Implementing Home Blood Pressure Monitoring into Clinical Practice

Liyanage-Don, Nadia; Fung, Deborah; Phillips, Erica; Kronish, Ian M.

doi:10.1007/s11906-019-0916-0

“…HBPM use remains low and poor adherence to hypertension guidelines may be attributable to barriers at the patient, clinician, and healthcare system levels [11]: 1) patients lack adequate knowledge about the optimal regimen for HBPM [20,24,29]; 2) presence of barriers to conducting morning and evening measurement for patients [11]; 3) lack of encouragement from healthcare providers or more detailed direction for HBPM not being provided to patients [25]; and 4) HBPM readings seldom being documented by clinicians [30]. Healthcare systems should further enhance the successful implementation of HBPM, supported by plans to encourage healthcare professionals and provide patients with HBPM regimens, such as selection of appropriate BP measurement devices, measurement conditions and selfmeasurement skills and protocols.…”

Section: Discussionmentioning

confidence: 99%

“…Hypertension guidelines from multiple countries [8][9][10] emphasize the importance of HBPM for diagnosis, treatment adjustment and long-term follow-up for most hypertension cases, and recommended incorporating HBPM in clinical practice. Following recommended best practice can facilitate the successful implementation of HBPM and impact how hypertension is managed in primary care settings [11,12].…”

Section: Introductionmentioning

confidence: 99%

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Assessing the routine-practice gap for home blood pressure monitoring among Chinese adults with hypertension

Zuo

¹

,

Ma

²

,

Wang

³

et al. 2020

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0

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Background: Home blood pressure monitoring (HBPM) is recommended for diagnosis, treatment adjustment and management of most hypertension cases in hypertension guidelines from multiple countries. This study aimed to evaluate HBPM behaviour and explore the routine-practice gap in HBPM among Chinese adults with hypertension. Methods: Data were collected from 20 communities across three cities and six townships in three provinces (Beijing, Shandong and Jiangsu) in China between October 2014 and November 2014. In total, 2,272 patients with hypertension aged ≥35 years that were registered with a primary health station in their local communities were selected by simple random sampling. Results: Among the 2,272 participants, 45.3% owned a home blood pressure (BP) monitor. In addition, 27.5% (625/2,272) engaged in HBPM weekly or more frequently. Healthcare providers’ advice was the strongest factor contributing to home BP monitor ownership and weekly HBPM behaviour, with odds ratios of 13.50 and 8.97, respectively. Approximately 4.4% of participants had achieved optimal HBPM regimens (duplicate measurements in the morning and evening for 7 days). Patients with uncontrolled office-measured BP were more likely to conduct HBPM regularly in the morning and evening, measure their BP two or three times in each session and maintain 7 consecutive days of HBPM than patients with controlled office BP (8.8% vs. 5.8%, P=0.042; 14.3% vs. 8.1%, P=0.002; and 19.9% vs. 12.4%, P=0.005, respectively). Only 16.0% (165/1,030) of participants actively reported their HBPM readings to doctors. Conclusion: The HBPM strategies specified in hypertension guidelines are seldom achieved in actual practice in China. Only a small proportion of patients actively participate in using HBPM to enhance their hypertension care. HBPM may be improved by healthcare providers offering specific advice and training.

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“…HBPM use remains low and poor adherence to hypertension guidelines may be attributable to barriers at the patient, clinician, and healthcare system levels [11]: 1) patients lack adequate knowledge about the optimal regimen for HBPM [20,24,29]; 2) presence of barriers to conducting morning and evening measurement for patients [11]; 3) lack of encouragement from healthcare providers or more detailed direction for HBPM not being provided to patients [25]; and 4) HBPM readings seldom being documented by clinicians [30]. Healthcare systems should further enhance the successful implementation of HBPM, supported by plans to encourage healthcare professionals and provide patients with HBPM regimens, such as selection of appropriate BP measurement devices, measurement conditions and selfmeasurement skills and protocols.…”

Section: Discussionmentioning

confidence: 99%

Assessing the routine-practice gap for home blood pressure monitoring among Chinese adults with hypertension

Zuo

¹

,

Ma

²

,

Wang

³

et al. 2020

Preprint

0

View full text Add to dashboard Cite

Background: Home blood pressure monitoring (HBPM) is recommended for diagnosis, treatment adjustment and management of most hypertension cases in hypertension guidelines from multiple countries. This study aimed to evaluate HBPM behaviour and explore the routine-practice gap in HBPM among Chinese adults with hypertension. Methods: Data were collected from 20 communities across three cities and six townships in three provinces (Beijing, Shandong and Jiangsu) in China between October 2014 and November 2014. In total, 2,272 patients with hypertension aged ≥35 years that were registered with a primary health station in their local communities were selected by simple random sampling. Results: Among the 2,272 participants, 45.3% owned a home blood pressure (BP) monitor. In addition, 27.5% (625/2,272) engaged in HBPM weekly or more frequently. Healthcare providers’ advice was the strongest factor contributing to home BP monitor ownership and weekly HBPM behaviour, with odds ratios of 13.50 and 8.97, respectively. Approximately 4.4% of participants had achieved optimal HBPM regimens (duplicate measurements in the morning and evening for 7 days). Patients with uncontrolled office-measured BP were more likely to conduct HBPM regularly in the morning and evening, measure their BP two or three times in each session and maintain 7 consecutive days of HBPM than patients with controlled office BP (8.8% vs. 5.8%, P=0.042; 14.3% vs. 8.1%, P=0.002; and 19.9% vs. 12.4%, P=0.005, respectively). Only 16.0% (165/1,030) of participants actively reported their HBPM readings to doctors. Conclusion: The HBPM strategies specified in hypertension guidelines are seldom achieved in actual practice in China. Only a small proportion of patients actively participate in using HBPM to enhance their hypertension care. HBPM may be improved by healthcare providers offering specific advice and training.

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“…In older patients with hypertension, four phenotypes can be recognised. Besides white coat hypertension which can be seen in up to 72 percent of clinic BP readings 8 , and masked hypertension which has a prevalence of 14-30 percent 8 ; two another types of hypertension are encountered in older patients namely, isolated systolic hypertension (BP ≥ 140/90/< 90 mmHg) which accounts for 60 to 80 percent of hypertension overall and prevalence increases with age 1 ; and postural hypotension (BP drop >20/10 mmHg within three minutes of standing) is common, affecting up to 20 percent of older people 1 .…”

Section: Hypertension In Older Patientsmentioning

confidence: 99%

Proteinuria and hypertension with and without type 2 dibetes mellitus: an update

Gan¹

2019

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INTRODUCTION In this update four related areas are reviewed. They are: (1) Blood Pressure (BP) definition and classification; (2) Hypertension diagnosis; (3) Hypertension and proteinuria in non-diabetic patients; and (4) Proteinuria and hypertension in the patient with diabetes. METHODOLOGY. PubMed searches were done for papers to the above four topics published in the last five years (2014 to 2019). These were supplemented by papers from hand searches. RESULTS. For diagnosis of hypertension, the current cut off of 140/90 mmHg can be reduced to 130/80 mmHg to improve cardiovascular outcomes and all-cause mortality. Diagnosis of hypertension should not be based on office BP readings alone. Hypertension in older patients should be treated to prevent worse outcomes and should be individualised. In non-diabetic patients, both low grade and microalbuminuria needs to be treated; adequate BP control is needed to prevent cardiovascular outcomes and all-cause mortality. In the diabetic patient, a BP target of less than 140/90 mmHg applies to most patients but individualisation of the BP goal is important. CONCLUSIONS. Much development in the management of proteinuria and hypertension has taken place in the last five years.

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Implementing Home Blood Pressure Monitoring into Clinical Practice

Cited by 42 publications

References 117 publications

Assessing the routine-practice gap for home blood pressure monitoring among Chinese adults with hypertension

Assessing the routine-practice gap for home blood pressure monitoring among Chinese adults with hypertension

Assessing the routine-practice gap for home blood pressure monitoring among Chinese adults with hypertension

Proteinuria and hypertension with and without type 2 dibetes mellitus: an update

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