Self-measured Blood Pressure Research Articles

Abstract P111: Comparison Of Automated Office Blood Pressure And Self-Measured Blood Pressure: Results From An Ongoing Self-Measured Blood Pressure Program

Background: HTN treatment based on AOBP lowers risk of CVD. SMBP has been promoted as an alternative to AOBP that could improve access and achieve more timely BP control. However, questions remain about the concordance between SMBP and AOBP. Objective: To compare SMBP and AOBP measurements in a 6-month SMBP program. Methods: In this quality improvement study, we examined data from an ongoing SMBP pilot program in a large general medicine practice in Boston. Referred patients underwent AOBP during an initialization clinic visit and then performed SMBP for a week each month over a 6 month period. During the 6 th month of the program, patients performed a final week of SMBP and returned to clinic for an AOBP assessment. We compared the 6 th month mean BPs via paired t-tests. Results: Of 129 patients referred, 74 underwent an initialization visit and at least 1 month of monitoring (mean age 59±13, 53% female, 28% Black). The mean referral BP was 140±11/84±11 mm Hg. In contrast, during program initialization, mean AOBP was 131±13/79±10 (difference compared to referral BP was -9/-5 mm Hg; P <0.001 for both). The mean BP measured the month after initialization using the 1-week SMBP protocol was 133±12/83±7 (difference compared to AOBP was +2/+4; P =0.18 for SBP; P <0.001 for DBP). For the 12 patients that completed 6-months thus far, mean AOBP at the 6-month visit was 127±10/76±8. The mean BP the week of SMBP during the 6 th month of the program was 124±9/79±5 (difference compared to 6-month AOBP was -3/+2 mm Hg; P >0.05 for both) ( Figure ). Conclusion: BP measures from SMBP tracked well with in-office AOBP measurements. These findings add to existing evidence that SMBP might be used in lieu of AOBP for HTN management.

Abstract P325: Early Insights From A Self-measured Blood Pressure Program In A Socially And Economically Disadvantaged Primary Care Population

Background: Meta-analyses have shown the success of SMBP in BP control. We aim to describe an SMBP QI program at our primary care clinic and assess its impact on BP. The Einstein CPC is a safety net practice that serves a socially and economically disadvantaged population facing many HTN management barriers. Methods: This program utilized a QI approach for BP control and patient-provider connection. Patient demographics, clinical features, and SDOH were assessed at baseline. Patients with uncontrolled HTN (SBP >140 mmHg) were asked to participate. To date, 111 patients enrolled. Patients were given a Bluetooth-enabled BP monitor connected to a mobile health app, HTN education, DASH diet recommendations, and orientation to SMBP protocols. Those reporting social needs or depression were referred to behavioral resources. Health staff continuously telemonitored patient usage, BP, and individualized interventions. We evaluated the difference in BP from baseline BP and estimated the change in time using a linear multilevel model with random intercept and random slope for each patient. We also calculated time in target range defined as time in SBP 100-130 and DBP 70-80 in mmHg. Results: Patient characteristics (Table 1). Those with at least 3 d of BP readings - 93% (103/111) were included in the BP analysis (Figure 1); mean follow-up 69±67 d and BP readings 42±52. Over 90 d, SBP, and DBP decreased by 11 (95% CI: 4-17) and 5 (95% CI: 3-8) mmHg, respectively. Conclusions: A QI-based SMBP program with robust telemonitoring and individualized interventions may effectively promote short-term adherence to remote BP monitoring and BP control in a socially and economically disadvantaged population.

Abstract 047: Understanding Patient And Practitioner Use Of The US Validated Device Listing (VDL™)

Hypertension is the leading preventable risk factor for cardiovascular disease, yet according to research, only one in four adults with hypertension have their blood pressure (BP) controlled. Clinical guidelines recommend the use of self-measured blood pressure to improve (SMBP) BP control among individuals with hypertension, however, research has shown that most BP devices available for purchase are not validated, raising concerns about the accuracy of BP readings taken by a patient. In response, the American Medical Association (AMA) launched the US Validated Device Listing (VDL)™, the first U.S. list of BP measurement devices developed to assist physicians and patients in identifying devices that have been validated for clinical accuracy. The VDL website, validateBP.org, has had more than 660,000 visitors since it launched in 2020. There are currently 60 devices from 16 manufacturers listed on the site. To better understand awareness and use of SMBP, the VDL, and validated devices, the AMA commissioned a survey from a panel of practitioners and patients. Results from over 300 practitioners indicate that while the vast majority of primary care physicians recommend at-home blood pressure devices to their patients (99%; 151/152), and most are aware of validation and accuracy concerns (58%; 88/152), less than one third of primary care physicians were aware of the Validated Device Listing (29%; 44/152). In a survey of over 300 patients, data indicate that over half prefer to measure blood pressure using a personal device (55%; 166/301), and among self-identified hypertensive patients with a device, the vast majority view accuracy of blood pressure readings as the most important factor when comparing blood pressure devices (83%; 146/176). Results from the small-scale survey point to the continued need for validation resources for SMBP devices, and the need to continue developing a greater awareness of the VDL amongst practitioners and patients.

Abstract P333: Self-measured Blood Pressure Monitoring During The Covid-19 Pandemic Among Persons Living In Rural Areas

Self-measured blood pressure monitoring (SMBP) plus clinical support can help control blood pressure among people with hypertension. The COVID-19 pandemic drove increased telehealth use, presenting an opportunity for increased SMBP use among groups with limited healthcare access. This study examined changes in the use and electronic reporting of SMBP among US adults aged ≥18 years with hypertension living in rural areas by race and ethnicity. With data from the Behavioral Risk Factor Surveillance System in 2019 and 2021, we used weighted Poisson regression to estimate the annual prevalence of adults with hypertension who reported using SMBP and who reported sharing SMBP results by phone or Internet. For each race and ethnicity and outcome, we estimated adjusted prevalence ratios (aPR) comparing 2021 to 2019, adjusted for age group, income, insurance status, sex, and education. The prevalence of SMBP use did not significantly change for any race or ethnicity from 2019 to 2021 (Figure). White, Black, and Hispanic adults reported SMBP measurements electronically more in 2021 than 2019 (aPR [95% CI]: 1.5 [1.1-1.9], 2.7 [1.2-6.0], 3.9 [1.7-9.0], respectively). Prevalence of electronic reporting among adults living in rural areas remained low in 2021, ranging from 10.5% in adults of other races to 21.7% in Hispanic adults. Despite changes that helped SMBP implementation during the COVID-19 pandemic, SMBP use did not change; electronic reporting increased but remained rare. Because SMBP can make blood pressure control more convenient and accessible, additional policies and programs can facilitate SMBP implementation, especially among populations with limited healthcare access.

PO9_06. Evaluation of home blood pressure self-measurements in a high-risk collective: remote monitoring can help to predict adverse outcomes in pregnant women at risk

PO9_06. Evaluation of home blood pressure self-measurements in a high-risk collective: remote monitoring can help to predict adverse outcomes in pregnant women at risk

Implementation Strategies to Improve Blood Pressure Control in the United States: A Scientific Statement From the American Heart Association and American Medical Association.

Hypertension is one of the most important risk factors that contribute to incident cardiovascular events. A multitude of US and international hypertension guidelines, scientific statements, and policy statements have recommended evidence-based approaches for hypertension management and improved blood pressure (BP) control. These recommendations are based largely on high-quality observational and randomized controlled trial data. However, recent published data demonstrate troubling temporal trends with declining BP control in the United States after decades of steady improvements. Therefore, there is a widening disconnect between what hypertension experts recommend and actual BP control in practice. This scientific statement provides information on the implementation strategies to optimize hypertension management and to improve BP control among adults in the United States. Key approaches include antiracism efforts, accurate BP measurement and increased use of self-measured BP monitoring, team-based care, implementation of policies and programs to facilitate lifestyle change, standardized treatment protocols using team-based care, improvement of medication acceptance and adherence, continuous quality improvement, financial strategies, and large-scale dissemination and implementation. Closing the gap between scientific evidence, expert recommendations, and achieving BP control, particularly among disproportionately affected populations, is urgently needed to improve cardiovascular health.

Self-measured home blood pressure highlights cardiovascular risk in women: the HOMED-BP study.

No studies examined sex differences in relation to the prognostic significance of self-measured home blood pressure (HBP). We compared the predictive power for the risk of cardiovascular events in 1547 women and 1516 men with hypertension using HBP captured at treatment-free baseline and during on-treatment follow-up, based on the Hypertension Objective Treatment Based on Measurement by Electrical Devices of Blood Pressure (HOMED-BP) study. To express the change in risk for the composite cardiovascular endpoint associated with a 1-SD increase in HBP at baseline or on treatment, we derived multivariable-adjusted hazard ratios (HR) based on a Cox regression model. Over a median follow-up of 7.3 years, 100 composite events occurred, including 40 events in women. In women, systolic HBP both at baseline and on-treatment showed significant risk increment (at baseline: HR per 1-SD increment, 1.62; 95% confidence interval [CI], 1.17-2.24. on-treatment: HR, 1.74; 95% CI, 1.32-2.29). However, systolic HBP at baseline did not predict cardiovascular events in men (P = 0.25). On-treatment HBP was significantly associated with cardiovascular risk (P ≤ 0.012) irrespective of sex. Nevertheless, the point estimate of HR for systolic HBP in men (1.33) was less than that in women (1.74), and the interaction of sex with 1 SD-increase in systolic HBP in cardiovascular risk was significant irrespective of baseline (P = 0.039) or follow-up (P = 0.040) measurement when they were mutually adjusted. The increase in cardiovascular risk with the systolic HBP was steeper in women than in men for both baseline and on-treatment. The current findings unveil the importance of the control of systolic HBP, especially in women. Clinical Trial Registration: UMIN Clinical Trial Registry ( http://www.umin.ac.jp/ctr ), Unique identifier: C000000137.

Non-Targeted Self-Measured Blood Pressure and Hypertension Control in Public and Private Health Systems in Brazil

Non-Targeted Self-Measured Blood Pressure and Hypertension Control in Public and Private Health Systems in Brazil

Digitally Based Blood Pressure Self-Monitoring Program That Promotes Hypertension Self-Management and Health Education Among Patients With Low-Income: Usability Study.

According to evidence-based clinical guidelines, adults with hypertension are advised to self-monitor their blood pressure (BP) twice daily. Self-measured BP monitoring is a recommended strategy for improving hypertension management. We aimed to determine the feasibility and acceptability of a digitally based BP self-monitoring program that promotes hypertension self-management and health education among low-income patients. We hypothesized that the program would be highly feasible and acceptable and that at least 50% of the patients would use the monitor at the rate required for the reimbursement of the device's cost (16 days of measurements in any 30-day period). Withings BPM Connect was deployed to patients at Family Health Centers of San Diego. Program elements included training, SMS text message reminders, and physician communication. Compliance, use, mean BP, and BP control status were calculated. A Kaplan-Meier time-to-event analysis was conducted to compare time to compliance between a strict definition (≥16 days in any rolling 30-day window) and a lenient definition (≥1 day per week for 4 consecutive weeks). A log-rank test was performed to determine whether the difference in time to compliance between the definitions was statistically significant. Mean systolic BP (SBP) and diastolic BP (DBP) before the intervention and after the intervention and mean change in SBP and DBP across patients were calculated. Paired sample t tests (2-tailed) were performed to assess the changes in SBP and DBP from before to after the intervention. A total of 179 patients received the monitors. The mean changes in SBP and DBP from before to after the intervention were +2.62 (SE 1.26) mmHg and +3.31 (SE 0.71) mmHg, respectively. There was a statistically significant increase in both SBP and DBP after the intervention compared with before the intervention (P=.04 and P<.001). At the first and last measurements, 37.5% (63/168) and 48.8% (82/168) of the patients had controlled BP, respectively. During the observation period, 83.3% (140/168) of the patients had at least 1 controlled BP measurement. Use decreased over time, with 53.6% (90/168) of the patients using their monitor at week 2 and only 25% (42/168) at week 11. Although only 25.6% (43/168) achieved the strict definition of compliance, 42.3% (71/168) achieved the lenient definition of compliance. The median time to compliance was 130 days for the strict definition and 95 days for the lenient definition. The log-rank test showed a statistically significant difference in time to compliance between the compliance definitions (P<.001). Only 26.8% (45/168) complied with the measurement rate that would result in device cost reimbursement. Few patients used the monitors at a rate that would result in reimbursement, raising financial feasibility concerns. Plans for sustaining costs among low-income patients need to be further evaluated.

Measuring the knowledge, attitude, and practice of self-measurement of blood pressure among cardiovascular patients in Pakistan

&lt;b&gt;Introduction: &lt;/b&gt;Self-measurement of blood pressure (SMBP) is a recent technique, already studied and validated, but it is still underused in the management of hypertension. The objective of the study was to evaluate the practice of SMBP in patients in management of hypertensive patients in Pakistan.&lt;br /&gt; &lt;b&gt;Materials and methods:&lt;/b&gt; We conducted a descriptive prospective study during six months at the Institute of Cardiology of Pakistan Islamabad. Our study included patients aged at least 18 years old who were diagnosed with hypertension for at least six months and followed up in outpatient clinics. The analysis and processing of data were performed by SPSS software version 22.&lt;br /&gt; &lt;b&gt;Results:&lt;/b&gt; Our study population was consisted of 300 patients with a male predominance (sex ratio of 1.46). The mean age of the patients was 41-60 years of age group. Our study showed that 39.6% of patients said they knew about blood pressure self-measurement before the therapeutic education; however, only 23.4% had already performed it. Medical staff talked to the patient about self-monitoring in 60% and encouraged the patient to perform SMBP.&lt;br /&gt; &lt;b&gt;Conclusions:&lt;/b&gt; The practice of SMBP was low. However, when properly practiced, it reduced the occurrence of cardiovascular complications. The practice medical staff talked to the patient about self-monitoring have positive effects on patients’ SMBP.

Validation of the Withings BPM Core Device for Self-Blood Pressure Measurements in General Population According to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization Universal Standard.

Most of the scientific societies recommend assessing the accuracy of electronic devices for blood pressure (BP) measurements using established validation protocol. To determine the accuracy of the BP measurements using the Withings BPM Core device in the general population according to the "Universal Standard (ISO 81060-2:2018/AMD 1:2020)". The Withings BPM Core is an oscillometric device measuring BP at the brachial level. The study was performed according to the "Universal Standard (ISO 81060-2:2018/AMD 1:2020) protocol" using the same-arm sequential BP measurement method. Subjects (n ≥ 85) fulfilling the age, gender, BP, and cuff distribution criteria of the protocol were included. Analysis was performed as required by the Universal protocol using Criterion 1 - differences between observers' mercury sphygmomanometer reference measurements and test device BP values (test versus reference) and their standard deviation (SD); and Criterion 2 - The SD of the mean BP differences between the test device and reference BP per subject. Eighty-six subjects were selected, 85 of whom were included. The mean BP differences between the simultaneous two observers' measurements were -0.2 ± 2.1 mmHg for systolic BP (SBP) and 0.3 ± 2.1 mmHg for diastolic BP (DBP). For validation criterion 1, the mean difference ± SD between the reference and device BP values was -0.6 ± 4.8 mmHg for SBP and 0.1 ± 3.7 mmHg for DBP (≤5 ± 8 mmHg for both SBP and DBP). For criterion 2, the SD of the mean BP differences between the test device and reference BP per subject was 3.2/2.6 mmHg for SBP and DBP (≤6.91/6.95 mmHg). The results of this study showed that the Withings BPM Core oscillometric device for home BP measurement fulfilled the accuracy requirements of the (ISO 81060-2:2018/AMD 1:2020) Universal protocol in the general population.

VASODILATION IS THE PREDOMINANT FACTOR OF BLOOD PRESSURE LOWERING DURING DEVICE-GUIDED SLOW BREATHING– ANALYSIS BY WAVE SHAPE PARAMETERS OF PULSE WAVE ANALYSIS

Objective: There is evidence that device-guided slow breathing with direct biofeedback of pulse arrival time (PAT) leads to favorable changes (increase) in PAT and blood pressure (decrease). Slow breathing modulates peripheral blood flow and may decrease blood pressure by vasodilation. The objectives of the study presented here was to identify hemodynamic mechanisms of the blood pressure lowering effect of device-guided breathing observed in a previously published study (Mengden Blood Pressure Monitoring 2023). Design and method: Patients with a systolic BP 130-160 mmHg or treated essential hypertension (21 females / 23 males) were trained to perform repeated and unattended device guided slow breathing exercises for 10 minutes and 5 minutes cool down over 5 days. Furthermore, they were skilled to perform a self-measurement of blood pressure before and after the breathing exercise using a validated upper-arm device. A simple device was used to measure pulse arrival time by electrocardiography and photoplethysmography connected with a smartphone or tablet to provide biofeedback. Using pulse wave analysis, time to systolic peak (tsys) and time to dicrotic notch (tnotch) were measured and normalized to RR interval, i.e., as tsys / tT and tnotch / tT. Results: Oscillometric self measured blood pressure showed a reproducible decrease in systolic blood pressure of 5 mmHg (p&lt;0.01, SD 8 mmHg). Absolute tsys increased by 13ms (p&lt;0.001, SD 36 ms) and relative tsys / tT increased by 0.013 (p&lt;0.001, SD 0.033) by the end of the exercise compared to baseline after cooling down (15 min). Similarly absolute tnotch increased by 11ms (p&lt;0.001, SD 31 ms) as well as relative tnotch / tT in total by 0.011 (p&lt;0.001, SD 0.036) compared to baseline. Conclusions: The delayed arrival of the first pulse wave maximum and the prolonged ejection time after adjustment for heart rate can be assumed here as a surrogate of a decreasing afterload. It is thus evident from this perspective that vasodilation is an important factor of blood pressure lowering during device-guided breathing.

THE GREAT PRETENDER: COULD A PHEOCHROMOCYTOMA MANIFEST ITSELF AS A SEIZURE?

Objective: Seizures are defined as transient occurrence of signs or symptoms due to the abnormally excessive or synchronous neuronal activity in the cerebral cortex. Pheochromocytomas and paragangliomas (PPGL) are chromaffin cell tumors arising from the adrenal medulla in 80–85% of patients and from extra-adrenal sympathetic tissue in 10–20% of patients. PPGL has been referred to as ‘‘the great mimic’’ disease. We present a patient with pheochromocytoma possibly disguised as seizures. Design and method: A 44 years old woman was referred to University Clinic of Endocrinology by radiologist. Two years earlier she had syncopal crises . She complained of headache, heart palpitation and malaise, heart palpitations and fatigue during exertion and sense of panic. The maximal self-measured blood pressure was 160/100 mmHg, the pulse is 90-100 beats per min. Abdominal US: a hyperechoic change, 76x65mm was seen, then described in the right lobe of the liver. The following year she had two commotional crises of consciousness and spasms of the extremities . She had a non-specific slowing of FC on EEG on the right for 1-2 seconds. MSCT abdomenal : in the right adrenal gland, a mass 144 x 90mm, with clear borders, pressing into the liver and pushing the right kidney,. The 24h urine was collected, which confirmed a norepinephrine secreting pheochromocytoma. We administered long acting alpha blocking agent preoperatively. The complete surgical excision of the right adrenal mass was done, pathohistological diagnosis: Pheochromocytoma. The last EEG after sleep deprivation performed 2 months postoperatively was described as normal. The patient had no headache or seizure. Results: PPGLs have a notable ability of boosting NE levels systemically and hypertension, the most common sign of PPGL could facilitate the permeability of blood brain barrier to NE. Studies showed NE could play its anticonvulsant property at an appropriate concentration but has a proconvulsant effect in either too high or too low concentrations . Conclusions: The definite pathogenetic mechanisms explaining how PPGL can cause seizures are far from being clearly understood, though “the great pretender” should be considered as a possible etiological factor of seizures.

PREVALENCE OF MASKED UNCONTROLLED HYPERTENSION IN TREATED HYPERTENSIVE PATIENTS

Objective: There are limited data in Tunisia on the quality of treated blood pressure (BP) control, and in particular, masked uncontrolled hypertension (MUCH) in treated hypertensive patients defined as controlled office BP but uncontrolled out-of-clinic BP. The objective of the study is to define the prevalence of MUCH in treated hypertensive patients. Design and method: An analytical cross-sectional study including 84 treated hypertensive patients aged &gt; 18 years, followed at the outpatient cardiology clinic of the Mohamed Taher Maamouri university hospital in Nabeul over a six months period (July-December 2021). The BP measurement in the office was performed on the day of inclusion. Patients were asked to measure BP at home as instructed by the physician using validated blood pressure self-measurement devices ( MICROLIFE BP A3 PLUS, MICROLIFE BP A2 Basic and Beurer BM 40 ). These devices were loaned to the patient who had to return them on the day of the ABPM installation. Laying of ABPM was performed immediately after the HBPM using a Bravo Mini validated device from Sun Tech Medical. The comparisons of percentages were carried out by the Chi-square test. Results: The mean age of our population was 59.37±13.10 years (range 21-92 years), composed of 43 women and 41 men. The prevalence of MUCH was 6% in HBPM and 8.3% in ABPM. The difference between these two methods was not statistically significant for the detection of masked uncontrolled hypertension (p = 0.320). The prevalence of MUCH was higher in women detected by HBPM (11.6% versus 0%; p = 0.055) and by ABPM (14% versus 2.4%; p = 0.110), the difference according to gender was not statistically significant. ABPM detected also masked uncontrolled nocturnal hypertension in 14.3% of cases. Conclusions: Office BP monitoring alone is thus inadequate to ascertain optimal BP control because of BP variation. HBPM and mainly ABPM which can detect elevated nocturnal BP were needed to confirm proper BP control especially in patients with high cardiovascular risk in whom the prevalence of MUCH is higher.

PREVALENCE OF THE WHITE COAT EFFECT IN A POPULATION OF HYPERTENSIVE PATIENTS

Objective: The white coat effect (WCE), defined as elevated office blood pressure (BP) and normal out-of-office BP, is of great importance in medical practice since it leads to overestimate the degree of BP figures. The objective of the study is to determine the prevalence of WCE in treated and untreated hypertensive patients. Design and method: we conducted an analytical cross-sectional study including 100 patients aged &gt; 18 years, followed at the outpatient cardiology clinic of the Mohamed Taher Maamouri university hospital in Nabeul over a six months period (July-December 2021). The BP measurement in the office was performed on the day of inclusion. Patients were asked to measure BP at home as instructed by the physician using validated blood pressure self-measurement devices (MICROLIFE BP A3 PLUS, MICROLIFE BP A2 Basic and Beurer BM 40 ). These devices were loaned to the patient who had to return them on the day of the ABPM installation. Laying of ABPM was performed immediately after the HBPM using a Bravo Mini validated device from Sun Tech Medical. The comparisons of percentages were carried out by the Chi-square test. Results: The average age of our population was 59.14±13.12 years (range 21-92 years), composed of 47 women and 53 men. 84% of the population has treated hypertension. The prevalence of WCE was 30% in HBPM and 27% in ABPM, 26 patients (31%) and 21 patients (25%) were objectified in treated hypertension respectively by HBPM and ABPM. The difference between these two methods was not statistically significant (p = 0.198). Conclusions: The prevalence of WCE was high in this population. HBPM and ABPM are two effective methods for diagnosing and confirming this phenomenon.

CORRELATION BETWEEN HOME AND AMBULATORY BLOOD PRESSURE MEASUREMENT: DIAGNOSIS AND MONITORING OF HYPERTENSION

Objective: Home Blood Pressure Measurement (HBPM) and Ambulatory Blood Pressure Measurement (ABPM) are 2 valid approaches to measure out of office blood pressure to confirm and monitor hypertension. The objective of our study was to compare the results of HBPM to ABPM considered as the reference technique and to determine its contribution in the management of hypertension Design and method: An analytical cross-sectional study including 100 patients aged &gt; 18 years, followed at the outpatient cardiology clinic of the Mohamed Taher Maamouri university hospital in Nabeul over a six months period (July-December 2021). Patients were asked to measure blood pressure (BP) at home as instructed by the physician using validated blood pressure self-measurement devices (MICROLIFE BP A3 PLUS, MICROLIFE BP A2 Basic and Beurer BM 40 ). Laying of ABPM was performed immediately after the HBPM using a Bravo Mini validated device from Sun Tech Medical. The correlation was analyzed using Pearson correlation coefficient (r). Results: Our population was composed of 47 women and 53 men. The mean age was 59.14±13.12 years. HBPM and ABPM were realized in 84% of cases for monitoring hypertensive patients and in 16% of cases to confirm newly diagnosed. The diagnosis of hypertension was confirmed in 75% by HBPM and in 62.5% by ABPM. White coat uncontrolled hypertension (WCUH) was noted in 31% of cases by HBPM and in 25% by ABPM and masked uncontrolled hypertension (MUCH) was noted in 6% of cases by HBPM and in 8.3% by ABPM. The difference between HBPM and ABPM was not statistically significant for the detection of MUCH (p = 0.320) and WCUH (p = 0.198). A strong correlation was found between HBPM and ABPM of systolic BP (P &lt;0.001; r = 0.728; Curve A) as well as of diastolic BP (P &lt;0.001; r = 0.773; Curve B). Conclusions: HBPM has a value very close to ABPM. So, it's important to increase its availability in clinics, outpatient clinics and even in private practice given its lower cost and better availability compared to ABPM for the diagnosis of hypertension and its monitoring.

PATIENT'S PERSPECTIVES ON TREATMENT ADHERENCE IN HYPERTENSION: RESULTS OF AN ESH SURVEY IN POLAND

Objective: The ESH Working group on Lifestyle, Cardiovascular Therapy and Adherence has developed a web-based questionnaire in different languages to investigate patients’ perspectives on hypertension and treatment adherence. The objective of this survey was to decipher patients’ perception of motivations for and barriers to treatment adherence in hypertension. Design and method: In Poland, a dedicated recruitment strategy has been developed to invite adult patients to complete the survey via targeted information on patient group websites and social media only. In other countries a direct communication from healthcare professional to patient was preferred. Data were collected from May to September 2022. Descriptive statistics were used for analyses. Results: We included 1359 participants (962 men (71%); 67% were hypertensive for &gt;5 years, 88% were treated with antihypertensive medications for at least 3 months). The total median number of tablets taken every day was 4 of which 2 were antihypertensive medications. Antihypertensive medications were prescribed most frequently once (56%) or twice (36%) daily. On a 10-point Likert scale, participants reported a modest impact of hypertension on their quality of life (4), social and family life (2). The median level of stress was 5 out of 10 points. Ninety two of patients performed self-blood pressure measurements at home, most frequently every day (34%) and a few times a week (28%). Self-reported adherence to treatment was perfect in 43% of patients, very high in 30% and intermediate-low in 26% of patients. Main reasons for low adherence to medication included forgetfulness (41%), improvement in well-being (15%), side effects (14%) and running out of medications (11%). The most useful approaches to support adherence reported by participants were cheaper and single-pill combinations as well as leaflets providing better information on treatment. Information provided by physicians on hypertension and its treatment was considered sufficient only for 54% of patients. Conclusions: In a web-based ESH survey in Poland, over 1,300 participants reported a modest impact of hypertension on their quality of life and a moderate level of anxiety, usually non-intentional non-adherence to prescribed antihypertensive medications, and the necessity to improve the information provided to them.

Self-Measured Blood Pressure Telemonitoring Programs: A Pragmatic How-to Guide.

Self-measured blood pressure (SMBP) telemonitoring is the process of securely storing and tele-transmitting reliably measured, patient self-performed blood pressure (BP) measurements to healthcare teams, while ensuring that these data are viewable and clinically actionable for the purposes of improving hypertension diagnosis and management. SMBP telemonitoring is a vital component of an overall hypertension control strategy. Herein, we present a pragmatic guide for implementing SMBP in clinical practice and provide a comprehensive list of resources to assist with implementation. Initial steps include defining program goals and scope, selecting the target population, staffing, choosing appropriate (clinically validated) BP devices with proper cuff sizes, and selecting a telemonitoring platform. Adherence to recommended data transmission, security, and data privacy requirements is essential. Clinical workflow implementation involves patient enrollment and training, review of telemonitored data, and initiating or titrating medications in a protocolized fashion based upon this information. Utilizing a team-based care structure is preferred and calculation of average BP for hypertension diagnosis and management is important to align with clinical best practice recommendations. Many stakeholders in the United States are engaged in overcoming challenges to SMBP program adoption. Major barriers include affordability, clinician and program reimbursement, availability of technological elements, challenges with interoperability, and time/workload constraints. Nevertheless, it is anticipated that uptake of SMBP telemonitoring, still at a nascent stage in many parts of the world, will continue to grow, propagated by increased clinician familiarity, broader platform availability, improvements in interoperability, and reductions in costs that occur with scale, competition, and technological innovation.

MHealth Intervention for Elevated Blood Pressure Among College Students: Single-Arm Intervention Study.

Current evidence reveals a growing pattern of hypertension among young adults, significantly increasing their risk for cardiovascular disease later in life. Young adults, particularly those of college age, often develop risk factors related to lifestyle choices in diet, exercise, and alcohol consumption. Developing useful interventions that can assist with screening and possible behavioral modifications that are suitable and appealing to college-aged young adults could help with early identification and intervention for hypertension. Recent studies indicate mobile health (mHealth) apps are acceptable and effective for communication and message delivery among this population. The purpose of this study was to examine the feasibility of using a mobile smartphone delivery system that provides tailored messages based on participant self-measured blood pressure (BP) with college-aged young adults. Using a single-arm intervention, pilot study design, the mHealth to Optimize BP Improvement (MOBILE) intervention was implemented with college students aged 18 years to 39 years who had systolic BP >120 mm Hg and diastolic BP ≥80 mm Hg. Participants were required to measure their BP daily for 28 days, submit the readings to the app, and receive preset educational text messages tailored to their BP value and related to encouraging healthy lifestyle modifications. Changes in a participant's BP was evaluated using a mixed regression model, and a postintervention survey evaluated their perspectives on the mHealth intervention. The participants' (N=9) mean age was 22.64 (SD 4.54) years; 56% (5/9) were overweight, and 11% (1/9) were obese. The average daily participation rate was 86%. Of the 9 participants, 8 completed the survey, and all indicated the intervention was easy to use, found it increased awareness of their individual BP levels, indicated the text messages were helpful, and reported making lifestyle changes based on the study intervention. They also provided suggestions for future implementation of the intervention and program. Overall, no significant changes were noted in BP over the 28 days. The mHealth-supported MOBILE intervention for BP monitoring and tailored text messaging was feasible to implement, as our study indicated high rates of participation and acceptability. These encouraging findings support further development and testing in a larger sample over a longer time frame and hold the potential for early identification and intervention among college-aged adults, filling a gap in current research.

Eliminating hypertension disparities in U.S. non-Hispanic black adults: current and emerging interventions.

Hypertension in non-Hispanic black (NHB) adults in the United States has an earlier onset, higher prevalence and increased severity compared with other racial/ethnic populations. Uncontrolled hypertension is responsible for the greater cardiovascular disease (CVD) morbidity and mortality and decreased longevity in NHB adults. Unfortunately, eliminating the persistent hypertension-associated disparities and the white/black mortality gap, worsened by the COVID-19 pandemic, has been challenging. Overcoming the social determinants of health (SDOH), implementing therapeutic lifestyle changes (TLC), and using intensive guideline-directed medical therapy are required. Moreover, novel approaches, including community-based interventions and self-measured blood pressure (SMBP) monitoring, may mitigate U.S. disparities in hypertension. In this review, we discuss recent data regarding the U.S. NHB adult disparate hypertension control and CVD morbidity and mortality. We note current approaches to address disparities, such as TLC, evidence-based pharmacotherapy, community-based interventions and SMBP. Finally, we explore future research and initiatives to seek hypertension-related health equity. In the final analysis, longstanding, unacceptable hypertension and CVD morbidity and mortality in U.S. NHB adults must be addressed. Appropriate TLC and evidence-based pharmacotherapy benefit all populations, especially NHB adults. Ultimately, novel community-based interventions and SMBP may help overcome the SDOH that cause hypertension disparities.