Most individuals prefer to monitor their BP at home to confirm a diagnosis of hypertension rather than visiting the doctor’s clinic or get their BP measured as a kiosk, according to a new study presented at the recently concluded virtual American Heart Association’s Hypertension Scientific Sessions 2021.

The study included 510 adults, average age 59 years, from the Blood Pressure Checks for Diagnosing Hypertension (BP-CHECK) trial. All of them presented to Kaiser Permanente Washington primary care clinics with high BP (average BP 150/88 mm Hg) but had not been diagnosed as having hypertension. None of the study participants were on any anti-hypertensive medication. Men comprised half of the study population. The objective of the study was to examine the adherence and acceptability of different blood pressure measuring methods and compare it to the gold-standard method to diagnose hypertension, ambulatory BP monitoring (ABPM).

The participants were randomised to three different methods of BP monitoring: clinic measurements, home monitoring or kiosk blood pressure monitoring.

Patients who were assigned to clinic measurements were asked to come back to have their BP checked at another visit. Those in the home monitoring group were asked to measure their BP morning and evening with two measurements each time for 5 days (total 20 measurements), while participants in the kiosk group were trained to use a BP kiosk with a smart card and asked to take their blood pressure at a kiosk in their clinic or at a nearby pharmacy on three separate days, with three measurements each time (total 9 measurements). Participants in the home monitoring group were given Bluetooth/web-enabled home BP machines and they were trained to use them. All the three groups were instructed to complete their BP measurements in 3 weeks’ time and then to undergo 24-hour ABPM. Each method was then examined for compliance. A questionnaire was used to assess the acceptability of each method.

Acceptability was found to be highest among participants assigned to home monitoring followed by the clinic measurement group and then the kiosk measurement group. Ambulatory BP monitoring was the least accepted method.

More than 90% of those in the home monitoring group adhered to the instructions regarding BP monitoring; adherence was more than 87% in the clinic group, while at 68%, the kiosk group had least adherence among the three methods evaluated. Adherence to the 24-hour ambulatory monitoring among all participants was 91%.

Over 50% of the participants selected home BP monitoring as their preferred choice because of the convenience and ease of use. Also, it did not disrupt their daily routine. In contrast, ABPM was not a popular option as it was perceived to be uncomfortable and disrupted daily routine activities and sleep.

Hypertensive patients are often advised to monitor their BP readings at home and home BP monitoring improves BP control and since it’s done within the comfort of home; it also avoids white coat hypertension, often seen during office BP measurements and reduces BP variability. Hence, it is a better predictor of cardiovascular morbidity and mortality. Moreover, it is also more economical. The patient must be trained to measure BP accurately. Involving the patient in managing their BP will help them understand their disease better and encourage patient compliance to pharmacological and nonpharmacological measures.

Reference

1. Thompson M, et al. Acceptability And Adherence To Home, Kiosk, Office Blood Pressure Measurement Compared To 24- Hour Ambulatory Monitoring In Primary Care. Hypertension. September 2021;78(Suppl 1):A50.