Eileen Koutnik-Fotopoulos
Staff Writer

Routine home blood pressure monitoring (HBPM) may help the 73 million individuals with hypertension better manage the disease, according to a new joint scientific statement from 3 health care organizations.

Hypertension increases the risk of heart attack and stroke, which can be prevented by patients controlling their blood pressure (BP) to reduce the risk. Statistics indicate that hypertension kills 50,000 individuals in the United States each year, according to the American Heart Association (AHA)—one of the organizations that coauthored the statement. The American Society of Hypertension and the Preventive Cardiovascular Nurses Association also authored the call to action.

The target HBPM goal for treatment is <135/85 mm Hg or <130/80 mm Hg in high-risk patients. Home monitoring is useful in the elderly—in whom both BP variability and the white-coat effect are increased—patients with diabetes, patients with kidney disease, and in pregnant women, according to the statement.

"Blood pressure measurement and tracking could be improved with home monitoring by the patients themselves, in much the way people with diabetes monitor their blood sugar levels with home glucose monitors," said Thomas G. Pickering, MD, PhD, chair of the statement writing group.

Studies have pointed out that the traditional way of measuring BP in adults can be misleading. Research has shown that between 10% and 20% of patients diagnosed with high BP in the physician's office actually have the white-coat effect, meaning that their pressures are within normal range under other conditions, but spike in the medical setting.

Because BP changes throughout the day, taking one reading at a physicians office every few months does not give an accurate assessment of an individual's condition. Dr. Pickering noted several benefits of home monitor use. Home monitors can take multiple measurements during each session, can be used at different times of the day, and will help to involve patients in the management of their own BP. Many home monitors are equipped to store average BP readings over time, providing key data for patients to take to their physicians so they can work together to diagnose and treat the condition. As for cost, many monitors retail for under $100.

As for the current use of HBPM, the researchers highlighted several key results from a Gallup poll of patients with hypertension conducted in 2005. The number of patients monitoring their BP at home has rose steadily over the past 5 years, being 38% in 2000 and 55% in 2005. The proportion of patients owning a monitor has increased from 49% in 2000 to 64% in 2005. In 2000, 35% of patients reported that a physician recommended the use of a home monitor, and rose to 47% in 2005.

Pharmacists are considered the most accessible health care provider. Because home BP monitors are typically sold at community pharmacies, and patients visit their pharmacy monthly to pick up their antihypertensive medication, pharmacists can play a key role in recommending HBPM and how to properly use the machine.

Although earlier AHA guidelines have included home monitors, this is the first statement to have detailed recommendations on their use. They include:

• Patients should purchase oscillometric monitors with cuffs that fit on the upper arm. They should use a proper fitting cuff, and ask a health care provider the proper way to use the monitors. Wrist monitors are not recommended.
• Patients should take 2 or 3 readings at a time, 1 minute apart, while resting in a seated position. The arm should be supported, with the upper arm at heart level, and feet on the floor (back supported, legs uncrossed). It is important to take the readings at the same time each day, such as morning and evening, or as a health care professional recommends.
• Use of a home monitor can confirm suspected or newly diagnosed hypertension and rule out diagnosis for patients whose readings at the physician's office do not reflect their actual pressures over time
• Home monitoring can be used to evaluate the response to any type of antihypertensive treatment, and to motivate patients to take their medications regularly

The statement was published recently online in Hypertension, the Journal of the American Society of Hypertension, the Journal of Clinical Hypertension, and in the June 2008 issue of the Journal of Cardiovascular Nursing.