Self-Blood Pressure Monitoring in an Urban, Ethnically Diverse Population | Journal Scan

Study Questions:

Does self-monitoring of blood pressure (BP) among minority urban hypertensive patients improve blood pressure control?

Methods:

This was a randomized controlled trial conducted in community clinics in New York in collaboration with the New York City Health Department. The Health Department started a program to have patients in 19 clinics (eight sites were included in the study), which serve medically underserved neighborhoods, self-monitor their blood pressure (BP). The patients in these clinics were predominately black or Hispanic. Participants were included if they had a diagnosis of hypertension (for 6 months or more) which was uncontrolled (defined as ≥140/90 mm Hg or ≥130/80 mm Hg for those with diabetes mellitus or chronic kidney disease). Participants in the intervention arm were provided with a home BP monitor, and training in the proper use of the monitor to record a resting BP. The control group received usual care. The primary outcome of interest was controlled BP.

Results:

A total of 900 participants (450 per arm) were included in the study. The majority of the participants (91% for the intervention group and 93% for the control group) completed a baseline visit and at least one follow-up visit within 10 months. The median number of visits for each participant was five for both study arms. After 9-month follow-up, no difference in BP was noted for the two groups (systolic BP 14.7 mm Hg for the intervention group vs. 14.1 mm Hg for the control group, p = 0.70). Controlled BP was achieved for 38.9% of the intervention group and 39.1% for the control group.

Conclusions:

The investigators concluded that self-monitoring of blood pressure did not improve BP control compared to usual care in an urban minority population.

Perspective:

As the authors point out, additional barriers for these participants, including those with limited means and without insurance, provided additional barriers to adequate control beyond self-monitoring. Tailoring interventions to improve BP control will likely include self-monitoring, but will also require additional measures.

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Hypertension

Keywords: Blood Pressure, Blood Pressure Determination, Blood Pressure Monitoring, Ambulatory, Primary Prevention, Control Groups, Follow-Up Studies, Hypertension, Medically Underserved Area, Urban Population, African Americans, Hispanic Americans, Metabolic Syndrome X


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