High blood pressure patients urged to use home monitors

High blood pressure patients urged to use home monitors

A panel of US experts said yesterday that patients with high blood pressure should be regularly measuring it at home to help them and their doctors manage the disease.

The advice was published online yesterday in the journal Hypertension, will be printed in the June issue of the Journal of Cardiovascular Nursing and comprises a joint statement from three medical organizations: the American Heart Association, American Society of Hypertension and the Preventive Cardiovascular Nurses' Association.

The panel wrote that an increasing number of patients are measuring their blood pressure regularly at home, and although this practice has been endorsed by national and international guidelines, there are no detailed guidelines.

Chair of the joint statement writing panel, Dr Thomas G Pickering said in a prepared statement that:

"High blood pressure is notoriously difficult to treat to goal; many patients fail to reach target levels despite treatment, and studies show home monitoring can help."

"Blood pressure measurement and tracking could be improved with home monitoring by the patients themselves, in much the [same] way people with diabetes monitor their blood sugar levels with home glucose monitors," added Pickering, who is director of the Center for Behavioral Cardiovascular Health at Columbia Presbyterian Medical Center in New York, NY.

Pickering said there was evidence that just monitoring blood pressure in the doctor's office could be misleading. Around 20 per cent of patients experience the "white coat effect" where being in the doctor's office raises their blood pressure temporarily, and other people have normal blood pressure in the surgery, but then it spikes at other times.

For many people, blood pressure is not at a constant level throughout the day, it fluctuates. So taking one reading at the doctor's surgery every few months is not a very reliable way to keep an eye on a person's condition, suggested Pickering.

A decent heart monitor retailing at around 100 dollars, takes several readings each time you use it, and you can use it several times a day. Also, there are devices on the market that can work out your average blood pressure from several readings, and show you how your blood pressure is behaving over a period of time. This could be useful information for your doctor when making a diagnosis and deciding how best to treat the condition.

The advisory panel said home monitoring would be particularly useful for elderly patients who tend to have greater variability in blood pressure and more frequently experience the white coat effect. Others who would also benefit would be pregnant women, patients with diabetes and patients with kidney disease.

Co-author and former president of the Preventive Cardiovascular Nurses Association, Nancy Houston Miller, RN, said:

"Home blood pressure monitoring also gives patients the physiologic feedback they need to see regarding blood pressure."

"Rather than three to four office blood pressure checks per year, if they measure blood pressure at home in addition to following up with their healthcare provider, patients are likely to achieve goals more quickly and be confident that medicines are working for them," said Miller, adding that nurses and nurse practitioners play a valuable role in interpreting blood pressure data from heart monitors and teaching patients about drugs and changes to lifestyle.

President of the American Society of Hypertension, Dr Suzanne Oparil, said:

"We're encouraged by this joint statement on the value of home blood pressure monitoring and confident it will be helpful in reducing the incidence of heart attack, stroke and kidney disease."

The panel wrote there are around 73 million Americans with hypertension. Home blood pressure monitoring has the potential to improve the quality and lower the cost of healthcare for this group.

The panel's advice includes details of the kinds of heart monitors that patients should use and how they should use them:

  • Use oscillometric monitors with cuffs that fit on the upper arm.
  • Use a proper fitting cuff; ask your healthcare provider to show you the correct way to fit the cuff and use the monitor.
  • Wrist monitors are not recommended, said the panel.
  • Take two or three readings at one minute apart, while you are sitting and resting.
  • When taking the readings, make sure your arm is supported, with the upper arm at heart level and your feet on the floor, legs uncrossed. Make sure your back is supported so you are relaxed in the chair.
  • Take the readings at the same time each day, for instance in the mornings, or in the evenings, or as advised by your healthcare professional.
  • Using a home monitor can confirm if you have high blood pressure that was diagnosed by your doctor, or it can rule it out in cases where the reading taken by the doctor in the surgery doesn't accurately reflect what happens to your pressure over a period of time.
  • Home monitoring can also help to keep an eye on how you react to blood pressure drugs, and it helps to keep patients motivated to take their medication regularly.
The panel wrote that the target goal for treatment with a home monitor is less than 135/85 millimeters of mercury (mmHg), or in the case of high risk patients, less than 130/80 mmHg. At least 12 readings should be used for clinical decisions, they wrote.

Pickering said he hoped this will lead to "a new era in patient-doctor partnerships".

"I think this is a very healthy trend and with a condition like high blood pressure, it really does depend on the patients remembering to change their lifestyles or remembering to take their pills," he added.

The panel warned there are lots of heart monitors for sale in the US that have not passed proper validation tests such as those carried out under protocols from the Association for the Advancement of Medical Instrumentation (AAMI) and British Hypertension Society (BHS).

They said the BHS website had a list of validated monitors at //www.bhsoc.org/default.stm

There is little scientific evidence that home monitoring reduces heart attacks, strokes and deaths more than just being monitored by visits to the doctor, but as Dr Daniel Jones, dean of the University of Mississippi School of Medicine and president of the American Heart Association told the Associated Press (AP), "we have reason to believe that it will."

The AP report also mentions there are some links between makers of heart monitors and the organizations behind the statement, including the fact that Pickering himself is a paid speaker for Omron, a manufacturer of heart monitors, that also sponsors some of the research at his university, as does another device maker, Microlife.

However, Jones said that industry links should not make the public doubt the advice, reported AP.

" Call to Action on Use and Reimbursement for Home Blood Pressure Monitoring: Executive Summary. A Joint Scientific Statement From the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association."

Thomas G. Pickering, Nancy Houston Miller, Gbenga Ogedegbe, Lawrence R. Krakoff, Nancy T. Artinian, and David Goff.

Hypertension, published online May 22, 2008.


Click here for Abstract.

Sources: Journal abstract, AHA press statement, Associated Press.

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Section Issues On Medicine: Cardiology