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 clinic26, SMBP is being used to avoid undertreatment of hypertension. Topic Initiated. 7 HBPM is also known as self-measured BP. We take your privacy seriously. 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. 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. Comparative Effectiveness Review No. How can I measure my blood pressure at home? To sign up for updates or to access your subscriberpreferences, please enter your contact information below. 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"" 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. SMBP differs from clinic-based and ambulatory blood . Study Selection: Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. Resource title: Effectiveness of Self-Measured Blood Pressure Monitoring in Adults With Hypertension. In studies of SMBP monitoring, how do clinical, surrogate, and intermediate outcomes (including SMBP monitoring adherence) vary by the type of additional support provided? They help us to know which pages are the most and least popular and see how visitors move around the site. Please enter a Recipient Address and/or check the Send me a copy checkbox. 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 Target: BP: Implement SMBP This one-page overview outlines the viability, costs, and returns for implementing an SMBP monitoring program based on Medicare reimbursement. SMBP measurements can be obtained from the upper arm, wrist, or fingers (or, if necessary, the lower extremity); however, experts recommend the use of upper arm devices due to the lack of validation and the high number of inaccurate measurements from the wrist and finger devices.26-28 Models for SMBP devices range from mechanical aneroid gauges (sphygmomanometers), which require self-inflation and auscultation (manual devices), to manually-inflated sphygmomanometers with automatic displays (semiautomated devices), to fully automated configurations that automatically inflate the sphygmomanometer and measure the BP (automated devices). 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. How to Measure Your Blood Pressure at Home [PDF 255 KB] Uhlig K, Balk EM, Patel K, Ip S, Kitsios GD, Obadan NO, et al. Show details Contents < Prev Next > Key Informants Susan Booth Project Leader, Personal Care & Wellness Consumer Reports Yonkers, NY Hayden Bosworth, Ph.D. Hypertension often requires lifelong treatment. SMBP Coverage Insights: Medicaid [PDF 232 KB] 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. Take this form [PDF 105 KB]with you on your first blood pressure visit to record important blood pressure-related information. See the resources below for specific recommendations. National Library of Medicine Apr 11, 2011. In that role, she provides scientific expertise to support research translation related to Million Hearts priority strategies. European Associations Review Dietary Therapies for Obesity, AHA Statement Ranks 10 Popular Diets for Heart Health. Careers. BP may rise in the clinic in response to the medical environment (referred to as white coat hypertension), or may be normal in the clinic but not outside of the clinic (referred to as masked hypertension).19,20 Prevalence of white coat hypertension ranges from 10 to more than 20 percent,21,22 and the prevalence of masked hypertension (MH) reaches 40 percent in some studies.23 The prognostic significance of either is unclear.24. 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. b W 35D43zi&J &lbP K 7X SMBP monitoring is the regular measurement of blood pressure by the patient outside the clinical setting, either at home or elsewhere. This is an official U.S. government web site managed by the Cite this: Self-Measured Blood Pressure Monitoring to Control Hypertension-Medscape-May06,2013. Telephone: (301) 427-1364, Powered by the Evidence-based Practice Centers. John M Eisenberg Center for Clinical Decisions and Communications Science. Together we can empower patients to take control of their hypertension, thereby reducing their risk for heart attack and stroke. Newer SMBP devices can automatically store readings and some are equipped to electronically transmit readings to a provider. 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. The https:// ensures that you are connecting to the 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. 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. Piper MA, Evans CV, Burda BU, Margolis KL, OConnor E, Smith N, Webber E, Perdue LA, Bigler KD, Whitlock EP. An official website of the Department of Health and Human Services, Latest available findings on quality of and access to health care. John M. Eisenberg Center for Clinical Decisions and Communications Science. 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. HHSA 290-2007-10055-I.) CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. First, a health care professional wraps an inflatable cuff around your arm. 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. Read the full Million Hearts Hypertension Control Change Package. include self-measured blood pressure monitoring (SMBP) plus additional clinical support and empowerment of non-physician clinicians (e.g. SMBP requires the use of a home blood pressure measurement device by the patient to measure blood pressure at different points in time. We take your privacy seriously. To determine predictors of adherence with SMBP monitoring. The site is secure. E-mail questions about the Forum toMillionHeartsSMBP@nachc.com. Patients may require some instruction on how to use SMBP devices.30,31. OF SELF-MEASURED BLOOD PRESSURE MONITORING INTERVENTIONS CENTERS FOR DISEASE CONTROL AND PREVENTION . Associate Director, Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center SMBP means you regularly use a personal blood pressure measurement device away from a doctor's office or hospitalusually at home.
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