Thursday, May 29, 2008

Scientific Statement Urges Use of Home Blood Pressure Monitors

A statement published online May 23, 2008 in Hypertension and the Journal of the American Society of Hypertension urges those with high blood pressure to make monitoring a home routine. The benefits of home blood pressure monitoring to patients with kidney disease, heart disease and diabetes are substantial, according to Dr Thomas Pickering (Columbia Presbyterian Medical Center, New York), chair of the writing committee, and colleagues. "Given the amount of accumulated evidence about the value of home blood-pressure monitoring [HBPM], it is time to make HBPM a part of routine management of hypertensive patients, especially those with diabetes, coronary heart disease, chronic kidney disease, substantial nonadherence, or a substantial white-coat effect, writes the committee. The statement is issued on behalf of the American Heart Association (AHA), American Society of Hypertension (ASH), and Preventive Cardiovascular Nurses Association (PCNA).

Improved blood pressure treatment of the 72 million people diagnosed with the condition, and healthcare savings are the primary goals. Blood pressure readings taken at your healthcare provider may not always be accurate. Average readings, taken over time may prove more accurate. Cases of suspected, or borderline high blood pressure can also be better defined when monitored at home. The value to seniors, pregnant women, diabetics and kidney patients is also noted. Home blood pressure monitoring would provide an effective means to measure response to medication.

People who are at risk for complications of high blood pressure should have readings that are less than 130/80. Newer guidelines say everyone’s blood pressure should be less than 135/85.

Drawbacks include the use of unreliable devices. Patients with variable heart rates get inconsistent blood pressure readings. Home monitoring might cause some confusion. Blood pressure equipment meeting international testing standards and should be validated for accuracy. Patients should be taught to measure results against traditional mercury measurements, something that requires training and may be difficult for those who live alone, have hearing impairment or other physical handicaps.

Machines with electronic cuff inflation can be purchased for home use. The cost is between $80 and $100. Fingers devices are not accurate. Wrist devices are accurate, but only if the arm is at heart level and the wrist is straight. They are not generally recommended because of the disadvantages associated with improper placement and use. Most insurance companies will reimburse for the purchase of a device with a doctor’s prescription. For a list of tested and approved home blood pressure monitors, visit the dabl Educational Website.

Source: Pickering TG, Houston-Miller N, Ogedegbe G, et al. Call to action on use and reimbursement for home blood pressure monitoring. Hypertension 2008; DOI: 10.1161/hypertensionaha.107.189010. Available at: