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Jackson SL, Gillespie C, Shimbo D, Rakotz M, Wall HK. Blood Pressure Cuff Sizes for Adults in the United States: National Health and Nutrition Examination Survey, 2015-2020. Am J Hypertens 2022; 35:923-928. [PMID: 36066190 PMCID: PMC10851131 DOI: 10.1093/ajh/hpac104] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/31/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Hypertension, defined as blood pressure (BP) ≥130/80 mm Hg or antihypertensive medication use, affects approximately half of US adults, and appropriately sized BP cuffs are important for accurate BP measurement and hypertension management. METHODS This cross-sectional study analyzed 13,038 US adults (≥18 years) in the National Health and Nutrition Examination Survey 2015-March 2020 cycles. Recommended BP cuff sizes were categorized based on mid-arm circumference: small adult (≤26 cm), adult (>26 to ≤34 cm), large adult (>34 to ≤44 cm), and extra-large adult (>44 cm). Analyses were weighted and proportions were extrapolated to the US population. RESULTS Among US adults (246 million), recommended cuff sizes were: 6% (16 million) small adult, 51% adult (125 million), 40% large adult (98 million), and 3% extra-large adult (8 million). Among adults with hypertension (116 million), large or extra-large cuffs were needed by over half (51%) overall, including 65% of those aged 18-34 years and 84% of those with obesity (BMI ≥30 kg/m2). By race/ethnicity, the proportion needing a large or extra-large cuff was 57% of non-Hispanic Black adults, 54% of Hispanic adults, 51% of non-Hispanic White adults, and 23% of non-Hispanic Asian adults. Approximately 40% of adults with hypertension in Medicare needed a large or extra-large cuff, compared to 54% for private insurance and 53% for Medicaid. CONCLUSIONS Over half of US adults with hypertension need a large or extra-large BP cuff.
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Affiliation(s)
- Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Cathleen Gillespie
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Daichi Shimbo
- Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Michael Rakotz
- American Medical Association, Improving Health Outcomes, Chicago, IL
| | - Hilary K Wall
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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Zuo HJ, Ma JX, Wang JW, Chen XR. Assessing the routine-practice gap for home blood pressure monitoring among Chinese adults with hypertension. BMC Public Health 2020; 20:1770. [PMID: 33228626 PMCID: PMC7686714 DOI: 10.1186/s12889-020-09901-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/16/2020] [Indexed: 12/18/2022] Open
Abstract
Background Home blood pressure monitoring (HBPM) is recommended for diagnosis, treatment adjustment and management of most hypertension cases in hypertension guidelines from multiple countries. This study aimed to evaluate HBPM behaviour and explore the routine-practice gap in HBPM among Chinese adults with hypertension. Methods Data were collected from 20 communities across three cities and six townships in three provinces (Beijing, Shandong and Jiangsu) in China between October 2014 and November 2014. In total, 2272 patients with hypertension aged ≥35 years that were registered with a primary health station in their local communities were selected by simple random sampling. Results Among the 2272 participants, 45.3% owned a home blood pressure (BP) monitor. In addition, 27.5% (625/2272) engaged in HBPM weekly or more frequently. Healthcare providers’ advice was the strongest factor contributing to home BP monitor ownership and weekly HBPM behaviour, with odds ratios of 13.50 and 8.97, respectively. Approximately 4.4% of participants had achieved optimal HBPM regimens (duplicate measurements in the morning and evening for 7 days). Patients with uncontrolled office-measured BP were more likely to conduct HBPM regularly in the morning and evening, measure their BP two or three times in each session and maintain 7 consecutive days of HBPM than patients with controlled office BP (8.8% vs. 5.8%, P = 0.042; 14.3% vs. 8.1%, P = 0.002; and 19.9% vs. 12.4%, P = 0.005, respectively). Only 16.0% (165/1030) of participants actively reported their HBPM readings to doctors. Conclusion The HBPM strategies specified in hypertension guidelines are seldom achieved in actual practice in China. Only a small proportion of patients actively participate in using HBPM to enhance their hypertension care. HBPM may be improved by healthcare providers offering specific advice and training. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-09901-0.
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Affiliation(s)
- Hui-Juan Zuo
- Department of community health research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, No.2 Road Anzhenli, Chaoyang District, Beijing, 100029, China.
| | - Ji-Xiang Ma
- Department of Chronic Non-communicable Diseases Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050, China
| | - Jin-Wen Wang
- Department of community health research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, No.2 Road Anzhenli, Chaoyang District, Beijing, 100029, China
| | - Xiao-Rong Chen
- Department of Chronic Non-communicable Diseases Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050, China
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Shimbo D, Artinian NT, Basile JN, Krakoff LR, Margolis KL, Rakotz MK, Wozniak G. Self-Measured Blood Pressure Monitoring at Home: A Joint Policy Statement From the American Heart Association and American Medical Association. Circulation 2020; 142:e42-e63. [PMID: 32567342 DOI: 10.1161/cir.0000000000000803] [Citation(s) in RCA: 181] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The diagnosis and management of hypertension, a common cardiovascular risk factor among the general population, have been based primarily on the measurement of blood pressure (BP) in the office. BP may differ considerably when measured in the office and when measured outside of the office setting, and higher out-of-office BP is associated with increased cardiovascular risk independent of office BP. Self-measured BP monitoring, the measurement of BP by an individual outside of the office at home, is a validated approach for out-of-office BP measurement. Several national and international hypertension guidelines endorse self-measured BP monitoring. Indications include the diagnosis of white-coat hypertension and masked hypertension and the identification of white-coat effect and masked uncontrolled hypertension. Other indications include confirming the diagnosis of resistant hypertension and detecting morning hypertension. Validated self-measured BP monitoring devices that use the oscillometric method are preferred, and a standardized BP measurement and monitoring protocol should be followed. Evidence from meta-analyses of randomized trials indicates that self-measured BP monitoring is associated with a reduction in BP and improved BP control, and the benefits of self-measured BP monitoring are greatest when done along with cointerventions. The addition of self-measured BP monitoring to office BP monitoring is cost-effective compared with office BP monitoring alone or usual care among individuals with high office BP. The use of self-measured BP monitoring is commonly reported by both individuals and providers. Therefore, self-measured BP monitoring has high potential for improving the diagnosis and management of hypertension in the United States. Randomized controlled trials examining the impact of self-measured BP monitoring on cardiovascular outcomes are needed. To adequately address barriers to the implementation of self-measured BP monitoring, financial investment is needed in the following areas: improving education and training of individuals and providers, building health information technology capacity, incorporating self-measured BP readings into clinical performance measures, supporting cointerventions, and enhancing reimbursement.
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The Association of Health Literacy with High-Quality Home Blood Pressure Monitoring for Hypertensive Patients in Outpatient Settings. Int J Hypertens 2020; 2020:7502468. [PMID: 32292599 PMCID: PMC7150690 DOI: 10.1155/2020/7502468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 01/06/2020] [Accepted: 02/11/2020] [Indexed: 01/10/2023] Open
Abstract
Worldwide hypertension (HT) guidelines recommend use of home blood pressure monitoring (HBPM) in patients with persistent suboptimal blood pressure (BP) readings. It is not clear how patients with limited health literacy could perform HBPM to assist BP control. This study aimed at finding the association between HBPM and patients from lower socioeconomic classes, particularly on the effect of health literacy or educational level. Three electronic databases (MEDLINE, EMBASE, and PubMed) were searched for primary studies with keywords including educational level, health literacy, numeracy, home blood pressure monitoring, accuracy, and quality. The PRISMA guideline was followed. The quality of the literature was assessed by the Cochrane tool and modified Newcastle-Ottawa Scale. Nineteen interventional studies and 29 cross-sectional studies were included. Different populations used different cutoffs to report patients' educational level, whereas health literacy was rarely measured. Three studies used psychometric validated tools to assess health literacy. The quality of HBPM could be assessed by the completion of the procedures' checklist or the number of HBPM readings recorded. The association between subjects' health literacy or educational level and the quality of HBPM was variable. The interventional studies showed that increasing professional-patient contact time could improve patients' knowledge, efficacy, and quality of HBPM. Conclusion. Patients' educational level and literacy were not the limiting factors to acquire high-quality HBPM. High-quality HBPM could be achieved by the structured educational intervention. The quality and amount of evidence on this topic are limited. Therefore, further studies are warranted.
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Chudek A, Owczarek AJ, Ficek J, Almgren-Rachtan A, Chudek J. Lower utilization of home blood pressure monitoring in younger, poorly educated hypertensive males – real-life data. Blood Press 2019; 29:95-102. [PMID: 31691573 DOI: 10.1080/08037051.2019.1684818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Anna Chudek
- Department of Pharmacovigilance, Europharma Rachtan Co. Ltd, Katowice, Poland
| | - Aleksander Jerzy Owczarek
- Department of Statistics (Department of Instrumental Analysis), Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Joanna Ficek
- Pathophysiology Unit, Department of Pathophysiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | | | - Jerzy Chudek
- Department of Internal Medicine and Oncological Chemotherapy, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
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Clinical Implementation of Self-Measured Blood Pressure Monitoring, 2015-2016. Am J Prev Med 2019; 56:e13-e21. [PMID: 30337237 PMCID: PMC6485411 DOI: 10.1016/j.amepre.2018.06.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/10/2018] [Accepted: 06/04/2018] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Self-measured blood pressure monitoring (SMBP) plus additional clinical support is an evidence-based strategy that improves blood pressure control. Despite national recommendations for SMBP use and potential cost savings, insurance coverage for implementation is limited in the U.S. and little is known regarding clinical implementation. METHODS In 2017, using 2015 and 2016 DocStyles survey data from 1,590 primary care physicians and nurse practitioners in U.S. outpatient facilities, SMBP-related clinical practices and provider roles were assessed. RESULTS Almost all (97%) respondents reported using SMBP. Among 1,539 who used SMBP, more than half (60%) used SMBP for a combination of diagnostic and treatment purposes, whereas 24% used SMBP for diagnosis only and 16% used SMBP for treatment only. The most common methods for patients to share SMBP results with clinical staff were paper log (68%); during appointments (66%); by telephone (37%); by secure website (22%); or by secure e-mail (19%). Nearly all (98%) respondents reported that medication adjustments were provided to patients based on SMBP readings. About 15% did not counsel patients regarding cuff size, and 8% did not validate patient devices. Only 13% of respondents reported having monitor loaner programs, and availability did not vary by the financial status of the patient population (p=0.59). CONCLUSIONS SMBP is used widely in outpatient facilities as reported in the survey, although provider roles and SMBP-related practices vary, and gaps exist regarding patient counseling, device validation, and loaner program availability. As part of efforts to improve hypertension control, healthcare professionals can promote increased use of best practices for SMBP, whereas insurers can implement standardization and support of SMBP.
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Carter EJ, Moise N, Alcántara C, Sullivan AM, Kronish IM. Patient Barriers and Facilitators to Ambulatory and Home Blood Pressure Monitoring: A Qualitative Study. Am J Hypertens 2018; 31:919-927. [PMID: 29788130 PMCID: PMC7190918 DOI: 10.1093/ajh/hpy062] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/13/2018] [Accepted: 05/15/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Guidelines recommend that patients with newly elevated office blood pressure undergo ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM) to rule-out white coat hypertension before being diagnosed with hypertension. We explored patients' perspectives of the barriers and facilitators to undergoing ABPM or HBPM. METHODS Focus groups were conducted with twenty English- and Spanish-speaking individuals from underserved communities in New York City. Two researchers analyzed transcripts using a conventional content analysis to identify barriers and facilitators to participation in ABPM and HBPM. RESULTS Participants described favorable attitudes toward testing including readily understanding white coat hypertension, agreeing with the rationale for out-of-office testing, and believing that testing would benefit patients. Regarding ABPM, participants expressed concerns over the representativeness of the day the test was performed and the intrusiveness of the frequent readings. Regarding HBPM, participants expressed concerns over the validity of the monitoring method and the reliability of home blood pressure devices. For both tests, participants noted that out-of-pocket costs may deter patient participation and felt that patients would require detailed information about the test itself before deciding to participate. Participants overwhelmingly believed that out-of-office testing benefits outweighed testing barriers, were confident that they could successfully complete either testing if recommended by their provider, and described the rationale for their testing preference. CONCLUSIONS Participants identified dominant barriers and facilitators to ABPM and HBPM testing, articulated testing preferences, and believed that they could successfully complete out-of-office testing if recommended by their provider.
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Affiliation(s)
- Eileen J Carter
- Columbia University School of Nursing, New York, New York, USA
- New York-Presbyterian Hospital, New York, New York, USA
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York, USA
| | | | - Alexandra M Sullivan
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York, USA
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Ayala C, Tong X, Neeley E, Lane R, Robb K, Loustalot F. Home blood pressure monitoring among adults-American Heart Association Cardiovascular Health Consumer Survey, 2012. J Clin Hypertens (Greenwich) 2017; 19:584-591. [PMID: 28371252 DOI: 10.1111/jch.12983] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 12/20/2016] [Accepted: 12/25/2016] [Indexed: 01/13/2023]
Abstract
Home blood pressure monitoring (HBPM) among hypertensive adults was assessed using the 2012 American Heart Association Cardiovascular Health Consumer Survey. The prevalence of hypertension was 25.5% and 53.8% of those reported HBPM. Approximately 63% of hypertensive adults 65 years and older reported HBPM followed by 51% and 34.6% (35-64 and 18-34 years, respectively; P=.001). Those who had seen a healthcare professional within a year reported HBPM compared with those who had not (54.8% vs 32.8%, P=.047). Those who believed that lowering blood pressure can reduce risk of heart attack and stroke had a higher percentage of HBPM compared with those who did not (55.5% vs 33.1%, P=.01). Age and the belief that lowering blood pressure could reduce cardiovascular disease risk were significant factors associated with HBPM. Half of the adult hypertensive patients reported HBPM and its use was greater among those who reported a positive attitude toward lowering blood pressure to reduce cardiovascular disease risk.
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Affiliation(s)
- Carma Ayala
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA
| | - Xin Tong
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA
| | - Eunice Neeley
- University of California at San Francisco Medical School, San Francisco, GA, USA
| | - Rashon Lane
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA
| | - Karen Robb
- American Heart Association/American Stroke Association, Dallas, TX, USA
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA
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Ye X, Shafi S, Negrete A, Davis WN, Sarac E, Negrete AM, Negrete H. Home blood pressure monitor use in patients with chronic kidney disease. Blood Press 2016; 25:280-5. [PMID: 27104796 DOI: 10.3109/08037051.2016.1167356] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Home blood pressure monitoring (HBPM) is recommended in patients with chronic kidney disease (CKD) and hypertension (HTN). However, little is known about the use and pattern of HBPM in CKD patients. A cross-sectional study was conducted in an out-patient nephrology clinic. A total of 285 patients participated in the study. Of all patients, 66% reported using HBPM. Self-reported compliance with BP medications (93.9% vs. 85.1%, p 0.03), exercise >3 days/week (45.9 vs. 26.3%, p <0.001) and dietary sodium restriction (85.6% vs. 71.6%, p < 0.001) were more common in HBPM users vs. non-HBPM users. Most patients with HBPM used upper arm cuff (82.3%), reported receiving education on correct use of HBPM (82.5%), had perception that home BP was controlled (75.4%) and believed that HBPM is helpful in managing hypertension (85.4%). Most common reason for not using HBPM was lack of advice by a physician (43.4%). HBPM use is common in patients with CKD and HTN. HBPM users are more likely to follow life-style and dietary modifications for blood pressure control.
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Affiliation(s)
- Xiaojing Ye
- a Department of Internal Medicine , Saint Elizabeth Health Center , Youngstown , Ohio , USA
| | - Salman Shafi
- b Department of Nephrology , Sharif Medical and Dental College , Lahore , Pakistan
| | - Andrea Negrete
- c Department of Undergraduate Medical Education , University of Toledo College of Medicine , Toledo , Ohio , USA
| | - William N Davis
- c Department of Undergraduate Medical Education , University of Toledo College of Medicine , Toledo , Ohio , USA
| | - Erdal Sarac
- a Department of Internal Medicine , Saint Elizabeth Health Center , Youngstown , Ohio , USA ;,d Department of Internal Medicine , Northeastern Ohio Medical University , Rootstown , Ohio , USA
| | - Alejandro M Negrete
- e Department of Public Health, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Hilmer Negrete
- a Department of Internal Medicine , Saint Elizabeth Health Center , Youngstown , Ohio , USA
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Polen KND, Sandhu PK, Honein MA, Green KK, Berkowitz JM, Pace J, Rasmussen SA. Knowledge and attitudes of adults towards smoking in pregnancy: results from the HealthStyles© 2008 survey. Matern Child Health J 2015; 19:144-54. [PMID: 24825031 DOI: 10.1007/s10995-014-1505-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Smoking during pregnancy is causally associated with many adverse health outcomes. Quitting smoking, even late in pregnancy, improves some outcomes. Among adults in general and reproductive-aged women, we sought to understand knowledge and attitudes towards prenatal smoking and its effects on pregnancy outcomes. Using data from the 2008 HealthStyles© survey, we assessed knowledge and attitudes about prenatal smoking and smoking cessation. We classified respondents as having high knowledge if they gave ≥ 5 correct responses to six knowledge questions regarding the health effects of prenatal smoking. We calculated frequencies of correct responses to assess knowledge about prenatal smoking and estimated relative risk to examine knowledge by demographic and lifestyle factors. Only 15 % of all respondents and 23 % of reproductive-aged women had high knowledge of the adverse effects of prenatal smoking on pregnancy outcomes. Preterm birth and low birth weight were most often recognized as adverse outcomes associated with prenatal smoking. Nearly 70 % of reproductive-aged women smokers reported they would quit smoking if they became pregnant without any specific reasons from their doctor. Few respondents recognized the benefits of quitting smoking after the first trimester of pregnancy. Our results suggest that many women lack knowledge regarding the increased risks for adverse outcomes associated with prenatal smoking. Healthcare providers should follow the recommendations provided by the American Congress of Obstetricians and Gynecologists, which include educating women about the health risks of prenatal smoking and the benefits of quitting. Healthcare providers should emphasize quitting smoking even after the first trimester of pregnancy.
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Affiliation(s)
- Kara N D Polen
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS E-86, Atlanta, GA, 30333, USA,
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Yi SS, Tabaei BP, Angell SY, Rapin A, Buck MD, Pagano WG, Maselli FJ, Simmons A, Chamany S. Self-blood pressure monitoring in an urban, ethnically diverse population: a randomized clinical trial utilizing the electronic health record. Circ Cardiovasc Qual Outcomes 2015; 8:138-45. [PMID: 25737487 DOI: 10.1161/circoutcomes.114.000950] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Hypertension is a leading risk factor for cardiovascular disease. Although control rates have improved over time, racial/ethnic disparities in hypertension control persist. Self-blood pressure monitoring, by itself, has been shown to be an effective tool in predominantly white populations, but less studied in minority, urban communities. These types of minimally intensive approaches are important to test in all populations, especially those experiencing related health disparities, for broad implementation with limited resources. METHODS AND RESULTS The New York City Health Department in partnership with community clinic networks implemented a randomized clinical trial (n=900, 450 per arm) to investigate the effectiveness of self-blood pressure monitoring in medically underserved and largely black and Hispanic participants. Intervention participants received a home blood pressure monitor and training on use, whereas control participants received usual care. After 9 months, systolic blood pressure decreased (intervention, 14.7 mm Hg; control, 14.1 mm Hg; P=0.70). Similar results were observed when incorporating longitudinal data and calculating a mean slope over time. Control was achieved in 38.9% of intervention and 39.1% of control participants at the end of follow-up; the time-to-event experience of achieving blood pressure control in the intervention versus control groups were not different from each other (logrank P value =0.91). CONCLUSIONS Self-blood pressure monitoring was not shown to improve control over usual care in this largely minority, urban population. The patient population in this study, which included a high proportion of Hispanics and uninsured persons, is understudied. Results indicate these groups may have additional meaningful barriers to achieving blood pressure control beyond access to the monitor itself. CLINICAL TRIAL REGISTRATION http://clinicaltrials.gov. Unique Identifier: NCT01123577.
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Affiliation(s)
- Stella S Yi
- From the Bureau of Chronic Disease Prevention and Tobacco Control (S.S.Y., S.C.), Primary Care Information Project (B.P.T., A.R., M.D.B., S.C.), and Division of Prevention and Primary Care (S.Y.A.), New York City Department of Health and Mental Hygiene, Queens; Lutheran Family Health Centers, Clinical Affairs Brooklyn; Riverdale Family Practice PC, Bronx; (F.J.M.); and Heritage HealthCare Center (A.S.); New York, NY.
| | - Bahman P Tabaei
- From the Bureau of Chronic Disease Prevention and Tobacco Control (S.S.Y., S.C.), Primary Care Information Project (B.P.T., A.R., M.D.B., S.C.), and Division of Prevention and Primary Care (S.Y.A.), New York City Department of Health and Mental Hygiene, Queens; Lutheran Family Health Centers, Clinical Affairs Brooklyn; Riverdale Family Practice PC, Bronx; (F.J.M.); and Heritage HealthCare Center (A.S.); New York, NY
| | - Sonia Y Angell
- From the Bureau of Chronic Disease Prevention and Tobacco Control (S.S.Y., S.C.), Primary Care Information Project (B.P.T., A.R., M.D.B., S.C.), and Division of Prevention and Primary Care (S.Y.A.), New York City Department of Health and Mental Hygiene, Queens; Lutheran Family Health Centers, Clinical Affairs Brooklyn; Riverdale Family Practice PC, Bronx; (F.J.M.); and Heritage HealthCare Center (A.S.); New York, NY
| | - Anne Rapin
- From the Bureau of Chronic Disease Prevention and Tobacco Control (S.S.Y., S.C.), Primary Care Information Project (B.P.T., A.R., M.D.B., S.C.), and Division of Prevention and Primary Care (S.Y.A.), New York City Department of Health and Mental Hygiene, Queens; Lutheran Family Health Centers, Clinical Affairs Brooklyn; Riverdale Family Practice PC, Bronx; (F.J.M.); and Heritage HealthCare Center (A.S.); New York, NY
| | - Michael D Buck
- From the Bureau of Chronic Disease Prevention and Tobacco Control (S.S.Y., S.C.), Primary Care Information Project (B.P.T., A.R., M.D.B., S.C.), and Division of Prevention and Primary Care (S.Y.A.), New York City Department of Health and Mental Hygiene, Queens; Lutheran Family Health Centers, Clinical Affairs Brooklyn; Riverdale Family Practice PC, Bronx; (F.J.M.); and Heritage HealthCare Center (A.S.); New York, NY
| | - William G Pagano
- From the Bureau of Chronic Disease Prevention and Tobacco Control (S.S.Y., S.C.), Primary Care Information Project (B.P.T., A.R., M.D.B., S.C.), and Division of Prevention and Primary Care (S.Y.A.), New York City Department of Health and Mental Hygiene, Queens; Lutheran Family Health Centers, Clinical Affairs Brooklyn; Riverdale Family Practice PC, Bronx; (F.J.M.); and Heritage HealthCare Center (A.S.); New York, NY
| | - Frank J Maselli
- From the Bureau of Chronic Disease Prevention and Tobacco Control (S.S.Y., S.C.), Primary Care Information Project (B.P.T., A.R., M.D.B., S.C.), and Division of Prevention and Primary Care (S.Y.A.), New York City Department of Health and Mental Hygiene, Queens; Lutheran Family Health Centers, Clinical Affairs Brooklyn; Riverdale Family Practice PC, Bronx; (F.J.M.); and Heritage HealthCare Center (A.S.); New York, NY
| | - Alvaro Simmons
- From the Bureau of Chronic Disease Prevention and Tobacco Control (S.S.Y., S.C.), Primary Care Information Project (B.P.T., A.R., M.D.B., S.C.), and Division of Prevention and Primary Care (S.Y.A.), New York City Department of Health and Mental Hygiene, Queens; Lutheran Family Health Centers, Clinical Affairs Brooklyn; Riverdale Family Practice PC, Bronx; (F.J.M.); and Heritage HealthCare Center (A.S.); New York, NY
| | - Shadi Chamany
- From the Bureau of Chronic Disease Prevention and Tobacco Control (S.S.Y., S.C.), Primary Care Information Project (B.P.T., A.R., M.D.B., S.C.), and Division of Prevention and Primary Care (S.Y.A.), New York City Department of Health and Mental Hygiene, Queens; Lutheran Family Health Centers, Clinical Affairs Brooklyn; Riverdale Family Practice PC, Bronx; (F.J.M.); and Heritage HealthCare Center (A.S.); New York, NY
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12
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Diagnosis of true uncontrolled hypertension using both home and ambulatory blood pressure monitoring. J Hum Hypertens 2013; 28:176-9. [DOI: 10.1038/jhh.2013.73] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 06/21/2013] [Accepted: 06/28/2013] [Indexed: 11/09/2022]
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13
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Variability in performance measures for assessment of hypertension control. Am Heart J 2013; 165:823-7. [PMID: 23622921 DOI: 10.1016/j.ahj.2013.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 01/07/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Definitions of multiple performance measures exist for the assessment of blood pressure control; however, limited data on how these technical variations may affect actual measured performance are available. METHODS We evaluated patients with hypertension followed routinely by cardiologists at Duke University Health System from 2009 to 2010. Provider hypertension control was compared based on reading at the last clinic visit vs the average blood pressure across all visits. The impact of home blood pressure measurements and patient exclusions endorsed by the American Heart Association, the American College of Cardiology, and the Physician Consortium for Performance Improvement were evaluated using medical record reviews. RESULTS Among 5,552 hypertensive patients, the rate of blood pressure control based on last clinic visit was 69.1%; however, significant clinic-to-clinic variability was seen in serial clinic blood pressure measurements in individual patients (average 18 mm Hg). As a result, provider performance ratings varied considerably depending on whether a single reading or average blood pressure reading was used. The inclusion of home blood pressure measurements resulted in modestly higher rates of blood pressure control performance (+6% overall). Similarly, excluding patients who met guideline-recommended exclusion criteria increased blood pressure control rates only slightly (+3% overall). In contrast, excluding patients who were on 2 or more antihypertensive medications would have raised blood pressure control rates to 96% overall. CONCLUSION Depending on definitions used, overall and provider-specific blood pressure control rates can vary considerably. Technical aspects of blood pressure performance measures may affect perceived quality gaps and comparative provider ratings.
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Tirabassi J, Fang J, Ayala C. Attitudes of primary care providers and recommendations of home blood pressure monitoring--DocStyles, 2010. J Clin Hypertens (Greenwich) 2013; 15:224-9. [PMID: 23551720 DOI: 10.1111/jch.12059] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 11/09/2012] [Accepted: 11/18/2012] [Indexed: 01/13/2023]
Abstract
To assess primary care providers' (PCPs) opinions related to recommending home blood pressure monitoring (HBPM) for their hypertensive patients, the authors analyzed a Web-based 2010 DocStyles survey, which included PCPs' demographics, health-related behaviors, recommendations on HBPM, views of patient knowledge, and use of continuing medical education. Of the 1254 PCPs who responded, 539 were family practitioners, 461 were internists, and 254 were nurse practitioners; 32% recommended HBPM to ≥90% of their patients and 26% recommended it to ≤40% of their patients. Nurse practitioners were significantly more likely to recommend HBPM than were internists (odds ratio, 0.55; 95% confidence interval, 0.40-0.78). The top reasons for not recommending HBPM were "patient can't afford it" and "patient doesn't need it." A total of 20% of PCPs indicated that their patients were poor to lower middle class; these PCPs were less likely to recommend HBPM to their patients than were those PCPs with most patients in higher economic classes. Additional efforts are needed to provide education to providers, especially physicians, about the benefits of HBPM in improved and cost-effective blood pressure control in the United States.
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Affiliation(s)
- Jill Tirabassi
- Centers for Disease Control and Prevention, Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA
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