Use Of Home Blood Pressure Monitoring Research Articles

Abstract P318: Provider Barriers and Facilitators to Treatment Intensification for Patients With Uncontrolled Blood Pressure

Background: Hypertension is the leading cause of cardiovascular disease and premature death worldwide, however, therapeutic inertia, failure to intensify pharmacotherapy when blood pressure (BP) is not at goal, is a key obstacle to hypertension control. We aimed to identify barriers and facilitators to increasing the dose or adding a different antihypertensive medication class for patients with uncontrolled BP. Methods: We conducted a qualitative study of healthcare providers from Kaiser Permanente Southern California (KPSC). Using a stratified purposeful sampling approach, we identified 300 providers across 15 medical centers and specialties and with a mix of treatment intensification rates. In 2 separate waves, we emailed a letter of invitation to 150 eligible providers followed by 2 reminder emails each two weeks apart. We sought to conduct 30 semi-structured interviews about management of patients newly diagnosed with hypertension including use of single-pill combination therapy (SPC) (the recommended first-line therapy within KPSC), barriers to therapeutic intensification and use of home BP monitoring for treatment intensification decision making. We used rapid analysis methods to code responses and develop themes. Results: A total of 11 interviews were completed with providers from family medicine (n=7), internal medicine (n=3) and cardiology (n=1) who had an average of 6 years of practice within KPSC. The majority of providers reported using monotherapy as first-line treatment while SPC therapy was reserved for younger patients and those with baseline systolic BP >160 mm Hg. Monotherapy was often preferred to help providers determine if the first-line medication is causing side effects. Nearly all providers reported maximizing the dose of one medication before adding another medication class. Providers ranked the barriers to intensifying patients’ treatment in order of importance as 1) side effects such as frequent urination, hyperkalemia, and hypotension, 2) nonadherence to the current antihypertensive medication regimen and patient preference/hesitancy, 3) comorbidities (e.g., kidney function), and 4) age-related factors such as memory loss and ability to complete follow-up labs. All providers reported using patients’ home BP readings for treatment decision-making with most recognizing that patients’ out-of-clinic BP may be lower than clinic BP. Conclusion: Providers embraced stepped-care treatment for newly diagnosed patients with hypertension with most preferring monotherapy as first-line treatment. Concerns with side effects, nonadherence to the medication regimen and shared decision-making are key factors in providers’ decisions to intensify therapy for patients with uncontrolled BP. Targeted interventions to address provider barriers to treatment intensification may be needed.

OPTIMA-BP: empOwering PaTients in MAnaging Blood Pressure – protocol for a randomised parallel group study comparing use of Kvatchii web-based patient education portal as an addition to home blood pressure monitoring

IntroductionHypertension is the leading modifiable risk factor for cardiovascular disease and is implicated in half of all strokes and myocardial infarctions. One-third of the adults in Scotland have hypertension yet...

Home Blood Pressure Monitoring and Its Association With Blood Pressure Control Among Hypertensive Patients With High Cardiovascular Risk in China.

Home blood pressure monitoring (HBPM) is viewed as a facilitating factor in the initial diagnosis and long-term management of treated hypertension. However, evidence remains scarce about the effectiveness of HBPM use in the real world. This study aimed to examine the associations of HBPM use with blood pressure (BP) control and medication adherence. This prospective cohort study included hypertensive patients with high cardiovascular risk who were aged ≥50 years. At baseline, information about types of BP monitor, frequency of HBPM, perception of anti-hypertensive treatment, and measured office BP were collected. During the 1-year follow-up (visits at 1, 2, 3, 6, and 12 months), information on medication adherence was collected at each visit. The 2 major outcomes were BP control at baseline and medication adherence during the 1-year follow-up. A log-binomial regression model was used to examine the association between frequency of HBPM and outcomes, stratified by the perceptions of anti-hypertensive treatment. A total of 5,363 hypertensive patients were included in the analysis. The age was (64.6 ± 7.2) years, and 41.2% (2,208) were female. Of the total patients, 85.9% (4,606) had a home BP monitor and 47.8% (2,564) had an incorrect perception of anti-hypertensive treatment. Overall, 24.2% (1,299) of patients monitored their BP daily, 37.6% (2,015) weekly, 17.3% (926) monthly, and 20.9% (1,123) less than monthly. At baseline, the systolic BP and diastolic BP were (146.6 ± 10.8) mmHg and (81.9 ± 10.6) mmHg, respectively, and 28.5% (1,527) of patients had their BP controlled. Regardless of whether the patients had correct or incorrect perceptions of anti-hypertensive treatment, there is no significant association between HBPM frequency and BP control at baseline. During the 1-year follow-up, 23.9% (1,280) of patients had non-adherence to medications at least once. In patients with an incorrect perception of anti-hypertensive treatment, those monitoring BP most frequently (daily) had the highest non-adherence rate (29.9%, 175/585). Compared with those monitoring their BP less than monthly, patients who monitored their BP daily were more likely not to adhere to anti-hypertensive medications (adjusted relative risk = 1.38, 95% confidence interval: 1.11-1.72, P = 0.004). HBPM performance among hypertensive patients in China is, in general, sub-optimal. No association was observed between using HBPM alone and hypertension control, indicating that the effects of HBPM could be conditional. Patients' misconceptions about anti-hypertensive treatment may impair the role of BP monitoring in achieving medication adherence. Fully incorporating the correct perception of hypertension into the management of hypertensive patients is needed.

The Standardization of Home Blood Pressure Monitoring in Primary Care: A Quality Improvement Project.

Current guidelines recommend the use of home blood pressure monitoring (HBPM) to screen for and manage hypertension. In this study, a quality improvement project was designed to standardize the use of HBPM in a primary care setting and demonstrate improved blood pressure outcomes. Initial systolic and diastolic values were compared to averages from patient logs. Patient and provider feedback was collected. Only 40% of patients enrolled presented to follow-up with actionable HBPM data. Patients encountered logistical challenges in obtaining and presenting HBPM data. Interprofessional collaboration and improved information technology systems would improve outcomes. This will require increased policy and insurer support to make this possible in small settings.

Abstract 16560: Home Blood Pressure Monitoring Among Hypertensive Patients and Their Caregivers in a North Indian Population

Introduction: Hypertension (HTN) management guidelines recommend home blood pressure monitoring (HBPM) as an important tool for BP control. Limited data exists on HBPM epidemiology among people with HTN and their caregivers in the Indian context. Aim: Assess the prevalence, training and technique of HBPM among people with HTN and their caregivers. Methods: People with HTN diagnosed >3 months ago, and their caregivers, were screened from outpatient departments of 3 hospitals (1 tertiary care, 2 community level) in North India and their HBPM use was evaluated. HBPM practices were assessed by observing participants measuring BP using a pre-validated, structured 16-point observational checklist. HBPM knowledge was assessed using a 19-point self-administered questionnaire based on 2017 AHA guidelines. Responses were graded and classified based on quartiles. Results: A total of 2750 participants were screened, of which 2588 (48.8% female) were included. The proportion of respondents using HBPM was 20.5% (424/2070) in urban, and 8.5% (44/518) in rural areas. Only 24.7% (n=116) of the 468 participants (232 caregivers) measuring BP at home recalled ever receiving training from any healthcare workers. The majority (75.2%, 352/468) of participants reported learning BPM themselves through observation, videos, and reading. Age, gender, residence, education and occupation had no impact on the length of time participants had used HBPM. In HPBM practice assessment, 15.9% of people with HTN (37/232) vs 5.9% caregivers (14/236) scored excellent (score >75%). In HPBM knowledge assessment, 0.4% of people with HTN (1/232) vs 0 caregivers scored excellent. HPBM practices were better than knowledge, with mean scores of 62.3 ± 13.1% and 40.1 ± 16.2% respectively. Higher education level was associated with improved patient knowledge (p=0.041), but not practices (p=0.225).The most common reason for non-use of HBPM was lack of knowledge of BPM (36.1%, 171/474) in rural areas, and most people in urban areas feeling it was not necessary (41.1%, 677/1646). Conclusion: There is need for more robust training on HBPM to enable affording people from all backgrounds to better manage their BP, especially in rural areas. Education level is not a barrier to learning good BPM technique.

Impact of home blood pressure monitors on self-monitoring and control of blood pressure in vulnerable adults.

To evaluate associations between home blood pressure monitoring (HBPM) and blood pressure (BP) in vulnerable adults during the COVID-19 pandemic, when access to in-person care was restricted. A retrospective cohort study was conducted in adults with hypertension or elevated BP given a home BP monitor vs. usual care. Change in BP from baseline to follow-up was compared between groups, controlling for potential confounders. Subgroup analyses of BP outcomes were also assessed in patients age >50 years. There was no difference in SBP reduction between n = 82 HBPM patients (-11.7/-2.9 mmHg) and n = 280 usual care patients (-12.5/-5.8 mmHg; P > 0.05). Results were similar in multivariable analysis controlling for potential confounders [coefficient 0.44, 95% confidence interval (CI) -3.98 to 4.87]. However, in the subgroup of patients aged>50 years, there was a significant association between SBP reduction and HBPM in the multivariable analyses (coefficient -7.2, 95% CI -13.8 to -0.62, P = 0.032). HBPM use was not associated with BP reduction in vulnerable adults overall during high telehealth use. An association between SBP reduction and HBPM was observed in those aged>50 years. Targeting limited HBPM resources to those aged >50 years old may have the most impact on BP.

EVALUATION IN REAL LIFE OF ‘SUIVI-HTA’, A FREE APPLICATION FOR HOME BLOOD PRESSURE MONITORING

Objective: Home Blood Pressure Monitoring (HBPM) is key to improve blood pressure control. To help hypertensive patients adopt HBPM and doctors use the results in their practice, the French ‘Fondation de Recherche en Hypertension Artérielle’ has developed the Suivi-HTA application, available since September 2020. We therefore aimed at carrying out a first real-life evaluation of the utilization of this application among hypertension specialists and their patients. Design and method: The survey was carried out in France between October 2020 and March 2021 in 8 hospitals and 2 private practices based on a standardized questionnaire assessing the acceptability and effective use of the application, as well as the doctor's opinion on patient satisfaction. Results: The survey included 135 hypertensive patients, 38% were women, 57% were over 55 years old. Only 27% regularly performed HBPM. If the application was offered, it was well accepted (women 65%, men 80%) with a more important rejection rate in hypertensives over 55 years old (26% vs. 3%, p<0.0003) and with more comorbidities (31% vs. 7%, p = 0.0005). Rejection was mainly related to digital technology (no smartphone or tablet, lack of knowledge on downloading or using applications). Among the 113 patients who agreed to test the application, 98 (87%) effectively performed HBPM, 77 (67%) did so using Suivi-HTA, of which 60 (53%) generated and transmitted a HBPM report. According to the doctor's opinion, 88% patients who have used Suivi-HTA will be future users of the application. Patient satisfaction with the application was assessed as “good” for 93% patients. Conclusions: This national survey shows that the Suivi-HTA application has a good rate of acceptance and effective use among hypertensives. It also generates a very positive opinion in the medical community. However, age and presence of comorbidities were risk factors for reduced acceptance, in connection with the difficulties to digital accessibility. It would therefore be interesting, while globally promoting the use of HBPM in hypertensive patients, to develop specific strategies targeting patients with more comorbidities and/or at higher cardiovascular risk.

A Cross-Sectional Study of Home Blood Pressure Monitoring after Stroke (P11-5.015)

<h3>Objective:</h3> In individuals with hypertension, lowering blood pressure after stroke can lower the risk of stroke recurrence, but many patients do not reach goal. Home blood pressure monitoring (HBPM) can help patients achieve their goal. However, rates of use and quality of technique have not been evaluated, which we aim to evaluate in this cross-sectional study. <h3>Background:</h3> Hypertension (HTN) affects approximately 70% of patients with a recent stroke and treatment is highly effective in reducing risk for recurrence. In multiple studies the reduction of blood pressure, by life style changes or pharmacotherapy have significantly reduced the risk for fatal or non-fatal stroke. Therefore, blood pressure lowering is effective for secondary stroke prevention. <h3>Design/Methods:</h3> We conducted a cross-sectional study of patients with stroke. Patients were eligible if they had a stroke within two years, had hypertension, and lived at home. We classified patients as correctly performing HBPM if they used an arm cuff, sat ≥1 min before measurement, took ≥2 measurements, and use within 6 months. The primary outcome was determine HBPM was used correctly. Which we calculated according to race and ethnicity. We ask for additional steps if BP out of range. <h3>Results:</h3> Among 150 participants, 120 (81%) possessed a HBPM and 29 (21%) used it correctly. We observed no significant disparity in rates of possession or correct use between non-Hispanic White participants and participants from underrepresented groups. Seventy percent of non-Hispanic White patients said they would contact their provider if their BP was above goal vs. 52% of underrepresented patients (p=0.21). <h3>Conclusions:</h3> Most patients after stroke have a HBPM, but only about 1 in 5 use it correctly. Approximately half of patients from underrepresented racial or ethnic groups do not have a plan for responding to values above goal. Our results indicate opportunities to improve the dissemination and correct use of HBPM. <b>Disclosure:</b> Dr. Mariscal has nothing to disclose. Dr. Forman has nothing to disclose. Ms. Viscoli has nothing to disclose. Katherine Meuer has nothing to disclose. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll. Dr. Sheth has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NControl. Dr. Sheth has received stock or an ownership interest from Astrocyte. Dr. Sheth has received stock or an ownership interest from Alva. The institution of Dr. Sheth has received research support from Biogen. The institution of Dr. Sheth has received research support from Novartis. The institution of Dr. Sheth has received research support from Bard. The institution of Dr. Sheth has received research support from Hyperfine. Dr. Sheth has received intellectual property interests from a discovery or technology relating to health care. Dr. Sansing has nothing to disclose. Dr. De Havenon has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Integra. Dr. De Havenon has stock in Certus. The institution of Dr. De Havenon has received research support from NIH/NINDS. The institution of Dr. De Havenon has received research support from Regeneron Pharmaceuticals. The institution of Dr. De Havenon has received research support from AMAG Pharmaceuticals. The institution of Dr. De Havenon has received research support from AMGEN. Dr. De Havenon has received publishing royalties from a publication relating to health care. Dr. Sharma has nothing to disclose. Dr. Kernan has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for various law firms.

Awareness and recommendation of home blood pressure measurement among physicians in India: Results from Asia HBPM survey 2020

BackgroundAwareness of hypertension and blood pressure (BP) control rates are still low in India. Home blood pressure monitoring (HBPM) is recognized as a valuable tool to diagnose and support hypertension treatment including the prevention of cardiovascular diseases(CVD) and target organ damage. We explored the prevailing knowledge and current recommendation of HBPM in daily practice by physicians in India. Materials and methodsAs part of Asia HBPM Survey 2020, a cross-sectional survey was conducted among healthcare providers from India between June 2020 to June 2021. The questionnaire consisted of 37 questions and sub-questions related to HBPM awareness and recommendations to patients. ResultsA total of 832 physicians participated in the survey. Almost 83% were male, whereas age, specialty and workplace were well distributed. 31.3% of physicians instruct their patients to measure their BP before taking antihypertensive drugs, while around 30% of physicians gave no instructions. The reference value of hypertension diagnosis amongst the physicians was substantially low based on clinic BP (34.4%) and home BP (15.1%). Among physicians who manage hypertensive patients, nearly 88% recommend HBPM to their patients, however, only 34.9% of their patients own HBPM device and 30.4% of the patients measure their own BP at home. ConclusionThe survey reveals that HBPM instructions to the patients are either lacking or not well aligned with the local hypertension guidelines which may have led to the low HBPM use among patients. Clear and practical educational material and sessions are needed to improve the understanding of HBPM amongst physicians.

Current realities of home blood pressure monitoring from physicians’ perspectives: results from Asia HBPM survey 2020

Uncontrolled hypertension is a significant problem in many parts of Asia. Effective management is essential to reduce the burden of hypertension. Home blood pressure monitoring (HBPM) is a promising tool that can aid in the diagnosis and management of hypertension. Experts from 11 countries/regions in Asia conceptualized a large-scale survey to examine the current realities of HBPM. A cross-sectional survey was conducted among health care professionals from China, India, Indonesia, Japan, Malaysia, the Philippines, Singapore, South Korea, Taiwan, Thailand, and Vietnam between November 2019 and June 2021. Physicians’ responses were summarized using descriptive statistics. A total of 7945 physicians participated in the survey. Among all respondents, 50.3% and 33.5% viewed HBPM as highly recognized by physicians and patients in their country/region, respectively. Lack of understanding of HBPM and concern with the accuracy and reliability of HBPM devices were identified as key barriers to HBPM recognition. Nearly all physicians (95.9%) reported recommending HBPM to their patients; however, they reported less than 50% of their patients measured home blood pressure (HBP). Among physicians who recommended HBPM, only 22.4% and 54.1% cited HBP diagnostic threshold values and timing of taking antihypertensive drugs that were consistent with available guidelines, respectively. The survey reveals that the recognition of HBPM as a valuable tool to diagnose and manage hypertension is suboptimal in most parts of Asia. Despite high recommendation of HBPM to hypertensive patients by physicians, there are considerable discrepancies between guidelines recommendations and practice realities.The recognition of HBPM as a valuable tool for the diagnosis and management of hypertension is suboptimal among both physicians and patients in Asia. A clear and consistent guidance for proper HBPM practice and use of validated and calibrated HBP monitors are among the top priorities to support the integration of HBPM into daily patient care. HBPM: home blood pressure monitoring, HBP: home blood pressure.

Prescriptions of antihypertensive drugs are influenced by the characteristics of general practitioners and their patients: a cross-sectional study in Normandy, France.

Hypertension is associated with significant cardio-vascular morbi-mortality. However, hypertension control is low, especially in France. The reasons influencing general practitioners' (GPs) prescription of antihypertensive drugs (ADs) remains unclear. This study aimed at assessing the influence of GP and patient characteristics on AD prescriptions. A cross-sectional study based on a sample of 2165 GPs was realized in Normandy (France) in 2019. The ration of AD prescription to overall prescription volume was calculated for each GP and allowed the definition of a 'low or high AD prescriber'. Associations of this AD prescription ratio with GP's age, gender, practice location, number of years of practice, number of consultations, number and age of registered patients, patients' income and number of patients with a chronic condition were assessed using univariate and multivariate analysis. Low prescriber GPs were 51.3±11.2 years-old and were mainly women (56%). In the multivariate analysis, low prescribers were associated with urban practice (OR: 1.47, 95%CI: 1.14-1.88), GP's younger age (OR: 1.87, 95%CI: 1.42-2.44), patient's younger age (OR: 3.39, 95%CI: 2.77-4.15), more patient consultations (OR: 1.33, 95%CI: 1.11-1.61), lower income patients (OR: 1.44, 95%CI: 1.17-1.76) and fewer diabetes mellitus patients (OR: 0.72, 95%CI: 0.59-0.88). Prescriptions of ADs are influenced by the characteristics of GPs and their patients. In future work, a more detailed assessment of all components of the consultation (in particular home blood pressure monitoring use) is necessary to explain AD prescription in general practice.

The Patient-Provider Gap: A Cross-sectional Survey to Understand Barriers and Motivating Factors for Home Blood Pressure Monitoring in a CKD Cohort

Blood pressure (BP) management can decrease morbidity and mortality in chronic kidney disease (CKD) patients. Evidence-based hypertension guidelines endorse home BP monitoring (HBPM), and the growing use of virtual health has highlighted the need for HBPM. A comprehensive understanding of HBPM adoption in our province is lacking. To identify the baseline practices, perspectives, barriers, and enablers in both providers and patients in our kidney care clinics regarding HBPM. Ultimately, this will inform the development of a provincial intervention that empowers providers to both increase patient understanding and equip them for accurate and reliable home BP measurement. Cross-sectional, descriptive study using online survey methodology. Kidney care clinic network in the province of British Columbia, Canada. Kidney care clinic staff and patients who perform HBPM. Data were collected using semi-structured online surveys, one for staff and one for patients and/or caregivers. These surveys were developed by an interdisciplinary working group that included patient partners and addressed some key components of the implementation of an HBPM program (including perceived barriers to uptake, education, and adoption of best practices). In all, 46 patients and 43 staff responded to the survey from 16 kidney care clinics. Of the patients 53% were women, and the most common age range was 60 to 69 years (25%); 93% of the staff respondents were women and 63% were nurses. We identified numerous areas of discordance between providers and patients and the need for improvement from the perspective of implementing best practices from hypertension guidelines, both in staff teaching and patient usage of HBPM. Blood pressure targets were not known to 18% of patients and 39% of patients had received a BP target from their kidney care clinic team; 89% of patients had not had their upper arm circumference measured for cuff size. Furthermore, 54% of patients knew what to do when their BP is off-target. All recognized the benefits of HBPM, providers were more likely to perceive anxiety as a barrier relative to patients, and patients were more likely to report expense as a barrier than providers. This study includes only a single provincial health care system limiting generalizability to other jurisdictions and sampled a small subset of patients and providers. The systematic evaluation of education, understanding, implementation of best practices, and barriers and motivating factors for HBPM from both patient and clinician perspectives is an important step in designing strategies to improve the use of HBPM. Given differences in staff and patient perspectives, targeted interventions based on these responses may lead to improved use of HBPM, and ultimately enhance hypertension self-management and BP control in our CKD patients.

PS-BPP05-4: PRESCRIPTIONS OF ANTIHYPERTENSIVE DRUGS ARE INFLUENCED BY THE CHARACTERISTICS OF GENERAL PRACTITIONERS AND THEIR PATIENTS

Background: Hypertension is associated with significant cardiovascular morbimortality. However, hypertension control is low, especially in France. The reasons influencing general practitioners (GP) prescription of antihypertensive drugs (AD) remains unclear. This study aimed at assessing the influence of GP and patient characteristics on AD prescriptions. Methods: A cross-sectional study based on a sample of 2,165 GPs working with French national health insurance was realized in Normandy (region of France) in 2019. Only GPs meeting the criteria for full-time GP practice were included. The ration of AD prescription to overall prescription volume, a relative measure of AD prescription level, was calculated for each GP and permited the low-high AD prescriber definition. Associations of this AD prescription ratio with GP age, gender, practice location, number of years of practice, number of home visits and consultations, number and age of registered patients, patient income and number of patient with a chronic condition were assessed using univariate and multivariate analysis. Results: The low prescribers GPs were 51.3 ± 11.2 year-old and were mainly women (56%) and practiced in urban context (53%). They prescribed less antihypertensives drugs (4% vs 8%, p &lt; 0.001) and had more low-income patients (6% vs 4%, p &lt; 0.001). In the multivariate analysis, low prescribers were associated to urban practice (OR: 1.47, 95%CI: 1.14;1.88), GP younger age (OR: 1.87, 95%CI:1.42;2.44), patients younger age (OR: 3.39, 95%CI: 2.77;4.15), more patients consultations (OR: 1.33,95%CI: 1.11;1.61), more low-income patients (OR: 1.44, 95%CI: 1.17;1.76) and less diabetes mellitus patients (OR: 0.72, 95%CI:0.59;0.88). Conclusions: Our study described a profile of the typical low er AD prescriber GP. In future work, a more detailed assessment of all components of the consultation (in particular home blood pressure monitoring use) is necessary to explain AD prescription in general practice.

S-04-4: INCONSISTENT GUIDELINES-BASED CONTROL STATUS OF OFFICE, HOME, AND AMBULATORY BLOOD PRESSURE MEASURED BY AN ALL-IN-ONE BP MONITORING DEVICE

Objective: Inconsistencies between office and out-of-office blood pressure (BP) values (described as white-coat hypertension or masked hypertension) may be attributable in part to differences in the BP monitoring devices used. We studied the inconsistency of the classification of BP control (well-controlled BP vs. uncontrolled BP) among office, home, and ambulatory BPs by using a validated all-in-one BP monitoring device. Design and method: In the nationwide, general practitioner-based multicenter HI-JAMP study, 2,322 hypertensive patients treated with antihypertensive drugs underwent office BP measurements and 24-h ambulatory BP monitoring (ABPM), consecutively followed by 5-day home BP monitoring (HBPM), using the same all-in-one device over a total of seven BP measurement days. Results: Using the thresholds of the JSH2019 and ESC2018 guidelines, the subjects with consistently well-controlled office (&lt;140mmHg) and home systolic BP (SBP) (&lt;135mmHg) (n = 970) also tended to have well-controlled 24-h SBP (&lt;130mmHg) (n = 808, 83.3%). The subjects with consistently uncontrolled office and home SBP (n = 579) also tended to have uncontrolled 24-h SBP (n = 444, 80.9%). Among the subjects with inconsistent classifications of office and home BP control (n = 803), 46.1% had inconsistent ABPM-vs.-HBPM out-of-office BP control status. When the 2017 ACC/AHA thresholds or JSH2019 target BP thresholds were applied as an alternative, the results were essentially the same. Conclusions: The combined assessment of office and home BP is useful in clinical practice. Especially for patients whose office BP classification and home BP classification conflict, the complementary clinical use of both HBPM and ABPM might be recommended.

Technical Dissonance in Home Blood Pressure Monitoring After Stroke: Having the Machine, but Not Using Correctly.

In individuals with hypertension (HTN), lowering blood pressure (BP) after a stroke can lower the risk of stroke recurrence, but many patients do not reach the goal. Home blood pressure monitoring (HBPM) can help patients get to the goal, but rates of use and quality of technique have not been evaluated. We conducted a cross-sectional study of patients with stroke. Patients were eligible if they had a stroke within 2 years, had HTN, and lived at home. We classified patients as correctly performing HBPM if they used an arm cuff, sat ≥ 1 min before measurement, took ≥ 2 measurements, and use within 6 months. The primary outcome was the proportion of patients who had an HBPM and used it correctly, which we calculated according to race and ethnicity. We also asked patients what they would do if they found results outside the goal. Among 150 participants, 120 (81%) possessed an HBPM and 29 (21%) used it correctly. We observed no significant disparity in rates of possession or correct use between non-Hispanic White participants and participants from underrepresented groups. Seventy percent of non-Hispanic White patients said they would contact their provider if their BP was above goal vs. 52% of underrepresented patients (P = 0.21). Most patients after stroke have an HBPM, but only about 1 in 5 use it correctly. Approximately half of the patients from underrepresented racial or ethnic groups do not have a plan for responding to the values above goal. Our results indicate opportunities to improve the dissemination and correct use of HBPM.

Effect of combined use of home blood pressure monitoring and nifedipine on blood pressure compliance and quality of life of patients with essential hypertension

Purpose: To investigate the effect of combination of home blood pressure monitoring (HBPM) and nifedipine on blood pressure compliance and quality of life in patients with essential hypertension.&#x0D; Methods: One hundred and twenty essential hypertension patients admitted to Jiaozuo Coal Industry (Group) Co. Ltd Central Hospital from February 2020 to February 2021 were retrospectively studied. They were equally divided into study group (SG) and control group (COG) according to the order of admission. All patients were treated with nifedipine. Blood pressure was regularly measured in COG patients in the consulting room, while for SG patients, blood pressure was measured at home. Treatment compliance, blood pressure-related indices and quality of life of the two groups were determined.&#x0D; Results: Treatment compliance values of patients in SG at 6 weeks (T2) and 12 weeks (T3) were significantly better than the corresponding values for patients in COG (p &lt; 0.05). The related indices of blood pressure at T2 and T3 were significantly better in SG than in COG (p &lt; 0.05), with higher blood pressure compliance at T2 and T3 in SG (60 and 70 %, respectively) than in COG (p &lt; 0.05). The quality-of-life scores at T3 in SG were significantly higher than those in COG (p &lt; 0.05).&#x0D; Conclusion: The combined use of HBPM and nifedipine improves treatment compliance, enhances the levels of related indices of blood pressure, increases blood pressure compliance, and quality of life of patients with essential hypertension. Therefore, the combined therapy merits further investigation on a larger scale.

PRESCRIPTIONS OF ANTIHYPERTENSIVE DRUGS ARE INFLUENCED BY THE CHARACTERISTICS OF GENERAL PRACTITIONERS AND THEIR PATIENTS: A CROSS-SECTIONAL STUDY IN NORMANDY (FRANCE)

Objective: Hypertension is associated with significant cardio-vascular morbi-mortality. However, hypertension control is low, especially in France. The reasons influencing general practitioners’(GP) prescription of antihypertensive drugs (AD) remains unclear. This study aimed at assessing the influence of GP and patient characteristics on AD prescriptions. Design and method: A cross-sectional study based on a sample of 2,165 GPs working with French national health insurance was realized in Normandy (region of France) in 2019. Only GPs meeting the criteria for full-time GP practice were included. The ration of AD prescription to overall prescription volume, a relative measure of AD prescription level, was calculated for each GP and permited the “low-high AD prescriber’’ definition. Associations of this AD prescription ratio with GP’s age, gender, practice location, number of years of practice, number of home visits and consultations, number and age of registered patients, man patient income and number of patient with a chronic condition were assessed using univariate and multivariate analysis. Results: The low prescribers GPs were 51.3 ± 11.2 year-old and were mainly women (56%) and practiced in urban context (53%). They prescribed less antihypertensives drugs (4% vs 8%, p &lt; 0.001) and had more low-income patients (6% vs 4%, p &lt; 0.001). In the multivariate analysis, low prescribers were associated to urban practice (OR: 1.47, 95%CI: 1.14;1.88), GP’s younger age (OR: 1.87, 95%CI: 1.42;2.44), patients younger age (OR: 3.39, 95%CI: 2.77;4.15), more patients consultations (OR: 1.33, 95%CI: 1.11;1.61), more low-income patients (OR: 1.44, 95%CI: 1.17;1.76) and less diabetes mellitus patients (OR: 0.72, 95%CI: 0.59;0.88). Conclusions: Our study described a profile of the typical lower AD prescriber GP. In future work, a more detailed assessment of all components of the consultation (in particular home blood pressure monitoring use) is necessary to explain AD prescription in general practice.

Home Blood Pressure Monitoring in Women of Child-Bearing Age With Hypertension From 2009 to 2014.

Hypertension (HTN) is a leading cause of maternal mortality, and HTN guidelines recommend home blood pressure monitoring (HBPM) to help achieve blood pressure (BP) control. Evidence suggests that HBPM be coupled with a care team to maximize its effectiveness. HBPM use and the prevalence of provider counseling in child-bearing age women with HTN are unknown. We used data from 3,614 women in the cross-sectional National Health and Nutrition Examination Surveys 2009-2014 to determine HBPM use and provider counseling for women of child-bearing age (20-50 years) with and without HTN. HBPM use and provider counseling were self-reported. We examined rates of HBPM use by race/ethnicity, poverty-income ratio (PIR), education, and insurance. Among women of child-bearing age with HTN, the mean (SE) age was 37.0 (0.3) years, the mean (SE) BMI was 35.5 (0.6) kg/m2, and 73% were on BP medication. Of these women with HTN, 49.6% reported HBPM use in the past year and 40.4% received provider counseling. There was no significant difference in HBPM use by race/ethnicity, PIR, or insurance, though higher education was associated with HBPM use. Women with HTN who received provider counseling were more likely to use HBPM (odds ratio = 15.7, 95% confidence interval 9.1-26.9). Nearly half of child-bearing age women with HTN have adopted HBPM, and provider counseling was strongly associated with HBPM use. This highlights a need and opportunity for providers to improve BP management by supporting a popular and valuable monitoring approach among women of child-bearing age with HTN.

Abstract 13643: Home Blood Pressure Monitoring in Pregnant Women and Women of Child-Bearing Age With Hypertension From 2009-2014

Introduction: Hypertension (HTN) is a leading cause of maternal mortality, and HTN guidelines recommend home blood pressure monitoring (HBPM) to help achieve blood pressure (BP) control. Evidence suggests that HBPM be coupled with a care team to maximize its effectiveness. HBPM and provider counseling in pregnant women with HTN are unknown. Objective: To assess HBPM use and provider counseling in pregnant women and women of child-bearing age with HTN Methods: We used data from 3,614 women in the National Health and Nutrition Examination Surveys 2009-2014 to determine HBPM use and provider counseling for pregnant women and women of child-bearing age (20-50 years) with HTN. HBPM use and provider counseling were self-reported. Results: For pregnant women with HTN, the mean (SE) age was 33.3 (1.6) years, the mean (SE) BMI was 44.8 (6.3) kg/m 2 , and 47.5% were on BP medication (Table). Among pregnant women with HTN, 51.2% reported HBPM in the past year, and 46.3% used HBPM at least weekly. However, only 9.6% of pregnant women with HTN received provider counseling. Among women of child-bearing age with HTN, 49.6% reported HBPM in the past year and 40.4% received provider counseling. Conclusions: While over half of pregnant women with HTN have adopted HBPM, less than 10% of this population received provider counseling. This gap highlights a need and opportunity for providers to improve BP management by supporting a popular monitoring approach among pregnant women with HTN.

Thai Physicians’ Opinions about the Use of Home Blood Pressure Monitoring

Hypertension is a powerful modifiable risk factor for cardiovascular disease. The prevalence of hypertension in Thailand is increasing progressively. Patients with hypertension are usually asymptomatic, and thus proper blood pressure measurement is required to diagnose and assess the blood pressure control. Home blood pressure monitoring (HBPM) is recognized as a useful tool in hypertension management and is recommended by many organizations, including the Thai Hypertension Society. The proven benefits of HBPM beyond the usual clinic measurement is that it allowed detection of white-coat hypertension and masked hypertension, better prediction of cardiovascular events, better assessment of the status of blood pressure control, and improved treatment compliance. Despite these benefits, the use of HBPM has remained low in many countries. The Asia HBPM Survey is a collaborative study of participants from 11 countries in Asia. The present study aimed to investigate physicians’ rationale, challenge, and attitudes toward the use of HBPM for hypertensive patients. Herein, the authors report Thai physicians’ responses in the Asia HBPM Survey.