Homing in on Blood Pressure Monitoring

The AHA, among other organizations, issued a "call to action" for home blood pressure monitoring for hypertensive patients.
Traditional office measurements provide an incomplete picture of a patient’s true blood pressure (BP). In 2005, a Gallup poll showed that 55% of hypertensive patients monitor their own BP; however, home BP monitoring (HBPM) has not been incorporated into standard clinical practice. The American Heart Association, the American Society of Hypertension, and the Preventive Cardiovascular Nurses Association recently endorsed the use of HBPM and issued a "call to action" for incorporating it into routine clinical practice. Highlights of the statement are as follows:

• The most reliable devices have been validated by a manufacturer-sponsored educational trust and measure brachial artery BP with the cuff on the upper arm. The best devices also have electrically inflated cuffs, oscillometric detection, and memory.
• Patients should take readings after resting for 5 minutes.
• For clinical decision making, patients should take at least two readings daily (each morning and evening) for 7 days; the first day’s readings should be disregarded. For long-term observation, HBPM should be performed for a minimum of 1 week, quarterly.
• HBPM is useful in managing a broad range of patients, including those with borderline office BP measurements or white-coat hypertension and those who seem to be refractory to treatment based on office BP measurements. HBPM might also improve medication adherence.

Comment: Many of our patients already use home blood pressure monitoring devices. The authors of this "call to action" ask physicians to follow their patients’ leads and to incorporate HBPM into routine care of most patients with hypertension or prehypertension. They also ask that third-party payers reimburse costs for HBPM devices.
— Jamaluddin Moloo, MD, MPH
Published in Journal Watch General Medicine June 24, 2008

Citation(s):

Pickering TG et al. Call to action on use and reimbursement for home blood pressure monitoring: Executive summary. A joint scientific statement from the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association. Hypertension 2008 Jul; 52:1.