Home blood-pressure monitoring among hypertensive patients in an Asian population

Abstract

Hypertension is a principal cause of mortality and morbidity in Singapore. The use of home blood-pressure monitoring (HBPM) to assess hypertensive control with digital devices in the local multi-racial population is unknown. The study determined the factors associated with hypertensive patients' use of HBPM in primary care in a multi-racial Asian population. Randomized crosssectional questionnaire survey of hypertensive patients managed in a district polyclinic. A model predicting use of HBPM was constructed by univariate and multivariate logistic regression. A total of 224 eligible subjects were randomly selected from 1943 patients. Response rate was 78.1% (n ¼ 175). In all, 61.7% of them were aware of HBPM but only 24% used HBPM. Using multivariate analysis by stepwise backward regression, the final fitted model showed that HBPM was associated with higher patients' socioeconomic status: (adjusted OR for middle-income status ¼ 2.85, 95% CI: 1.2-6.78, P ¼ 0.018; adjusted OR for high-income status ¼ 3.46, 95% CI: 1.22-9.87, P ¼ 0.020) and their documented diastolic BP (adjusted OR for diastolic BP480 mmHg ¼ 2.26, 95% CI: 1.06-4.82, P ¼ 0.034). Nonusers cited failure to recognize benefits (54.1%), lack of HBPM awareness (29.3%), understanding of device operation (18.8%) and perception of inaccuracy (10.5%) as deterrents. 76.2% of users were satisfied with HBPM but lacked knowledge in maintenance of devices. In conclusion, 61.7% of the study population were aware of HBPM but only 24% used it. Patients' failure to recognize benefits, lack of awareness, cost and perception of inaccuracy were barriers. Higher socioeconomic status and patient's documented diastolic BP correlated with HBPM usage.

Home blood pressure measurements associated with better blood pressure control: the J-HOME study

“…In previous studies, compared to patients who had not taken home BP measurements, patients who had taken home BP measurements were younger, more often male and had a higher educational level or higher socioeconomic status. 15,21 Taking home BP measurements might not be associated with socioeconomic status in Japan, since the socioeconomic status of the present population is essentially equivalent. Furthermore, in the present study, patients with a family history of hypertension were more likely to take home BP measurements.…”

“…In several countries, the prevalence of patients who had taken home BP measurements among hypertensive patients has been reported to range from 19.7 to 87.3%. 15,[21][22][23][24] In Japan, approximately 30 million home BP measuring devices have been distributed. 19 Additionally, both in the guidelines for self-measurement of BP at home 18 and in the Japanese Society of Hypertension Guidelines for the Management of Hypertension, 7 the Japanese Society of Hypertension strongly recommended that patients measure their own BP at home.…”

Home blood pressure measurement: a means for improving blood pressure control?

“…A study designed at assessing the factors associated with HBP measurement in a multiracial Asian population of hypertensive patients in a primary care setting revealed 61.7% of the sample (175 patients randomly selected from 1943 patients) was aware of HBP, but only 24% used this procedure. 16 Failure to recognize benefits, lack of HBP awareness and perception of inaccuracy were, in ranking order, the most common barriers for HBP use.…”

Use of home blood pressure measurement by hypertensive patients in Southern Greece

“…We categorized all the patients who either performed self-measurements or had their BP measured at home by relatives or pharmacists as one group, since it has been shown that the lower level of home-in comparison to clinic BP-seems to be exclusively attributed to the effect of different setting (outside the hospital), rather than to the person who is taking measurements. 6 The majority of the patients used aneroid devices (in contrast to the cohort in Singapore study 5 ), since these are considerably cheaper than electronic ones, in spite of the greater difficulty in their use.…”