Home Blood Pressure Self-monitoring Research Articles

Conquering hypertension in Vietnam: 12- month follow up results from a cluster-randomised controlled trial

BackgroundApproximately 20% of adults in Vietnam have hypertension, and management of this chronic condition remains challenging. This study aimed to assess the effectiveness of a multicomponent intervention in reducing blood pressure (BP) in adults with uncontrolled hypertension. MethodsThis cluster randomised controlled trial was conducted in sixteen communities (8 intervention and 8 comparison) in a rural setting in Vietnam (2017-2022). Consenting adults (aged≥18 years) with uncontrolled hypertension were enrolled. Sixteen communities were equally randomised to an intervention or comparison group stratified by district. Consenting adults were assigned to study groups by community. The comparison arm received training sessions about hypertension prevention and management for health workers, and patient education materials. The intervention arm received training sessions about hypertension prevention and management for health workers, and patient education materials and three enhancement components including a storytelling intervention, home BP self-monitoring, and expanded community health worker services. The primary outcome was the difference in changes in patient’s levels of systolic BP between the study groups over a 12-month follow-up period. Patients and outcome assessors were masked. FindingsA total of 671 patients (340: intervention, 331: comparison) were enrolled in the trial. The mean age was 66 years and 45% were men. At the 12-month follow-up, the mean systolic BP declined by 18.4 mmHg in the intervention group and 3.7 mmHg in the control group (differential decline of 14.7 mmHg [95% CI: 11.8 – 17.6]). The intervention group also achieved better BP control and medication adherence than the control group. There were no serious adverse events related to study participation. InterpretationThe results of this trial demonstrate that a multicomponent intervention can effectively reduce elevated BP in individuals with uncontrolled hypertension in Vietnam. Trial registrationThis trial was registered at ClinicalTrials.gov, NCT03590691. FundingNational Heart, Lung, and Blood Institute

Fidelity to and utility of a home blood pressure self-monitoring regime in people with pre-hypertension: results from the REVERSE study.

Around 40% of adults have pre-hypertension (120-139/80-89mmHg) increasing their risk of developing hypertension and associated cardiovascular conditions. Guidance on pre-hypertension management focuses on improving lifestyle. Self-monitoring may improve awareness and understanding of blood pressure (BP) for people with pre-hypertension, allowing them to modify their lifestyle risks. To determine the fidelity to and utility of a home BP self-monitoring regime in people with pre-hypertension. This sub-study is part of a larger prospective, non-randomised feasibility study. Individuals with pre-hypertension were identified via GP records and pharmacy NHS Health Checks in Northwest England. Participants received training for home BP self-monitoring. They were asked to complete two readings (leaving a 5-minute interval) on the first three days of the month for six months, colour-code their readings and take action using a simple algorithm, then send them to the research team within 7 days. Eighty participants (aged 40-79, mean=59) enrolled. The majority were female (n=45, 56%), White British (n=79, 99%), and had not previously monitored their BP (n=55, 69%). Seventy-five (94%) participants completed the training. Sixty-one (81%) received online training and 14 (19%) opted for a face-to-face session. Sixty-one (81%) completed all six months of readings, 51 (68%) also returned them on time. All in-person training participants completed all six months of readings on time. Reasons for non-compliance to the protocol included battery issues, forgetting, and struggling to find a consistent time for readings. Home BP self-monitoring can be feasible and easily implementable for people with pre-hypertension - however, some barriers were identified.

Long-Term Effect of Home Blood Pressure Self-Monitoring Plus Medication Self-Titration for Patients With Hypertension

Patient empowerment through pharmacologic self-management is a common strategy for some chronic diseases such as diabetes, but it is rarely used for controlling blood pressure (BP). Several trials have shown its potential for reducing BP in the short term, but evidence in the longer term is scarce. To evaluate the longer-term effectiveness of BP self-monitoring plus self-titration of antihypertensive medication vs usual care for patients with poorly controlled hypertension, with passive follow-up and primary-care nursing involvement. The ADAMPA (Impact of Self-Monitoring of Blood Pressure and Self-Titration of Medication in the Control of Hypertension) study was a randomized, unblinded clinical trial with 2 parallel arms conducted in Valencia, Spain. Included participants were patients 40 years or older, with systolic BP (SBP) over 145 mm Hg and/or diastolic BP (DBP) over 90 mm Hg, recruited from July 21, 2017, to June 30, 2018 (study completion, August 25, 2020). Statistical analysis was conducted on an intention-to-treat basis from August 2022 to February 2024. Participants were randomized 1:1 to usual care vs an individualized, prearranged plan based on BP self-monitoring plus medication self-titration. The main outome was the adjusted mean difference (AMD) in SBP between groups at 24 months of follow-up. Secondary outcomes were the AMD in DBP between groups at 24 months of follow-up, proportion of patients reaching the BP target (SBP <140 mm Hg and DBP <90 mm Hg), change in behaviors, quality of life, health service use, and adverse events. Among 312 patients included in main trial, data on BP measurements at 24 months were available for 219 patients (111 in the intervention group and 108 in the control group). The mean (SD) age was 64.3 (10.1) years, and 120 patients (54.8%) were female; the mean (SD) SBP was 155.6 (13.1) mm Hg, and the mean (SD) diastolic BP was 90.8 (7.7) mm Hg. The median follow-up was 23.8 months (IQR, 19.8-24.5 months). The AMD in SBP at the end of follow-up was -3.4 mm Hg (95% CI, -4.7 to -2.1 mm Hg; P < .001), and the AMD in DBP was -2.5 mm Hg (95% CI, -3.5 to -1.6 mm Hg; P < .001). Subgroup analysis for the main outcome showed consistent results. Sensitivity analyses confirmed the robustness of the main findings. No differences were observed between groups in behaviors, quality of life, use of health services, or adverse events. In this secondary analysis of a randomized clinical trial, BP self-monitoring plus self-titration of antihypertensive medication based on an individualized prearranged plan used in primary care reduced BP in the longer term with passive follow-up compared with usual care, without increasing health care use or adverse events. These results suggest that simple, inexpensive, and easy-to-implement self-management interventions have the potential to improve the long-term control of hypertension in routine clinical practice. ClinicalTrials.gov Identifier: NCT03242785.

The Logics of Invited and Uninvited Material Participation

This paper addresses debates concerning the ‘participatory turn’ in healthcare. It focuses on the case of blood pressure self-monitoring, understanding this as a form of patient participation at the level of individual care. Drawing and expanding on the work of Marres and Wynne and their notions of material participation and of uninvited engagement, we examine how patients’ home blood pressure self-monitoring is incorporated into clinical care, how the materials of blood pressure self-monitoring mediate participation and how we might characterise the practices of participation found within everyday clinical care. Our analysis makes new conceptual links, suggesting that, in this context, invited participation appears to align with participation made easy, while uninvited participation involves more invested, more engaged participation. We offer two further developments of these concepts. First, we trouble characterisations of invited and uninvited participation as distinct and separate, observing movement between these. Second, through applying the logics of material participation in a new context, everyday clinical practice, we suggest that the logic of participation made easy might be extended beyond lay people, to apply to professionals as well. Our analysis illustrates how materials are mobilised to facilitate invited and uninvited participation within the context of the on-going asymmetries in doctor patient relationships.

Home Blood Pressure Self-monitoring plus Self-titration of Antihypertensive Medication for Poorly Controlled Hypertension in Primary Care: the ADAMPA Randomized Clinical Trial

BackgroundPatient empowerment through pharmacological self-management is a common strategy in some chronic diseases such as diabetes, but it is rarely used for controlling blood pressure.ObjectiveThis study aimed to assess self-monitoring plus self-titration of antihypertensive medication versus usual care for reducing systolic blood pressure (SBP) at 12 months in poorly controlled hypertensive patients.DesignThe ADAMPA study was a pragmatic, controlled, randomized, non-masked clinical trial with two parallel arms in Valencia, Spain.ParticipantsHypertensive patients older than 40 years, with SBP over 145 mmHg and/or diastolic blood pressure (DBP) over 90 mmHg, were recruited from July 2017 to June 2018.InterventionParticipants were randomized 1:1 to usual care versus an individualized, pre-arranged plan based on self-monitoring plus self-titration.Main MeasureThe primary outcome was the adjusted mean difference (AMD) in SBP between groups at 12 months.Key ResultsPrimary outcome data were available for 312 patients (intervention n=156, control n=156) of the 366 who were initially recruited. The AMD in SBP at 12 months (main analysis) was −2.9 mmHg (95% CI, −5.9 to 0.1, p=0.061), while the AMD in DBP was −1.9 mmHg (95% CI, −3.7 to 0.0, p=0.052). The results of the subgroup analysis were consistent with these for the main outcome measures. More patients in the intervention group achieved good blood pressure control (<140/90 mmHg) at 12 months than in the control group (55.8% vs 42.3%, difference 13.5%, 95% CI, 2.5 to 24.5%, p=0.017). At 12 months, no differences were observed in behavior, quality of life, use of health services, or adverse events.ConclusionSelf-monitoring plus self-titration of antihypertensive medication based on an individualized pre-arranged plan used in primary care may be a promising strategy for reducing blood pressure at 12 months compared to usual care, without increasing healthcare utilization or adverse events.Trial RegistrationEudraCT, number 2016-003986-25 (registered 17 March 2017) and clinicaltrials.gov, NCT03242785.

IS HOME BLOOD PRESSURE SELF MONITORING HERE TO STAY? AN EVALUATION OF PATIENT SATISFACTION WITH HOME BLOOD PRESSURE MONITORING IN A RURAL POPULATION DURING THE COVID PANDEMIC

Objective: During the COVID pandemic patients with hypertension were trained to self-monitor blood pressures at home. A post service transformation evaluation was undertaken as COVID restrictions were eased to assess if patients would prefer office blood pressure vs home monitoring for ongoing care. Design and method: A retrospective analysis of all patients who consented to home blood monitoring during the COVID pandemic was undertaken at 12 months across three health centre in a rural population. Patients were asked of their perception of doing home blood pressure readings and their confidence and satisfaction with this method vs office. Method: Patients were asked during routine medication reviews and at the end of 12 months of their confidence and satisfaction and difficulties with managing home blood pressure monitoring in order to understand their preferences for future care Results: Of the total of over 2000 patients with known diagnosis of hypertension n = 2000, a sample cohort of 500 patients (sample size 25%) were asked as they had medication reviews of their confidence with the self-monitoring. The no of patients who felt confident and wished to continue was quite high 70% this did not vary across the ages i.e. both young and the elderly were content doing their own home blood readings. Only 50 patients (11.8%) wanted office readings reasons were affordability and lack of confidence with the reliability of home readings and those who were very elderly wanted the human contact which they previously had. Conclusions: Home blood pressure self-monitoring is a safe reliable and evidenced based and previously underutilized method of monitoring patients with hypertension. We believe the office readings of blood pressure still have a place in routine care but the overwhelming response and satisfaction with home blood pressure is likely to change monitoring and lead to better overall blood pressure control.

Community-Academic Partnership to Improve Nutrition and Blood Pressure in Seniors: Outcomes &amp; Impact of COVID-19

The Dietary Approaches to Stop Hypertension (“DASH diet”) has been proven in research settings to lower blood pressure, but its implementation is untested among seniors in congregate meals settings. We report the planning, implementation, impact of COVID-19, and results of an Administration of Community Living-funded study to test whether two evidence-based interventions - DASH-alignment of congregate meals, and home blood pressure self-monitoring, can lower systolic blood pressure and increase blood pressure control among community-dwelling seniors.. Congregate meal menus were aligned with the DASH eating plan, through collaboration of Bionutrition professionals on the research team, CBN food services leadership, and the NYC Department for the Aging. Seniors provided feedback on the DASH-modified meal options. The intervention began on October 15, 2019 (Site 1) and February 3, 2020 (Site 2). The study was interrupted by the COVID-19 pandemic in March 2020, when congregate meals ceased, and when approximately 75% of primary outcome data were collected. Modified implementation permitted completion of modified study outcomes. Preliminary analyses suggest that some participants were able to lower their blood pressure in this program. The DASH diet implemented in the congregate meal setting, along with programs to support BP self-efficacy through modification of existing programs, may be a valuable and scalable model to reduce cardiovascular risk among community-living seniors.

Abstract 9844: Virtual Outreach Facilitates Blood Pressure Self-Monitoring Among Black Men at a Federally Qualified Health Center

Introduction: Rates of uncontrolled hypertension are higher in Black men than in the general population. Prior studies have shown that home self-monitoring of blood pressure (SMBP), in addition to clinical support and education, helps patients lower their blood pressure (BP). This study evaluated a SMBP program for Black men with hypertension at a Federally Qualified Health Center (FQHC). Hypothesis: We hypothesized that virtual outreach would increase SMBP adoption and lower BP among Black Men at a FQHC. Methods: Black men &gt;18 years old with severe hypertension (&gt;160 mmHg systolic or &gt; 100 mmHg diastolic) were contacted by student volunteers and offered a free BP cuff with program enrollment. Students attempted &gt; 4 calls with each participant over the course of 2 plan-do-study-act (PDSA) cycles. Students provided BP education and asked participants to report SMBP readings. Univariate analyses were performed to explore the effect of our SMBP program on clinic BPs. Results: Of 258 eligible, 137 (53.1%) were successfully contacted and 82 (31.8%) received a BP cuff. By the end of PDSA cycle 2, 52 men (20.2%) had reported a BP reading to their student caller. For those who had an updated BP documented in the medical record after cycle 1, subsequent office systolic BP changed by an average of -24.9 (95% CI: -30.8, -19.0) mmHg for the 37 men who used their BP cuff (p&lt;0.001) and by -21.4 (95% CI: -25.1, -16.8) mmHg for the 108 men who did not (p&lt;0.001). The reduction in BP was larger for the group that used BP cuffs (difference -3.5 [95% CI: -12.1, 5.1] mmHg, p=0.35), but this change was not statistically significant. Conclusions: Creating partnerships via virtual communication between university students and community members led to adoption of SMBP among Black men. BP reduction trended greater in the group that began self-monitoring, but difficulty in follow-up and a small sample size limited statistical power.

Conquering hypertension in Vietnam\u2014solutions at grassroots level: study protocol of a cluster randomized controlled trial

BackgroundVietnam has been experiencing an epidemiologic transition to that of a lower-middle income country with an increasing prevalence of non-communicable diseases. The key risk factors for cardiovascular disease (CVD) are either on the rise or at alarming levels in Vietnam, particularly hypertension (HTN). Inasmuch, the burden of CVD will continue to increase in the Vietnamese population unless effective prevention and control measures are put in place. The objectives of the proposed project are to evaluate the implementation and effectiveness of two multi-faceted community and clinic-based strategies on the control of elevated blood pressure (BP) among adults in Vietnam via a cluster randomized trial design.MethodsSixteen communities will be randomized to either an intervention (8 communities) or a comparison group (8 communities). Eligible and consenting adult study participants with HTN (n = 680) will be assigned to intervention/comparison status based on the community in which they reside. Both comparison and intervention groups will receive a multi-level intervention modeled after the Vietnam National Hypertension Program including education and practice change modules for health care providers, accessible reading materials for patients, and a multi-media community awareness program.In addition, the intervention group only will receive three carefully selected enhancements integrated into routine clinical care: (1) expanded community health worker services, (2) home BP self-monitoring, and (3) a “storytelling intervention,” which consists of interactive, literacy-appropriate, and culturally sensitive multi-media storytelling modules for motivating behavior change through the power of patients speaking in their own voices. The storytelling intervention will be delivered by DVDs with serial installments at baseline and at 3, 6, and 9 months after trial enrollment. Changes in BP will be assessed in both groups at several follow-up time points. Implementation outcomes will be assessed as well.DiscussionResults from this full-scale trial will provide health policymakers with practical evidence on how to combat a key risk factor for CVD using a feasible, sustainable, and cost-effective intervention that could be used as a national program for controlling HTN in Vietnam.Trial registrationClinicalTrials.gov NCT03590691. Registered on July 17, 2018. Protocol version: 6. Date: August 15, 2019.

Healthcare practitioner views and experiences of patients self-monitoring blood pressure: a vignette study.

BackgroundHome self-monitoring of blood pressure is widely used in primary care to assist in the diagnosis of hypertension, as well as to improve clinical outcomes and support adherence to medication. The National Institute for Health and Care Excellence (NICE) care pathways for hypertension recommend specific guidelines, although they lack detail on supporting patients to self-monitor.AimTo elicit primary care practitioners’ experiences of managing patients’ home blood pressure self-monitoring, across surgeries located in different socioeconomic areas.Design & settingA qualitative focus group study was conducted with a total of 21 primary care professionals.MethodParticipants were GPs and practice nurses (PNs), purposively recruited from surgeries in areas of low and high deprivation, according to the English indices of multiple deprivation. Six vignettes were developed featuring data from interviews with people who self-monitor and these were used in five focus groups. Results were thematically analysed.ResultsThemes derived in the thematic analysis largely reflected topics covered by the vignettes. These included: advice on purchase of a device; supporting home monitoring; mitigating patient anxiety experienced as a result of home monitoring; valuing patients’ data; and effect of socioeconomic factors.ConclusionThe work provides an account of methods used by primary care practitioners in the management of home blood pressure self-monitoring, where guidance may be lacking and primary care practitioners act on their own judgement. Findings complement recent policy documentation, which recognises the need to adopt new ways of working to empower patients (for example, additional support from healthcare assistants), but lacks detail on how this should be done.

Arterial hypertension and antihypertensive treatment in the unorganized Moscow population

Background. The epidemiology of hypertension (HTN) and antihypertensive treatment (AHT) in the Russian Federation was repeatedly estimated in epidemiology trials with various methodology, but situation in Moscow region has not been fully explored.Objective. To examine the rate, age and gender features of HTN and AHT in unorganized Moscow cohort.Design and methods. 532 participants older than 16 years old were interviewed in Moscow park after signing informed consent. Information about sex, age, rate of diagnosed HTN, AHT and its effectiveness was collected based on a questionnaire. Arterial blood pressure (BP) was measured consequently three times.Results. Median and interquartile range of participants age was 57 (38–66) years, 71,1 % were women. Women were significantly older than men (59 (46–67) and 48 (31–61) years respectively, p = 0,0001). 42,7 % reported previously diagnosed HTN, 62,5 % received AHT. 79,7 % participants receiving AHT (49,8 % HTN patients) considered it effective. Home BP self-monitoring was performed by 43,7 % respondents (sex- and age-adjusted rates). While measured, 29,7 % participants had optimal BP level, 22,6 % — normal and 15,2 % — high normal. BP &gt; 140 and/or 90 mm Hg was measured in 32,6 % of participants (rates are sex and age adjusted). BP &gt; 140 / 90 mm Hg at assessment was found in 48,8 % HTN patients and 16,4 % participants without previously diagnosed HTN (8,7 % in entire studied cohort). There were no significant differences in the rate increased BP level at assessment and in HTN patients who received AHT or not (49,5 and 46,9 %). HTN rate was 39,6 % in participants who considered their AHT effective, and 75,5 % — ineffective, p &lt; 0,0001. 63,4 % participants taking AHT could specify the drugs (65,3 % received monotherapy, 27,1 % — 2 drugs and 7,6 % — 3 drugs; fixed combinations received 17 %). BP levels and HTN did not differ in HTN patients who received one or more drugs.Conclusions. In unorganized Moscow cohort age and gender adjusted rate of HTN at BP measurement was 32,6 %. In 8,7 % participants high BP was detected at first time. Only 62,5 % patients with previously diagnosed HTN received AHT. 39,6 % participants who considered AHT effective demonstrate high BP at assessment. AHT was not associated with the lower HTN rate or BP level, which may be attributed to excessive use of monotherapy and insufficient application of fixed combinations.

Abstract TP415: Regular Home Blood Pressure Monitoring Reduces the Risk of Stroke Recurrence

Background: High blood pressure (BP) is a well recognized risk factor for ischemic stroke, and aggressive BP control is critical for secondary stroke prevention. However, hypertensive (HTN) outpatients are often found to have uncontrolled BP, in part due to poor compliance with daily at-home BP monitoring and consequent poor medication adherence. Here, we explore the association of patient home BP self-monitoring compliance with stroke recurrence. Method: Ischemic stroke patients with pre-existing HTN were prospectively recruited in accordance with IRB protocol for this observational study. All patients were trained on BP self-monitoring as per standard of care, and were asked to monitor BP at home daily consistently for 2 weeks. BP monitoring compliance, per completion of BP log, was assessed at each follow-up clinical visit by an investigator blinded to patient outcome. Stroke recurrence was followed for 5 years and independently adjudicated by two vascular neurologists. Result: In a total of 219 patients, only 36 patients (16.4%) were compliant in completing the home BP log as instructed. The compliant and non-compliant groups showed no baseline difference and no medication usage difference (p&gt;0.05) (Table 1). Compliance with at-home BP monitoring was associated with well controlled systolic (p&lt;0.001) and diastolic BP (p&lt;0.001). Of note, 30 patients (16.4%) had recurrent strokes in the non-compliant group, while there were no recurrent strokes in the compliant group. BP self-monitoring compliance is associated with reduced incidence of stroke recurrence (p=0.030) and the significance remains robust after adjusting for multiple confounders (p=0.029) (Table 2). Conclusion: Regular home BP monitoring is associated with lower risk of stroke recurrence in HTN stroke patients. Study in expanded patient cohort is ongoing to leverage technology for better home BP monitoring and to create incentives for compliant behavior for better secondary stroke prevention.

Feasibility of Emergency Department-initiated, Mobile Health Blood Pressure Intervention: An Exploratory, Randomized Clinical Trial.

We aimed to assess the feasibility of a text messaging intervention by determining the proportion of emergency department (ED) patients who responded to prompted home blood pressure (BP) self-monitoring and had persistent hypertension. We also explored the effect of the intervention on systolic blood pressure (sBP) over time. We conducted a randomized, controlled trial of ED patients with expected discharge to home with elevated BP. Participants were identified by automated alerts from the electronic health record. Those who consented received a BP cuff to take home and enrolled in the 3-week screening phase. Text responders with persistent hypertension were randomized to control or weekly prompted BP self-monitoring and healthy behavior text messages. Among the 104 patients enrolled in the ED, 73 reported at least one home BP over the 3-week run-in (screening) period. A total of 55 of 73 reported a home BPof ≥140/90 and were randomized to SMS intervention (n=28) or control (n=27). The intervention group had significant sBP reduction over time with a mean drop of 9.1mmHg (95% confidence interval= 1.1 to 17.6). The identification of ED patients with persistent hypertension using home BP self-monitoring and text messaging was feasible. The intervention was associated with a decrease in sBP likely to be clinically meaningful. Future studies are needed to further refine this approach and determine its efficacy.

Home Blood Pressure Self-Monitoring in Patients Treated With Anti-Angiogenic Drugs for the Detection of Arterial Hypertension

Introduction: We compared in a prospective open-label study two different protocols of home self-measurement of arterial blood pressure (ABP) for the detection of antiangiogenic drugs (AAG)-induced arterial hypertension (AHT). Material and methods: We performed 3 measurements every morning and evenings measurements for 3 successive days (hBP-3d) and compared them to a single daily morning measurement of BP for 7 days (hBP-7d) during 2 consecutive treatment cycles with bevacizumab or sunitinib. Results: Among the 26 patients treated with AAG, there was a significant difference between the number of AHT episode based on hBP-3d and hBP-7d protocol (116 against 183, p<0.0005). AHT did not correlated with tumoral progression/stabilization and no significant predictability could be established using the 2 protocols. Conclusion: Detection of AHT episod in patients treated with AAG was linked to the BP monitoring protocol and should be specifically designed for cancer patients treated with AAG.

UK Guidelines Call for Routine 24-Hour Ambulatory Blood Pressure Monitoring in All Patients to Make the Diagnosis of Hypertension-Not Ready for Prime Time in the United States

UK Guidelines Call for Routine 24-Hour Ambulatory Blood Pressure Monitoring in All Patients to Make the Diagnosis of Hypertension-Not Ready for Prime Time in the United States

Automedida de la presión arterial domiciliaria. Influencia del sistema de cálculo de la media en el diagnóstico de la hipertensión de bata blanca

To describe the variations in the diagnosis performance of home blood pressure self-monitoring (hBPSM) with different methods for mean calculation, in order to diagnose white-coat hypertension (WCH). Multi-centre, descriptive, and comparative study to assess the diagnosis performance of a test method. Four primary health care centres. A total of 157 recently-diagnosed, untreated patients with mild-moderate hypertension took part in the study. The results obtained with hBPSM (3 consecutive days with readings in triplicate, morning-night) were compared with a "gold standard" out-patient blood pressure reading (OutBP). Systolic and diastolic BP values of the first day and first reading (morning-night) were higher than the remaining days and readings (linear trend P< .001). Results in hBPSM diagnostic performance using all readings to calculate the mean were: sensitivity (S), 47.6%; specificity (Sp), 77.4%; positive and negative predictive values (PPV and NPV), 58.8% and 68.6%, with positive and negative probability coefficients (PPC and NPC), 2.10 and 0.67. When readings with greater patient alarm reaction (first day and first reading, morning-night) were removed, greater values of S (61.9%) were obtained, albeit at expense of an excessive loss in Sp (64.5%) and without improvement in PPC (1.74). The diagnostic performance of hBPSM in WCH was low and failed to improve with the use of different systems to calculate mean BP.

Home blood pressure self-monitoring: diagnostic performance in white-coat hypertension

To determine the diagnostic performance of home blood pressure self-monitoring in white-coat hypertension using a 3-day reading program. One hundred and ninety nontreated patients recently diagnosed with mild-moderate hypertension, selected consecutively at four primary healthcare centers in the city of Barcelona, were included. Each patient underwent morning and night home blood pressure self-monitoring with readings in triplicate for three consecutive days, followed by 24-h ambulatory blood pressure monitoring. The normality cut-off point value for home blood pressure self-monitoring and daytime ambulatory blood pressure monitoring was 135/85 mmHg. Sixty-three patients were diagnosed with white-coat hypertension with home blood pressure self-monitoring (34.8%; 95% confidence interval: 27.9-42.2) and 74 with ambulatory blood pressure monitoring (41.6%; 95% confidence interval: 33.7-48.4). No statistically significant differences were observed between home blood pressure self-monitoring values and those of diurnal ambulatory blood pressure monitoring [137.4 (14.3)/82.1 (8.3) mmHg vs. 134.8 (11.3)/81.3 (9.5) mmHg]. Home blood pressure self-monitoring diagnostic performance parameters were sensitivity 50.0% (95% confidence interval: 38.3-61.7), specificity 75.7% (95% confidence interval: 66.3-83.2), positive and negative predictive values 58.7% (95% confidence interval: 45.6-70.8) and 68.6% (95% confidence interval: 59.4-76.7), respectively, and positive and negative probability coefficients 2.05 and 0.66, respectively. Analysis of different normality cut-off points using a receiver operating characteristic curve failed to produce significant improvement in the diagnostic performance of home blood pressure self-monitoring. The diagnostic accuracy of a 3-day home blood pressure self-monitoring reading program in white-coat hypertension was poor. Ambulatory blood pressure monitoring continues to be the test of choice for this indication.

Home Self-Monitoring of Blood Pressure Is Fully Automated Oscillometric Technique as Good as Conventional Stethoscopic Technique?

Home blood pressure (HBP) measurement is becoming increasingly popular as an additional source of information for the practicing physician. Whether HBP measured with a fully automated oscillometric device (oHBP) is more reliable than HBP measured with an aneroid sphygmomanometer and a stethoscope (sHBP) remains unclear. We compared sHBP with oHBP using as a reference method daytime ambulatory blood pressure (ABP), as this is believed to be a better index of an individual's overall level of pressure. Forty-six hypertensive patients measuring HBP with aneroid devices were retrained by a standard 30 min protocol that included training in the technique of measurement, checking patients' devices, and testing patients' performance in stethoscopic measurement. Patients were randomized to measure for 2 weeks either sHBP using their own calibrated aneroid devices or oHBP using a validated fully automated oscillometric device (Omron HEM-705CP). Then 24 h ABP monitoring was performed (SpaceLabs 90207) and patients crossed over for a second 2 week period by using the alternative HBP measurement technique. Mean sHBP was not different from mean oHBP, and there was a close correlation between them (r = 0.82/0.76 for systolic/diastolic BP, P < .001). Daytime ABP was not different from oHBP or sHBP and was closely related to both of them (oHBP, r = 0.59/0.72 systolic/diastolic BP, P < .001; sHBP, 0.50/0.65, P < .001). Age was significantly related with diastolic ABP-sHBP difference (r = 0.33, P < .05). These results suggest that HBP measured with validated fully automated oscillometric devices is equally reliable in predicting average ABP as that measured with calibrated aneroid sphygmomanometers used by very carefully trained patients. In clinical practice, HBP monitoring by using reliable automated devices is probably more feasible than to achieve a high standard of stethoscopic HBP measuring technique.

Home self-monitoring of blood pressure: Is fully automated oscillometric technique as good as conventional stethoscopic technique?

Home blood pressure (HBP) measurement is becoming increasingly popular as an additional source of information for the practicing physician. Whether HBP measured with a fully automated oscillometric device (oHBP) is more reliable than HBP measured with an aneroid sphygmomanometer and a stethoscope (sHBP) remains unclear. We compared sHBP with oHBP using as a reference method daytime ambulatory blood pressure (ABP), as this is believed to be a better index of an individual's overall level of pressure. Forty-six hypertensive patients measuring HBP with aneroid devices were retrained by a standard 30 min protocol that included training in the technique of measurement, checking patients' devices, and testing patients' performance in stethoscopic measurement. Patients were randomized to measure for 2 weeks either sHBP using their own calibrated aneroid devices or oHBP using a validated fully automated oscillometric device (Omron HEM-705CP). Then 24 h ABP monitoring was performed (SpaceLabs 90207) and patients crossed over for a second 2 week period by using the alternative HBP measurement technique. Mean sHBP was not different from mean oHBP, and there was a close correlation between them ( r = 0.82 0.76 for systolic/diastolic BP, P < .001). Daytime ABP was not different from oHBP or sHBP and was closely related to both of them (oHBP, r = 0.59 0.72 systolic/diastolic BP, P < .001; sHBP, 0.50 0.65 , P < .001 . Age was significantly related with diastolic ABP-sHBP difference (r = 0.33, P < .05). These results suggest that HBP measured with validated fully automated oscillometric devices is equally reliable in predicting average ABP as that measured with calibrated aneroid sphygmomanometers used by very carefully trained patients. In clinical practice, HBP monitoring by using reliable automated devices is probably more feasible than to achieve a high standard of stethoscopic HBP measuring technique.

The Problem of Compliance with Antihypertensive Regimens

Lack of compliance with prescribed antihypertensive regimens is the major reason why only 20% of hypertensives are found to have adequate blood pressure control on community surveys. Research during the last few years has led to the development and testing of several simple techniques that can be applied to the detection and improvement of compliance at the primary care level. Low compliance can be detected by routine monitoring of attendance and response to therapy coupled with asking patients directly about their compliance. The keys to improving low compliance include vigorous follow-up of patients who miss appointments, increasing attention to and supervision of low compilers through more frequent appointments and recruitment of other health professionals and the patient’s family, and encouraging the patient to take an active role in his own therapy, using such measures as home self-monitoring of blood pressure.