Home blood pressure monitoring: a position statement from the Korean Society of Hypertension Home Blood Pressure Forum

Ihm, Sang‐Hyun; Park, Jae‐Hyeong; Kim, Jang Young; Kim, Ju Han; Kim, Kwang Il; Lee, Eun Mi; Lee, Hyeok-Hee; Park, Sungha; Shin, Jinho; Kim, Cheol-Ho

doi:10.1186/s40885-022-00218-1

Cited by 12 publications

(24 citation statements)

References 90 publications

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“… 5 Home BP monitoring can help overcome physician inertia by the provision of multiple readings which allow for better treatment decision-making and informed medication titration thereby improving BP control. 2 , 6 Furthermore, HBPM is an important predictor of target organ damage and provides better prognostic information than office BP and, although the evidence base is still developing, HBPM is suggested by Hypertension Canada to be used in conjunction with standardized office measurement for long-term BP monitoring. 2 , 6 - 12 There exists a paucity of data on uptake, barriers, and facilitators of HBPM in non-dialysis CKD patients, a group likely to benefit from improved BP control due to a high prevalence of hypertension and cardiovascular disease and BP control slowing the trajectory of kidney function decline.…”

Section: Introductionmentioning

confidence: 99%

“…2,6 Furthermore, HBPM is an important predictor of target organ damage and provides better prognostic information than office BP and, although the evidence base is still developing, HBPM is suggested by Hypertension Canada to be used in conjunction with standardized office measurement for long-term BP monitoring. 2,[6][7][8][9][10][11][12] There exists a paucity of data on uptake, barriers, and facilitators of HBPM in nondialysis CKD patients, a group likely to benefit from improved BP control due to a high prevalence of hypertension and cardiovascular disease and BP control slowing the trajectory of kidney function decline. 4,[13][14][15][16] Patient-centered care, which focuses on enabling patients to self-manage aspects of their health care, is encouraged in many CKD management guidelines.…”

Section: Introductionmentioning

confidence: 99%

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The Patient-Provider Gap: A Cross-sectional Survey to Understand Barriers and Motivating Factors for Home Blood Pressure Monitoring in a CKD Cohort

Borkum

Levin

Williams³

et al. 2023

Can J Kidney Health Dis

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Background: Blood pressure (BP) management can decrease morbidity and mortality in chronic kidney disease (CKD) patients. Evidence-based hypertension guidelines endorse home BP monitoring (HBPM), and the growing use of virtual health has highlighted the need for HBPM. A comprehensive understanding of HBPM adoption in our province is lacking. Objective: To identify the baseline practices, perspectives, barriers, and enablers in both providers and patients in our kidney care clinics regarding HBPM. Ultimately, this will inform the development of a provincial intervention that empowers providers to both increase patient understanding and equip them for accurate and reliable home BP measurement. Design: Cross-sectional, descriptive study using online survey methodology. Setting: Kidney care clinic network in the province of British Columbia, Canada. Patients or Sample or Participants: Kidney care clinic staff and patients who perform HBPM. Methods: Data were collected using semi-structured online surveys, one for staff and one for patients and/or caregivers. These surveys were developed by an interdisciplinary working group that included patient partners and addressed some key components of the implementation of an HBPM program (including perceived barriers to uptake, education, and adoption of best practices). Results: In all, 46 patients and 43 staff responded to the survey from 16 kidney care clinics. Of the patients 53% were women, and the most common age range was 60 to 69 years (25%); 93% of the staff respondents were women and 63% were nurses. We identified numerous areas of discordance between providers and patients and the need for improvement from the perspective of implementing best practices from hypertension guidelines, both in staff teaching and patient usage of HBPM. Blood pressure targets were not known to 18% of patients and 39% of patients had received a BP target from their kidney care clinic team; 89% of patients had not had their upper arm circumference measured for cuff size. Furthermore, 54% of patients knew what to do when their BP is off-target. All recognized the benefits of HBPM, providers were more likely to perceive anxiety as a barrier relative to patients, and patients were more likely to report expense as a barrier than providers. Limitations: This study includes only a single provincial health care system limiting generalizability to other jurisdictions and sampled a small subset of patients and providers. Conclusions: The systematic evaluation of education, understanding, implementation of best practices, and barriers and motivating factors for HBPM from both patient and clinician perspectives is an important step in designing strategies to improve the use of HBPM. Given differences in staff and patient perspectives, targeted interventions based on these responses may lead to improved use of HBPM, and ultimately enhance hypertension self-management and BP control in our CKD patients.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Patient-Provider Gap: A Cross-sectional Survey to Understand Barriers and Motivating Factors for Home Blood Pressure Monitoring in a CKD Cohort

Borkum

Levin

Williams³

et al. 2023

Can J Kidney Health Dis

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“…In routine practice at hypertension clinic, the clinic BP is measured by a physician or qualified nurse using a validated oscillometric automated device after resting for 5 min, and the average of at least three measurements taken at 1 min intervals is recorded. Physicians and qualified nurses provided instructions to the participants on how to use a validated oscillometric upper arm cuff device for measuring their home BP [17,18]. To ensure the accuracy of the BP measurement method, patients were requested to bring their HBPM devices to the clinic, where the measurement technique underwent validation by physicians and qualified nurses.…”

Section: Blood Pressure Measurementmentioning

confidence: 99%

Blood pressure and variability responses to the down-titration of antihypertensive drugs

Kim,

Lee,

Shin

et al. 2024

Journal of Hypertension

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Objectives: Several recent guidelines have proposed the gradual reduction of antihypertensive drugs for patients with well controlled blood pressure (BP). However, no studies have examined alterations in BP variability (BPV) during the down-titration of antihypertensives. This study aims to investigate changes in home BPV during the down-titration of antihypertensives. Methods: We analyzed 83 hypertensive patients who underwent down-titration of antihypertensives and had available home BP data during the down-titration. Down-titration was performed when home SBP was less than 120 mmHg, regardless of the clinic SBP. Primary exposure variable was the standard deviation (SD) of home BP. Results: Among 83 patients (mean age 66.3 ± 11.9 years; 45.8% men), down-titration led to increase home SBP (from 110.5 to 118.7 mmHg; P < 0.001), and home DBP (from 68.8 to 72.8 mmHg; P = 0.001) significantly. There were no significant differences in SDs of SBP [from 6.02 ± 3.79 to 5.76 ± 3.09 in morning, P = 0.570; from 6.13 ± 3.32 to 6.63 ± 3.70 in evening, P = 0.077; and from 6.54 (4.80, 8.31) to 6.37 (4.65, 8.76) in home SBP, P = 0.464] and SDs of DBP during the down-titration of antihypertensive drugs. Conclusion: Down-titration of antihypertensive drugs did not have notable impact on clinic BP and home BPV, while significantly increasing home BP. These findings provide important insights indicating that the potential concern related to an increase in BPV in the planned strategy of reducing antihypertensive drugs is not substantial.

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“…The median (5th-95th percentiles) number of days on which morning and evening home BP readings were taken by each patient was 13 (6)(7)(8)(9)(10)(11)(12)(13), and the number of morning and evening home SBP readings per patient was 39 (18-39; Table S1).…”

Section: Home Bp Quality Controlmentioning

confidence: 99%

“…3 Current guideline documents and other publications consider out-of-office BP monitoring (ie, home and ambulatory BP) to be an essential component of diagnostic and therapeutic strategies for hypertension. [4][5][6][10][11][12][13][14] The Ohasama study was the first to show that home BP is a more reliable predictor of outcome than office BP, 9 and these findings have been widely replicated and extended. [15][16][17][18][19][20][21][22] Spline regression analysis performed in the HONEST study (Home BP Measurement With Olmesartan Naive Patients to Establish Standard Target BP) found that a morning home SBP of 124 mm Hg was associated with the lowest risk of cardiovascular events.…”

mentioning

confidence: 99%

Potential Long-Term Benefit of Home Systolic Blood Pressure Below 125 mm Hg for Cardiovascular Risk Reduction: The J-HOP Study Extended

Kario,

Okawara,

Kanegae

et al. 2023

Hypertension

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BACKGROUND: The long-term benefit of achieving the Japanese Society of Hypertension home systolic blood pressure (SBP) target of <125 mm Hg has not been fully evaluated. This study investigated the long-term risk of cardiovascular disease events in individuals with home SBP <125 versus 125 to <135 or ≥135 mm Hg who participated in the J-HOP study (Japan Morning Surge-Home Blood Pressure). METHODS: The J-HOP study enrolled outpatients with ≥1 cardiovascular risk factor between 2005 and 2012, with follow-up until March 2015 and extended follow-up from December 2017 to May 2018. Cardiovascular disease events (stroke, coronary artery disease, congestive heart failure, and aortic dissection) were compared between home SBP subgroups. RESULTS: During mean 5.9 years of follow-up in 4231 participants (mean age, 65 years), cardiovascular events included stroke (n=89), coronary artery disease (n=116), congestive heart failure (n=37), and aortic dissection (n=8). The adjusted 10-year risk of total cardiovascular disease was slightly higher, and stroke risk was significantly higher when baseline home SBP was ≥135 versus <125 mm Hg (adjusted hazard ratio, 1.39 [95% CI, 0.97–2.00] for overall cardiovascular disease and 2.68 [95% CI, 1.34–5.38] for stroke; this was largely due to between-group differences in the first 5 years of follow-up, which were maintained over the subsequent 5 years). Findings were similar in the subgroup of high-risk patients (those with diabetes or stroke history). CONCLUSIONS: These data highlight the potential long-term benefit of strict home SBP control and validate this as an appropriate Japanese Society of Hypertension guideline target although confirmation in larger populations is needed. REGISTRATION: URL: XXX; University Hospital Medical Information Network Clinical Trials Registry; Unique identifier: UMIN000000894 (Japan Morning Surge-Home Blood Pressure study).

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Home blood pressure monitoring: a position statement from the Korean Society of Hypertension Home Blood Pressure Forum

Cited by 12 publications

References 90 publications

The Patient-Provider Gap: A Cross-sectional Survey to Understand Barriers and Motivating Factors for Home Blood Pressure Monitoring in a CKD Cohort

The Patient-Provider Gap: A Cross-sectional Survey to Understand Barriers and Motivating Factors for Home Blood Pressure Monitoring in a CKD Cohort

Blood pressure and variability responses to the down-titration of antihypertensive drugs

Potential Long-Term Benefit of Home Systolic Blood Pressure Below 125 mm Hg for Cardiovascular Risk Reduction: The J-HOP Study Extended

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