Despite guideline recommendations and improved access to care, people with hypertension are often not monitoring their blood pressure at home as frequently as advised, according to researchers at Mass General Brigham. In a retrospective cohort study, investigators found that even when patients were provided with free blood pressure devices, education, and personalised support, engagement with home monitoring remained low. The findings underline the need for more convenient and less burdensome approaches to blood pressure assessment. The results were published in JAMA Cardiology.
Previous studies indicate that home blood pressure measurements are frequently more accurate than readings taken in clinical settings. Current American Heart Association guidelines recommend that patients with hypertension take two readings, one minute apart, twice daily for up to seven days to establish an accurate average before a clinical appointment.
A single blood pressure reading in the doctor’s surgery can be misleading. Stress, recent physical activity, or anxiety during a visit can artificially raise readings. Collecting multiple measurements each day at home over several days provides a far more reliable picture of a patient’s true blood pressure and allows doctors to tailor treatment more effectively.
The study included 3,390 patients enrolled in a remote hypertension management programme. The programme was designed to determine whether home blood pressure monitoring could effectively reduce blood pressure. All participants received education and complimentary home monitors and were asked to complete 28 readings per week, which were automatically transmitted to patient navigators.
The primary analysis showed that participants who regularly measured their blood pressure at home and progressed to the maintenance phase experienced reductions in blood pressure associated with a 40% relative risk reduction in major cardiovascular events and all-cause mortality.
Researchers assessed the number of readings completed during seven-day periods to evaluate adherence. Engagement was categorised as no engagement (0 measurements), low engagement (1–11 measurements), intermediate engagement (12–23 measurements), and high engagement (24–28 measurements). Levels of participation varied considerably: 32.7% of patients showed no engagement, 14.3% demonstrated low engagement, while 18.2% and 34.8% achieved intermediate and high engagement, respectively.
These findings point to the need for more innovative and user-friendly technologies, similar to continuous glucose monitoring systems used in diabetes care. Such devices could passively collect blood pressure data, reducing the effort required from patients and potentially improving adherence.
Future research will focus on identifying the specific barriers that contribute to low engagement with home blood pressure monitoring. With several new devices currently in development or awaiting approval from the U.S. Food and Drug Administration, investigators are also evaluating whether treatment outcomes differ between patients using conventional monitors and those using newer wearable continuous monitoring systems.
Current guidelines call for frequent, carefully timed blood pressure measurements to ensure accuracy, but the realities of daily life often make this difficult for patients. This gap highlights the need for low-burden technologies that can capture reliable blood pressure data without requiring patients to reorganise their lives around their condition.
Source: Mass General Brigham
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