Patients prefer home BP measurements over in-office, kiosk or 24-hour ambulatory
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Patients with elevated BP most preferred home measurement to monitor BP compared with in-office, kiosk or 24-hour ambulatory measurement with a wearable device, a speaker reported.
According to research presented at the American Heart Association’s Hypertension Scientific Sessions, home BP measurements also conferred better adherence compared with in-office or kiosk methods. Although 24-hour ambulatory BP measurements with a wearable device had similar adherence to home measurements, it was the least preferred method of hypertension diagnosis by patients.
“Most hypertension is diagnosed and treated based on blood pressure measurements taken in a doctor’s office, even though the U.S. Preventive Services Task Force and [AHA] recommend that blood pressure measurements be taken outside of the clinical setting to confirm the diagnosis before starting treatment,” Beverly Green, MD, MPH, family physician at Kaiser Permanente Washington Health Research Institute and Kaiser Permanente Washington in Seattle, said in a press release. “It is the standard that blood pressure monitoring should be done either using home blood pressure monitoring or 24-hour ambulatory blood pressure monitoring prior to diagnosing hypertension.”
According to the presentation, there is little evidence on the acceptability by patients of different methods of confirming hypertension, and most investigations were small observational studies that did not compare measurement methods.
Therefore, researchers designed the BP-CHECK trial that compared the acceptability and adherence of clinic, home, kiosk and 24-hour ambulatory BP monitoring.
Researchers included 510 adult patients with elevated BP and no prior hypertension diagnosis (mean age, 59 years; 80% white; 51% men) who presented to Kaiser Permanente Washington primary care clinics. Participants were randomly assigned to one of three arms: office, home and kiosk. Ambulatory BP monitoring was conducted on all participants.
According to the study, patients assigned to in-office BP measurements were asked to return to the clinic for at least one additional BP check. The home BP monitoring group received home BP machines and were trained to use them to take their BP twice per day for 5 days. Participants in the kiosk group were asked to take their BP at a kiosk in their clinic or local pharmacy on 3 separate days, with three measurements each day.
BP measurement method acceptability was measured using a questionnaire to calculate an overall score and adherence was calculated as the proportion of participants who completed BP testing protocols.
The overall mean BP was 150/88 mm Hg.
According to the presentation, home BP monitoring received the highest overall acceptability score (mean, 6.2; standard deviation [SD], 0.7), and 24-hour ambulatory BP monitoring received the lowest acceptability score (mean, 5; SD, 1). Scores were intermediate for clinic (mean, 5.5; SD, 1.1) and kiosk (mean, 5.4; SD, 1) groups, but both received higher acceptability scores compared with ambulatory BP monitoring.
“Home blood pressure monitoring was the most preferred option because it was convenient, easy to do, did not disturb their daily personal or work routine as much, and was perceived as accurate,” Green said in the release. “Participants reported that ambulatory blood pressure monitoring disturbed daily and work activities, disrupted sleep and was uncomfortable.”
Participant adherence to the minimum number of BP readings for method were as follows:
- home BP measurement, 90.6%;
- in-office BP measurement, 87.2%;
- kiosk BP measurement, 67.9%; and
- 24-hour ambulatory BP measurement, 91%.
“Health care professionals should work toward relying less on in-clinic visits to diagnose hypertension and supporting their patients in taking their blood pressure measurements at home,” Green said in the release. “Home blood pressure monitoring is empowering and improves our ability to identify and treat hypertension, and to prevent strokes, heart attacks, heart failure and cardiovascular death.”
Reference:
- There’s no place like home ... to track blood pressure. https://newsroom.heart.org/news/theres-no-place-like-home-to-track-blood-pressure. Published Sept. 27, 2021. Accessed Sept. 30, 2021.
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Green B. Presentation 50. Presented at: American Heart Association’s Hypertension Scientific Sessions; Sept. 27-29, 2021 (virtual meeting).
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