Statement on Self-Measured BP Monitoring at Home
- Authors:
- Shimbo D, Artinian NT, Basile JN, et al.
- Citation:
- Self-Measured Blood Pressure Monitoring at Home: A Joint Policy Statement From the American Heart Association and American Medical Association. Circulation 2020;Jun 22:[Epub ahead of print].
The following are key points to remember from this joint policy statement from the American Heart Association (AHA) and American Medical Association on self-measured blood pressure (BP) monitoring at home:
- Controlling BP is among the most important risk factors for reducing incident cardiovascular events. According to the 2017 Hypertension Clinical Practice Guidelines, 45.6% of US adults had hypertension, defined as an office systolic BP (SBP) ≥130 mm Hg, office diastolic BP (DBP) ≥80 mm Hg, or taking antihypertensive medication.
- BP may differ considerably when measured in the office and when measured outside of the office setting (self-monitoring or ambulatory BP monitoring [ABPM]). The following table shows corresponding values of SBP/DBP for office BP and self-measured BP (AHA 2017):
Office BP, mm Hg Self-Measured BP, mm Hg 120/80 120/80 130/80 130/80 140/90 135/85 160/100 145/90 - Higher out-of-office BP is associated with increased cardiovascular risk independent of office BP. Although ABPM is recommended as the preferred out-of-office BP assessment method in some guidelines, it is not widely available in primary care settings. Thus, self-measured BP monitoring, which has been well validated, is an important part of hypertension management in the US.
- Self-measured BP monitoring indications include persons without known hypertension and evidence for white-coat hypertension (WCH = office but not home) and masked hypertension (MH = home but not office), and in persons with documented hypertension, on-treatment identification of white-coat effect, and masked uncontrolled hypertension. Other indications include confirming the diagnosis of resistant hypertension and detecting morning hypertension.
- Compared with out-of-office sustained normal BP, WCH is associated with either no increased or moderately increased risk of cardiovascular events and mortality. WCH is associated with a lesser risk of cardiovascular events and mortality compared with sustained hypertension, defined as having high BP on both office and out-of-office BP measurements.
- Validated self-measured BP monitoring devices and a standardized (e.g., AHA) BP measurement and monitoring protocol should be followed. Evidence from meta-analyses of randomized trials indicates that self-measured BP monitoring is associated with a reduction in BP and improved BP control, and the benefits of self-measured BP monitoring are greatest when done along with cointerventions. The addition of self-measured BP monitoring to office BP monitoring is cost-effective compared with office BP monitoring alone or usual care among individuals with high office BP.
- The use of self-measured BP monitoring is commonly reported by both individuals and providers. Therefore, self-measured BP monitoring has high potential for improving the diagnosis and management of hypertension in the United States. Randomized controlled trials examining the impact of self-measured BP monitoring on cardiovascular outcomes are needed.
- To adequately address barriers to the implementation of self-measured BP monitoring, financial investment is needed in the following areas: improving education and training of individuals and providers, building health information technology capacity, incorporating self-measured BP readings into clinical performance measures, supporting cointerventions, and enhancing reimbursement.
- Quick take summary: Compared with normal office and normal self-monitored BP measurements, isolated WCH is associated with no increased or moderately increased risk of cardiovascular events and mortality. In contrast, isolated MH (self-monitored but not office) and masked uncontrolled hypertension are associated with an increased risk of cardiovascular events and mortality.
Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Vascular Medicine, Hypertension
Keywords: Antihypertensive Agents, Blood Pressure, Blood Pressure Determination, Blood Pressure Monitoring, Ambulatory, Cost-Benefit Analysis, Hypertension, Masked Hypertension, Medical Informatics, Primary Health Care, Primary Prevention, Risk Factors, White Coat Hypertension
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