Home-based Blood Pressure Monitoring Research Articles

Role of Home Blood Pressure Monitoring in Treatment Follow-up by Hypertensive Patients Cohort

Background: The main benefit of home-based blood pressure monitoring (HBPM) is the potential approach to reduce the risk of white-coat hypertension (HTN) and to encourage patients to take ownership of their condition. This study was conducted to assess the role of HBPM in treatment follow-up in a cohort of hypertensive patients. Materials and methods: This was a prospective observational study conducted from December 2017 to May 2018. A total of 100 patients fulfilling the inclusion and exclusion criteria were selected by purposive sampling from Medicine Outdoor of Dhaka Medical College Hospital (DMCH). In total, 100 hypertensive patients were enrolled, and informed consent was obtained. Subsequently, the study subjects received information and training on BP self-management and performed 2 resting measurements per day for 4 days per week for 3 months. All measurements were performed using validated BP monitors.The study endpoints included patient awareness, attainment of BP goals, adherence to antihypertensive treatment, lifestyle modification, assessment of discrepancy between office and HBPM, and white coat HTN or masked HTN at 3 months. SPSS version 22.0 was used for data analysis and reporting. Results: Overall, the mean age was 57.76 ±12.60 years with a range of 34 – 80 years. Males were more prevalent than females, and the ratio was 1.17:1. The majority of cases (76.0%) had established HTN with a history of taking medication, whereas others were non-compliant with medications. Among them 47% had obesity, and 24% had diabetes mellitus. Of the patients, 91% adherence to HBP monitoring, 84.0% adherence to medication, and 75.0% achieved their target BP. The achievement of target blood pressure was significantly higher among the study subjects who adhered to HBP monitoring, and the p-value was < 0.04 (Fisher’s Exact test). Conclusion:  In a cohort of patients with arterial hypertension, information, and training on BP self-measurement and direct involvement of patients using HBPM led to improvement in BP control and could be an effective method by incorporating it into the usual care of hypertensive patients in the hypertension management center of the community. J MEDICINE 2024; 25: 17-23

Assessing Usability of Smartwatch Digital Health Devices for Home Blood Pressure Monitoring among Glaucoma Patients.

Glaucoma is a leading cause of blindness worldwide. Blood pressure (BP) dysregulation is a known risk factor, and home-based BP monitoring is increasingly used, but the usability of digital health devices to measure BP among glaucoma patients is not well studied. There may be particular usability challenges among this group, given that glaucoma disproportionately affects the elderly and can cause visual impairment. Therefore, the goal of this mixed-methods study was to assess the usability of a smart watch digital health device for home BP monitoring among glaucoma patients. Adult participants were recruited and given a smartwatch blood pressure monitor for at-home use. The eHEALS questionnaire was used to determine baseline digital health literacy. After a week of use, participants assessed the usability of the BP monitor and related mobile app using the Post-study System Usability Questionnaire (PSSUQ) and the System Usability Scale (SUS), standardized instruments to measure usability in health information technology interventions. Variations in scores were evaluated using ANOVA and open-ended responses about participants' experience were analyzed thematically. Overall, usability scores corresponded to the 80th-84th percentile, although older patients endorsed significantly worse usability based on quantitative scores and additionally provided qualitative feedback describing some difficulty using the device. Usability for older patients should be considered in the design of digital health devices for glaucoma given their disproportionate burden of disease and challenges in navigating digital health technologies, although the overall high usability scores for the device demonstrates promise for future clinical applications in glaucoma risk stratification.

A Telemedicine Approach For Assessment, Empowerment And Triage For COVID-19 Patients with Comorbidities

Abstract Introduction: COVID-19 pandemic has forced healthcare system to organize the healthcare delivery differently. Methodology: We conducted a retrospective analysis of the Diabetes Wellness Care (DWC) database to understand implications of new virtual clinic model initiated through telemedicine which was extended to manage COVID-19 patients (n=218) Results: 17% of COVID-19 patients were known cases of Type 2 Diabetes (n=37). In these subset of patients, typical COVID-19 pneumonia was present in 45% (n= 17) with 35% (n= 6) requiring hospitalization. COPD/ bronchial asthma pre-existed in 14.5% (n=31) of patients with 3 patients required hospitalization and of which one patient was a known case of diabetes. 11% (n=23) were known hypertensives of which one patient required hospitalization, with coexisting diabetes. 5.5% (n=12) had Coronary Artery Disease and none required hospitalization. 6 patients had concomitant renal impairment. Patients were under strict recommendations to monitor blood glucose and BP by SMBG and Home-Based Blood Pressure Monitoring (HBPM). Doxycycline and ivermectin were prescribed. Azithromycin was added if cough or sore throat was present. Favipiravir was prescribed if elevated CRP and IL-6 with concomitant fever. Pulse oximeter to measure SpO2 was convenient and clinically meaningful during home isolation. X- Ray chest or HRCT scan of chest was mandated including elderly > 60 years. LMWH was utilized only in 2 cases in home isolation (with high D Dimer). 8 patients required hospitalization. Conclusion: Our telemedicine approach enabled a prompt detection of the symptoms, which enabled an effective triage and led to isolation of infectious patients Keywords: Telemedicine, COVID-19, Comorbidities, Diabetes, Hypertension Abbreviations: SMBG- Self Monitoring of Blood Glucose Funding and Conflicts of Interest: None

Society of Behavioral Medicine position statement: Support the updated hypertension guidelines and modify Medicare Part B to improve hypertension management.

Hypertension contributes to significant global health and economic burdens. The American College of Cardiology/American Heart Association's latest guideline lowers the blood pressure threshold for hypertension, and as a result, the number of adults with hypertension has increased. Hypertension is a major risk factor for cardiovascular morbidity, especially among older adults. Many individuals who are diagnosed with hypertension at the new, lower threshold may benefit from lifestyle counseling, but changes to existing Medicare policies are required to increase utilization of evidence-based lifestyle counseling approaches to hypertension management. We recommend appropriate funding for the reimbursement of evidence-based lifestyle counseling for hypertension management, the expansion of medical nutrition therapy counseling coverage as an option for Medicare beneficiaries with hypertension, the inclusion of home-based blood pressure monitoring devices in the list of Durable Medical Equipment Coverage, and modifications to the Medicare Benefit Policy Manual to prioritize evidence-based programs such as Dietary Approaches to Stop Hypertension, American Heart Association, and plant-predominant dietary programs.

Author response: Blood pressure from mid- to late life and risk of incident dementia.

We appreciate the comments of Lattanzi et al. on our article.1 We agree that further exploration of the relationship between blood pressure measures and dementia is necessary. We also acknowledge that incorporating additional measures such as blood pressure variability over time and pulse pressure and home-based blood pressure monitoring data would offer additional useful insight into this relationship. Additional exploration is ongoing within the Framingham study, and elsewhere, to further delineate these associations.

Withdrawal of antihypertensive therapy in people with dementia: feasibility study

BackgroundThis study explored the feasibility of a randomised controlled withdrawal trial of antihypertensive medication in normotensive people with dementia. Feasibility aspects included response, recruitment, exclusion and drop-out rates, suitability of outcome measures, acceptability of study procedures and an indicative economic evaluation for a randomised controlled trial.MethodsA cohort study attempting the withdrawal of antihypertensive drugs where appropriate and a feasibility study of home-based blood pressure monitoring, in people with dementia treated for hypertension, was undertaken. Interviews with participants and carers and an indicative economic evaluation were also undertaken.ResultsThree hundred and sixty-two primary care practices in the East Midlands were contacted of which only 41 (11% (95%CI 8–15%)) agreed to support the study. These 41 practices posted 940 letters to potential participants. Thirty participants were enrolled in the cohort study of whom 9 were eligible for the antihypertensive withdrawal programme, 20 participated in a home blood pressure monitoring sub-group analysis and 12 took part in an interview study. Twenty-two of those enrolled in the cohort study were followed up at 6 months. The withdrawal programme was acceptable to participants and general practitioners (GPs). The study procedures including assessments and home blood pressure monitoring were acceptable to the participants and their carers. The economic evaluation was not possible.ConclusionA withdrawal trial of antihypertensive medication in normotensive people with dementia may not be feasible in the UK because of low recruitment rates.

Home Based Blood Pressure Monitoring in Indian Setting: A Consensus Document

Home Based Blood Pressure Monitoring in Indian Setting: A Consensus Document

Correspondence: Home Based Blood Pressure Monitoring in Indian Setting: A Consensus Document

Correspondence: Home Based Blood Pressure Monitoring in Indian Setting: A Consensus Document

Perception about home-based monitoring of blood pressure and blood sugar among urban and rural individuals

Background: Hypertension and diabetes are the two chronic noncommunicable diseases requiring lifelong care and management. The present study was conducted to understand the perceptions of diabetic and hypertensive individuals regarding the home-based monitoring of blood pressure and blood sugar. Materials and Methods: This cross-sectional study was conducted from August through November 2013 at Saveetha Medical College, Chennai city, located in South India. A convenient sample of 100 individuals was enrolled in this study. Individuals having hypertension or diabetes and visiting to the Internal Medicine, outpatient department (OPD) of Saveetha Medical College were approached for the inclusion in the study. Information about sociodemographic characteristics, disease information source, knowledge, attitude, and practices, and economic aspects related to home-based monitoring of blood pressure and blood sugar. Results: The average age of the participants was 59 years (standard deviation (SD) = 11). Half of the subjects were males (52%) from urban locations (89%). More than half of them have followed some form of dietary measures (58%) to control the blood sugar level in normal limits. Majority of them have heard about home-based blood sugar monitoring device (99%) and 71% of them have heard about home-based blood pressure monitoring devices (electronic or manual). Forty-seven percent of the participants were monitoring their blood pressure, and 90% of them were monitoring their blood sugar at home. Conclusion: There is a need of further research on large scale to evaluate the knowledge, attitude, and practices related to the management of hypertension and diabetes among the individuals monitoring their blood pressure and blood sugar at home.

Effectiveness of Home Blood Pressure Monitoring Among Low-Income Adults in Rural Appalachia.

High blood pressure (BP) is a common chronic condition in the United States. For many people, BP control through pharmacologic intervention alone is not effective at maintaining a healthy BP. Team-based, patient-focused care and home-based BP monitoring in addition to pharmacologic interventions have been shown to be effective for controlling BP. To determine the effectiveness of the hypertension management program at the Heritage Community Clinic in Athens, Ohio. Medical records of 43 patients who took part in the hypertension management program were retrospectively reviewed and included clinical data such as age, sex, BP, body mass index, comorbidities, family history, and demographic information. In addition to standard pharmacologic interventions, the program provided equipment for at-home BP monitoring, education on behavior and lifestyle modification, and 5 follow-up visits. Data from the 5 follow-up visits were analyzed. Linear mixed-effects regression models of BP suggested that the visit factor was significantly associated with BP (P<.001). On average at each visit, patients showed a 6.8-mm Hg reduction in systolic BP and a 3.8-mm Hg reduction in diastolic BP after controlling for demographic variables. General stress level, marital status, and depression were all significantly associated with BP (P<.05). In addition, 67.5% of the patients who took part in this program achieved the target treatment guidelines of the Eighth Joint National Committee for hypertension management. A clinic-based hypertension management program comprising patient education, support, medication, and home BP monitoring was effective at reducing BP.

THE CONCERNS OF BLOOD PRESSURE MONITORING IN ARTERIAL HYPERTENSION OUTPATIENTS

Aim. To analyze correctness of office blood pressure (BP) measurement by physicians and home-based BP monitoring (HBPM) — by the patients, and to assess the efficacy of patients teaching for correct BP self-measurement and control. Material and methods. Totally, 46 physicians questioned (32 local internists and 14 general practitioners with experience 2-27 years) and 290 patients with arterial hypertension (AH). Results. It was revealed that the following parameters were not unified: choice of arm, size of a cuff, times BP measured, time interval for repeated measurement, recording of BP by patients and physicians. These parameters did not suffice totally the Russian guidelines on diagnostics and treatment of arterial hypertension. About a half of BP patients by themselves corrected antihypertension treatment and dealt with the “crises”. Conclusion. Education of patients for BP measurement rules must be performed in “AH schools” and in offices (prevention departments) under supervision of local internists and general practitioners. Such events, as regular update of sphygmomanometers and supply physicians by cuffs of various size, will help to achieve better BP measurement quality in office, as in screening.

Uncontrolled Hypertension is Associated with Postprandial Hypotension

Background: In a previous study that incorporated post-lunch measurements to the conventional scheme of home-based bloodpressure monitoring, we detected postprandial hypotension in about a quarter of hypertensive patients. The coexistence ofhypertension with hypotension poses a therapeutic dilemma, suggesting that the control of hypertension might attenuatepostprandial hypotension.Objectives: The aim of this study was to compare the postprandial change of systolic blood pressure, and the correspondingchronotropic response, associated to the control of hypertension.Methods: We prospectively evaluated 140 treated hypertensive patients, aged over 40 years, with home-based blood pressuremonitoring. The control of hypertension was based on the average morning and evening blood pressure, considering 135/85mmHg as cutoff value. Postprandial hypotension was defined as a drop in systolic blood pressure equal to or greater than 20mmHg with respect to the preprandial value in at least one of three lunches.Results: Postprandial hypotension was found in 13.2% (n=10) of patients with controlled hypertension and in 42.2% (n=27)with uncontrolled hypertension (p<0.001). After lunch, the average decrease of systolic blood pressure was 9.5±10.5 mmHg(6.4%±7.8%) in patients with uncontrolled hypertension and 3.2±7.8 mmHg (2.6%±6.5%) in those with controlled hypertension(p<0.001), with no significant difference in the chronotropic response. After stratifying the patients by hypertension control, the postprandial response of heart rate and systolic blood pressure showed a significant inverse correlation in controlledhypertensive patients (r=-0.24; p=0.035), and a not significant correlation in uncontrolled patients. On the multiplelinear regression analysis, lack of blood pressure control (beta=0.26, p=0.002) and female gender (beta=0.22; p<0.001) weresignificant predictors of a postprandial drop in systolic blood pressure, without a significant influence of age or number ofantihypertensive drugs.Conclusion: Lack of blood pressure control was associated with an abnormal postprandial circulatory response that predisposesto hypotension.

Role of Home Blood Pressure Monitoring in Overcoming Therapeutic Inertia and Improving Hypertension Control

Hypertension remains the most common modifiable cardiovascular risk factor, yet hypertension control rates remain dismal. Home blood pressure (BP) monitoring has the potential to improve hypertension control. The purpose of this review was to quantify both the magnitude and mechanisms of benefit of home BP monitoring on BP reduction. Using a structured review, studies were selected if they reported either changes in BP or percentage of participants achieving a pre-established BP goal between randomized groups using home-based and office-based BP measurements. A random-effects model was used to estimate the magnitude of benefit and relative risk. The search yielded 37 randomized controlled trials with 9446 participants that contributed data for this meta-analysis. Compared with clinic-based measurements (control group), systolic BP improved with home-based BP monitoring (-2.63 mm Hg; 95% CI, -4.24, -1.02); diastolic BP also showed improvement (-1.68 mm Hg; 95% CI, -2.58, -0.79). Reductions in home BP monitoring-based therapy were greater when telemonitoring was used. Home BP monitoring led to more frequent antihypertensive medication reductions (relative risk, 2.02 [95% CI, 1.32 to 3.11]) and was associated with less therapeutic inertia defined as unchanged medication despite elevated BP (relative risk for unchanged medication, 0.82 [95% CI, 0.68 to 0.99]). Compared with clinic BP monitoring alone, home BP monitoring has the potential to overcome therapeutic inertia and lead to a small but significant reduction in systolic and diastolic BP. Hypertension control with home BP monitoring can be enhanced further when accompanied by plans to monitor and treat elevated BP such as through telemonitoring.

An operational study on development of human resources for home based blood pressure monitoring among residents of Dadu Majra colony,UT,Chandigarh,2007

An operational study on development of human resources for home based blood pressure monitoring among residents of Dadu Majra colony,UT,Chandigarh,2007

An operational study on development of human resource for home based blood pressure monitoring among residents of Dadu Majra colony, UT, Chandigarh, 2007

An operational study on development of human resource for home based blood pressure monitoring among residents of Dadu Majra colony, UT, Chandigarh, 2007