Home Blood Pressure Monitoring and Diabetes

Abstract

Home blood pressure monitoring (HBPM) may be useful in the management of many patients with hypertension and diabetes. Blood pressure monitoring traditionally has been carried out in providers’ offices. However, many patients visit their providers only once or twice a year, which limits their ability to monitor hypertension. Over the past several years, HBPM technology has evolved to a point where accuracy and ease of use now make this form of monitoring feasible and useful in many cases. This evolution has been similar in some ways to that of blood glucose meters. When relatively accurate and easy to use blood glucose monitors were first produced, their role was a subject of debate. Today, they are widely accepted as a standard part of care. Whether HBPM will follow a similar course remains to be seen. This article provides a brief overview of methods of blood pressure measurement, recommendations from expert groups on the use of this technology, potential benefits and problems, and a review of some of the more useful devices. Individuals with diabetes are at great risk for cardiovascular disease. Part of this increased risk is because of hypertension. There is a very high incidence of hypertension in patients with diabetes. One survey estimated that 54.8% of Caucasians, 60.4% of African Americans, and 65.3% of Mexican Americans who had diabetes also had hypertension.1 Several trials have also demonstrated the importance of blood pressure–lowering in hypertensive patients with diabetes. Two of the most significant of these trials were the United Kingdom Prospective Diabetes Study (UKPDS) and the Hypertension Optimal Treatment (HOT) study. The HOT study reported a 51% reduction in cardiac events in the diabetes subpopulation ( n = 1,501) who were randomized to the more intensive blood pressure arm (goal: diastolic blood pressure of 80 vs. 90 mmHg).2 The …