- Self-measured blood pressure (SMBP) monitoring at home or in a non-clinic setting is an evidence-based approach for hypertension diagnosis and treatment.
- Adding SMBP monitoring to BP measurement in the office is cost-effective when compared to office BP measurement alone among individuals with high office BP.
- Improvements in patient education, provider training, insurance coverage and provider reimbursement, among other measures, would help break down barriers to widespread use of SMBP monitoring.
WASHINGTON, D.C., June 22, 2020 — Self-measured blood pressure (SMBP) offers clinical benefits and the potential for being cost-effective over blood pressure (BP) monitoring conducted in a medical office, but improvements in patient education, provider training and insurance coverage are needed for broader adoption of the practice, according to a new policy statement by the American Heart Association and American Medical Association.
The statement was published today in the journal Circulation, the flagship medical journal of the American Heart Association, the nation’s oldest and largest voluntary organization dedicated to fighting heart disease and stroke.
“With fewer patients visiting medical offices during the COVID-19 pandemic, SMBP monitoring is more important than ever for people at risk for hypertension and uncontrolled BP,” said Daichi Shimbo, MD, associate professor of medicine at Columbia University Medical Center and the statement’s lead author. “SMBP monitoring is not only convenient for patients – it is superior to in-office BP measurements for predicting cardiovascular events and is potentially cost-effective.”
SMBP monitoring is BP measurement by a patient outside a medical office, usually at home. Several national and international hypertension guidelines endorse SMBP monitoring, which can prevent the misclassification of hypertension in patients with elevated in-office blood pressure (white-coat hypertension) and patients without elevated in-office blood pressure (masked hypertension).
The policy statement reviews the effectiveness of SMBP monitoring in diagnosing and managing hypertension, which is critical to narrowing disparities and improving blood pressure control in low-income and medically underserved communities, rural communities and communities of color that experience significant disparities in hypertension rates. High-blood pressure is more prevalent in Black Americans – almost 60% – than any other racial and ethnic group. The prevalence of hypertension is 46% among all American adults. Rural communities also experience a greater prevalence of hypertension compared to urban areas. Of the millions of Americans with hypertension, less than half do not have the condition under control, with many cases going undiagnosed.
The policy statement says potential cost savings from out-of-office BP measurements are highest among patients with elevated in-office blood pressure, who are susceptible to misdiagnoses of hypertension and unnecessary treatment. According to the statement, the potential cost savings of self-measured BP monitoring include reduced office visits and fewer cardiovascular events as a result of improved BP control, and avoiding overtreatment in patients with white coat hypertension.
Barriers to widespread use of SMBP monitoring inhibit its wider implementation in the US. The statement recommends addressing these barriers by:
- Educating patients and providers about the benefits of SMBP monitoring and the optimal approaches for SMBP monitoring.
- Establishing clinical core competency criteria to ensure high-quality SMBP monitoring is supported in clinical practice.
- Incorporating cointerventions that increase the effectiveness of SMBP monitoring, including behavioral change management and counseling, communication of treatment recommendations back to patients, medication management and prescription and adherence monitoring.
- Creating systems for SMBP readings to be transferred from devices to electronic health records.
- Improving public and private health insurance coverage of validated SMBP monitoring devices prescribed by a health care provider.
- Reimbursing providers for costs associated with training patients, transmitting BP data, interpreting and reporting BP readings and delivering cointerventions.
“SMBP monitoring has the potential to improve the detection and control of hypertension through cost-effective means,” Shimbo said. “Barriers to implementation of self-measured BP monitoring should be addressed through effective education and integration of patients, providers and health care systems.”
A detailed description of SMBP monitoring technique and device accuracy, including guidance for patients, was included in the American Heart Association’s 2019 scientific statement, “Measurement of Blood Pressure in Humans,” published in the AHA journal Hypertension.
Self-measured BP is a major focus area of Target: BP™, a national initiative launched by the American Heart Association and the American Medical Association in response to the high prevalence of uncontrolled BP. Target: BP helps health care organizations and care teams, at no cost, improve BP control rates through the evidence-based MAP BP Program and recognizes organizations for their ongoing commitment to their patients’ cardiovascular health.
About the American Heart Association
The American Heart Association is a leading force for a world of longer, healthier lives. With nearly a century of lifesaving work, the Dallas-based association is dedicated to ensuring equitable health for all. We are a trustworthy source empowering people to improve their heart health, brain health and well-being. We collaborate with numerous organizations and millions of volunteers to fund innovative research, advocate for stronger public health policies and share lifesaving resources and information. Connect with us on heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1.
About the American Medical Association
The American Medical Association is the physicians’ powerful ally in patient care. As the only medical association that convenes 190+ state and specialty medical societies and other critical stakeholders, the AMA represents physicians with a unified voice to all key players in health care. The AMA leverages its strength by removing the obstacles that interfere with patient care, leading the charge to prevent chronic disease and confront public health crises, and, driving the future of medicine to tackle the biggest challenges in health care. For more information, visit ama-assn.org.