CDC: Self-measured BP monitoring guidelines not always followed

Kennedy Ganti, MD, FAAFP

As a board-certified primary care physician at Cooper Primary Care in New Jersey, I find that the treatment of high blood pressure in my patients is one of the more gratifying yet challenging parts of clinical care. Treating high blood pressure is one the most important services that I can offer my patients. As physician informatician at Cooper Medical Informatics and Care Delivery Innovation, I see the benefits of health information technology and connected medical devices that extend care outside the walls of the hospital or medical office, especially when it comes to self-monitoring of blood pressure.

According to the CDC, one in three Americans, or 75 million people, have high blood pressure. This condition is a significant risk factor for many serious diseases such as heart attack, stroke and kidney failure. Treating and controlling high blood pressure has a tremendous positive health and economic impact on the health of populations and society in general.

The treatment of high blood pressure can become very complicated, especially in the presence of other comorbid diseases, such as diabetes and high cholesterol. As people age, the control of blood pressure can become especially challenging as the risk of falls becomes a more and more important event to prevent. Aggressive treatment of high blood pressure in the elderly has been linked to the increased risk of falls.

Since blood pressure varies with time, it is a dynamic function of the cardiovascular system with influences from neurological, pulmonary and genitourinary systems and others. There is much more to high blood pressure management than just medication use: diet, physical activity, and controlling stress levels all can contribute to successful or unsuccessful management of high blood pressure.

In this study, Jackson et al suggest that self-measured blood pressure monitoring may serve a benefit to patients to aid in consistent control of high blood pressure. The implementation of various recording methods (from paper to internet-based methods) introduced variability that likely partially obscured the benefit of self-measured blood pressure monitoring.

The concept of self-measured blood pressure is gaining traction. For select patients, I have recommended this procedure. In the past, I asked patients to obtain a home blood pressure monitor and take their blood pressure while recording on a tracking form I give them. This has aided many patients in achieving long term control over their high blood pressure. The rise of health information technology has yielded patient portals and connected devices that gives way to ‘push button care.’

The new era of technologically driven health care offers promise and peril for patients with high blood pressure. The promise of blood pressure monitoring outside the medical office could be offset by a ‘data deluge’ mounting outside the office. The challenge will be balancing the use of connected blood pressure monitors into the workflows of physicians and advanced practice providers without data or cognitive overload.

The era of ‘big data’ in high blood pressure management is coming and self-measured blood pressure monitoring stands as a pillar of that movement. As we look to the technology enabled future, we may see that self-measurement of blood pressure may become a standard of care rather than the emerging concept we see today.