This list of resources from the Million Hearts Hypertension Control Change Package can help assign care team roles for an SMBP monitoring program and guide patients on selecting a home blood pressure monitor. in the management of hypertension, a systematic review of 49 studies examined the comparative effectiveness and adherence predictors of SMBP monitoring. No studies evaluated children. 5600 Fishers Lane Apr 11, 2011. pressure monitoring and refers to the regular use of a There is no consensus on the precise protocol for SMBP monitoring in the management of hypertension regarding timing, frequency and duration. Several national and international hypertension guidelines endorse self-measured BP monitoring. To increase nationwide implementation of SMBP plus clinical support, multiple issues must be addressed. Patient-provider feedback loop.Source:Centers for Disease Control and Prevention. In response, providers offer customized support and advice, such as medication or lifestyle adjustments. To review the role of self-measured blood pressure (SMBP) monitoring with or without additional support (interventions such as telemonitoring, counseling, education, Web support, behavioral interventions, home visits, etc.) >gL/?eEAV c,1t D~ 8-?x}0 KQUo~TJa&A6@sY(|x D G&pA32^Y|VLEcx 71HbFFhi3"9#+Z~GqESHm,Y-G1. The choice of treatment is largely dependent on the cause of hypertension, severity of the condition, as well as the presence or absence of existing comorbid states. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. To address comparative effectiveness, we included prospective comparative studies of SMBP with or without additional support versus usual care or an alternative SMBP intervention. Telephone: (301) 427-1364, Powered by the Evidence-based Practice Centers, Self-Measured Blood Pressure Monitoring: Comparative Effectiveness, https://effectivehealthcare.ahrq.gov/products/measuring-blood-pressure, Comment on Key Questions and Draft Reports, 25 Years of the AHRQ Evidence-based Practice Center Program, U.S. Department of Health & Human Services. AHRQ Publication No. 45.) This review does not explore the validity, reproducibility, or comparability of BP measurements across devices or techniques (which was addressed by the 2002 EPC report25), or the use of SMBP as a diagnostic tool. Disclaimer. In people with hypertension (adults and children), does self-measured blood pressure (SMBP) monitoring, compared with usual care or other interventions without SMBP, have an effect on clinically important outcomes? Prior to joining CDC, Allison worked on the Global Polio Eradication Initiative at CARE International where she designed curricula for health workers and conducted evaluation field research on global polio eradication efforts. Before Background Hypertension often requires lifelong treatment. 5600 Fishers Lane CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Ann Intern Med. Self-Measured Blood Pressure Monitoring: Action Steps for Clinicians [PDF 947 KB] Self-Measured Blood Pressure Monitoring: Comparative Effectiveness [Internet]. Data Sources: Talk with your health care team about regularly measuring your blood pressure at home, also called self-measured blood pressure (SMBP) monitoring. Clinical support includes regular one-on-one counseling, web-based or telephonic support tools, and educational classes. This may facilitate direct communication with a provider via phone call or email and result in shorter turn-around times in responding to a BP reading and thus ultimately to better BP control. This article presents strategies for strengthening the United States ability to address hypertension in women focusing on pregnancy-related considerations for self-measured blood pressure monitoring. [3] (Figure 1). Figure 1 shows possible comparisons between SMBP, SMBP plus additional support, support without SMBP, and usual care. Past forum recordings, slides, and other resources can be found on the SMBP ForumConfluence page. This AMAAHA joint initiative can help health care professionals launch an SMBP monitoring program. While patient self-participation in chronic disease management appears promising, the sustainability and clinical impact of SMBP remains uncertain. Use this tool to keep track of your blood pressure measurements at home. How do different devices for SMBP monitoring compare with each other (specifically semiautomatic or automatic versus manual) in their effects on clinical, surrogate, and intermediate outcomes (including SMBP monitoring adherence)? SMBP = self-measured BP; KQ = Key Question. Study Selection: However, reviews of evidence should not be construed to represent clinical recommendations or guidelines. Your feet should be flat on the floor and your legs . SMBP measurements can be obtained from the upper arm, wrist, or fingers (or, if necessary, the lower extremity); however, experts recommend the use of upper arm devices due to the lack of validation and the high number of inaccurate measurements from the wrist and finger devices.26-28 Models for SMBP devices range from mechanical aneroid gauges (sphygmomanometers), which require self-inflation and auscultation (manual devices), to manually-inflated sphygmomanometers with automatic displays (semiautomated devices), to fully automated configurations that automatically inflate the sphygmomanometer and measure the BP (automated devices). Rockville, MD 20857 SMBP CPT Coding [PDF 1 MB] Resource description: This research summary of a systematic review compares the effectiveness of various methods and approaches to blood pressure measurement by patients or companions. Randomized-controlled trials have shown that self-measured blood pressure predicts cardiovascular morbidity and mortality better than office BP measurements. Strong scientific evidence shows that self-measured blood pressure (SMBP) monitoring, also known as home blood pressure monitoring, plus clinical support helps people with hypertension lower their blood pressure. We take your privacy seriously. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. SMBP monitoring may be used as a tool for disease self-management and to improve adherence with lifestyle and diet modification, or with drug treatment. Cite this: Self-Measured Blood Pressure Monitoring to Control Hypertension-Medscape-May06,2013. This table from a 2021 Current Atherosclerosis Reports journal article features oscillometric blood pressure devices validated for accuracy during pregnancy. Careers. Measurements may interfere with a patient's activity or sleep. Background: The primary objective of this review is to evaluate whether the use of SMBP monitoring influences outcomes in adults and children with hypertension and to what extent these changes in outcomes can be attributable to the use of self monitoring devices alone or the use of SMBP with additional support or attention provided. Page originally created December 2020. SMBP = self-measured BP; KQ = Key Question The figure shows a schematic of possible comparisons between SMBP, SMBP plus additional, support without (more), In light of the potential health care benefits and knowledge gaps highlighted above, a topic titled Self Blood Pressure Monitoring was developed through the processes of topic identification, selection, and refinement for Comparative Effectiveness Review (CER) within the Agency for Healthcare Research and Quality (AHRQ) Effective Health Care program.34. (Prepared by the Tufts Evidence-based Practice Center under Contract No. https://effectivehealthcare.ahrq.gov/products/measuring-blood-pressure/research. To determine predictors of adherence with SMBP monitoring. The CDC 6|18 Initiative supports providing access for SMBP monitoring for home use and creating individual, provider, and health system incentives for compliance and meeting goals. Target: BP: CME Course: Using SMBP to Diagnose and Manage High Blood Pressure May 28, 2010. (Prepared by the Tufts Evidence . Possible comparisons between SMBP, SMBP plus additional support, support without SMBP, and usual care, Agency for Healthcare Research and Quality (US). 2012 Feb 15. Resources for Public Health Professionals, Improving Medication Adherence Among Patients with Hypertension, Hypertension Control Challenge Rules and Eligibility, Hypertension Control Champions Success Stories, Hospitals & Health Systems Recognition Program, Spotlight: NYC Health + Hospitals/Metropolitan, Spotlight: The Ohio State University and Wexner Medical Center, Spotlight: New Hanover Regional Medical Center, COVID-19 and Cardiovascular Disease Partner Toolkit, Heart-Healthy Steps Campaign Partner Toolkit, "Live to the Beat" Campaign Partner Toolkit, Self-Measured Blood Pressure (SMBP) Monitoring Implementation Toolkit [PDF - 2 MB], U.S. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. The trials were greatly heterogeneous, varying in population, intervention, and outcome measures and definitions. Research shows that SMBP: Can improve adherence and health outcomes for hypertensive patients1 Project Timeline. The goals of this report, therefore, are to inform physicians' decision whether to encourage the use of SMBP monitoring alone or along with additional support and to assist health care policymakers and payers with decisions regarding coverage and promotion of SMBP monitoring. SMBP requires the use of a home blood pressure measurement device by the patient to measure blood pressure at different points in time. National Library of Medicine SMBP monitoring can provide more frequent BP readings and if these are transmitted back to the provider, they can be used for more rapid and frequent adjustments in blood pressure medication to ensure adequate BP control. Purpose: To systematically review the trial evidence on the comparative effectiveness of hypertension management with versus without SMBP monitoring, and of different additional support interventions with SMBP. HHSA 290-2007-10055-I.) The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. Self Measured Blood Pressure Monitoring (SMBP), the self measurement of blood pressure (BP) outside of the health care setting may be an effective tool to facilitate BP control. in the management of hypertension, a systematic review of 49 studies examined the comparative effectiveness and adherence FOIA If you are concerned about your blood pressure numbers, talk to your health care team. SMBP differs from clinic-based and ambulatory blood . This one-page overview outlines the viability, costs, and returns for implementing an SMBP monitoring program based on Medicare reimbursement. [1] SMBP monitoring plus clinical support has been found to be effective in helping patients control their blood pressure.[2]. Screening for High Blood Pressure in Adults: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. Lozano P, Henrikson NB, Morrison CC, Dunn J, Nguyen M, Blasi P, Whitlock EP. dabl Educational Trust: Sphygmomanometers for Self-measurement of Blood Pressure, British Hypertension Society: Blood Pressure Monitors Validated for Home Use, AHRQ Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Unauthorized use of these marks is strictly prohibited. The bold lines indicate the comparisons addressed in the Key Questions (see below). These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. In a comparative effectiveness review supported by the Agency for . Given clinical heterogeneity and limited head to head comparisons, the evidence limits our ability to draw definitive conclusions about the incremental effect of any specific additional support. In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Progestogens for Prevention of Preterm Birth. This summary is provided to assist in clinical decisionmaking along with consideration of a patient's values and preferences. This video from the NACHC features Natalia, a patient who explains how she has taken control of her blood pressure with SMBP monitoring. Conclusions: Hello. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. In total, 49 studies met eligibility criteria. Lin JS, O'Connor E, Rossom RC, Perdue LA, Burda BU, Thompson M, Eckstrom E. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013 Nov. Report No. However, there is uncertainty about the appropriate home BP targets for guiding treatment decisions and whether these should be based on the same cut-points from clinic BP or from ABPM for defining hypertension.32. These include ambulatory BP monitoring (ABPM), self monitoring (or self measurement or home based) BP which is usually done by the patient at home, at work, or in any conducive environment. SMBP with or without additional support may confer a small benefit in BP control compared with usual care, but the BP effect beyond 12 months and the attendant long-term clinical consequences remain unclear. You've successfully added to your alerts. Careers. Self-measured blood pressure (SMBP) monitoring, the regular measurement of blood pressure (BP) by the patient at home, has been proposed as a means of improving treatment adherence and BP control. On the other hand, if more frequent home BP measurements lead to more encounters for counseling, modification of lifestyle behaviors, drug treatments along with management of adverse effects, SMBP may actually increase cost, at least in the short term, since it takes several years for improved BP control to improve clinical outcomes. To address comparative effectiveness, we included prospective comparative studies of SMBP with or without additional support versus usual care or an alternative SMBP intervention. SMBP monitoring is the regular measurement of blood pressure by the patient outside the clinical setting, either at home or elsewhere. Figure 1. Untreated or ineffectively treated hypertension leads to increased cardiovascular . Lipid Screening in Childhood for Detection of Multifactorial Dyslipidemia: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]. Self-Measured Blood Pressure Monitoring Definition and Indications SMBP plus additional clinical support is one alternative to traditional oce care that could improve access to care and quality of care for individuals with hypertension while making blood pressure control more convenient and accessible across the population. To summarize evidence about the effectiveness of self-measured blood pressure (SMBP) monitoring in adults with hypertension. J Athl Train. Rockville (MD): Agency for Healthcare Research and Quality (US); 2014 Dec. Report No. These cookies may also be used for advertising purposes by these third parties. This SMBP coverage summary from the American Medical Association shows Medicaid coverage by state for automated SMBP blood pressure devices, standalone cuffs, and related clinical services. endstream endobj 294 0 obj <>/Metadata 50 0 R/Names 317 0 R/Outlines 332 0 R/PageMode/UseOutlines/Pages 291 0 R/StructTreeRoot 110 0 R/Type/Catalog/ViewerPreferences<>>> endobj 295 0 obj <>/Font<>/ProcSet[/PDF/Text]/Properties<>>>/Rotate 0/StructParents 0/Tabs/S/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 296 0 obj <>stream Clipboard, Search History, and several other advanced features are temporarily unavailable. Please enable it to take advantage of the complete set of features! The health care professional will slowly let air out of the cuff while listening to your pulse with a stethoscope and watching the gauge. Murakami L, Rakotz M. Improving health outcomes: Blood pressure. Readings by a person can be affected by observer training, preference, and bias. pharmacists and nurse practitioners) to manage patients' HBP (Figure 1). Unable to load your collection due to an error, Unable to load your delegates due to an error, Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. PMC If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. Content last reviewed August 2018. Use this list of questions to ask your health care team [PDF 173 KB]to help you manage your blood pressure. Target: BP: Implement SMBP The .gov means its official. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. There are two BP monitoring strategies that can currently be used at home: Ambulatory and SMBP monitoring. How does SMBP monitoring compare with usual care or other interventions without SMBP in its effect on relevant clinical outcomes (cardiovascular events, mortality, patient satisfaction, quality of life, and adverse events related to antihypertensive agents)? Self-Measured Blood Pressure Monitoring: Key Findings from a National Health Information Technology Landscape Analysis[PDF 1.3 MB] A reading that says your blood pressure is lower than it actually is may give you a false sense of security about your health. Rockville, MD: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services; 2012. This site needs JavaScript to work properly. This document provides action steps for public health practitioners to facilitate the implementation of SMBP monitoring plus additional support in five key areas: Understanding the environment; Working with payers and purchasers; Working with health care providers; Spreading the word to the public; and Monitoring/assessment of SMBP, plus additional support implementation. 45. CDCs 6|18 Initiative: Accelerating Evidence into Action The Evidence-based Practice Center (EPC) reviewed the existing body of evidence on the effects of SMBP on clinical, surrogate, and intermediate outcomes in the management of hypertension. Data Synthesis: This 2020 AMA handout for Current Procedural Terminology (CPT) provides codes and descriptions for SMBP-related services. Self-Measured Blood Pressure Monitoring: Comparative Effectiveness. Introduction. SMBP Coverage Insights: Medicaid [PDF 232 KB] One study estimated that the global prevalence of hypertension in 2000 was 26 percent in the adult population. These blood pressure monitors are easy and safe to use. It predicted a rise by 24 percent in developed countries and 80 percent in developing countries by 2025.4 The World Health Report 2002 estimates that over 1 billion people have hypertension, which is estimated to cause 4.5 percent of the global disease burden.5 In addition, high BP directly results in 7 million deaths annually.6 Within the United States, about 76.4 million adults are affected.7 Data from the National Health and Nutrition Examination Surveys (NHANES) from 1999 to 2008 indicated that 30 percent of all adults in the U.S. 18 years and older were hypertensive, with a higher prevalence among African Americans and the elderly.8 The prevalence of verified hypertension in children is more than 3 percent.2 A study from 2002 reported a lifetime risk of developing hypertension among adults aged 55 to 65 years in the U.S. as greater than 90 percent.9 Despite improvements in the quality of health care and life expectancy, it is expected that the prevalence of hypertension will continue to rise as the population ages. sharing sensitive information, make sure youre on a federal With training, additional support and treatment algorithms, patients may be able to self adjust medications based on SMBP results. For SMBP plus additional support versus SMBP alone or with less intense additional support, the strength of evidence is low, failing to support a difference in BP. Types of clinical support include one-on-one counseling, Web-based and telephone support, and educational classes. Internet Citation: CER 45 Self-Measured Blood Pressure Monitoring Comparative Effectiveness Surveillance Final 4.7 AHRQ%Systematic%Review%% Surveillance%Program% CER$#45:$Self'Measured"Blood"Pressure"Monitoring:"$ Comparative"Effectiveness" Original$Release$Date:$nuary Ja "2012" Surveillance$Report: "vember"2012No " Surveillance$Report: "rchMa "2016"" How do health care professionals measure my blood pressure? Take at least two readings, 1 or 2 minutes apart.
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