Avoid white-coat hypertension with home monitoring

An intervention that helped patients monitor their blood pressures at home resulted in improved hypertension control and reduced medical costs, according to a new study presented at the American Heart Association's Joint Hypertension 2018 Scientific Sessions, an annual conference focused on recent advances in hypertension research.

Home monitoring combined with doctor visits to measure a patient's blood pressure helps to avoid numbers skewed by "white-coat hypertension," when blood pressure is high in a medical setting but not in everyday life, and "masked hypertension," when blood pressure is normal in a medical setting but high at home.

However, as study author Roy R. Champion, MSc, BSN, clinical quality RN at Scott and White Health Plan (Temple, TX) has noted, home blood pressure monitoring isn't a common part of most treatment plans. Based on trends observed during medical record reviews, Champion said less than one in five providers were including home blood pressure monitoring in documentations for hypertension patients.

"Meanwhile, in the charts that did use home blood pressure monitoring, approximately 86 percent of those patients had their hypertension under control," Champion said.

Champion and co-researchers studied the impact of an intervention that provided free home blood pressure monitors, online and print resources for tracking their readings, and monitoring reminders to 2,550 adult patients with persistent uncontrolled high blood pressure. In each case, the patient's provider would know the patient received a free at-home blood pressure monitor and resources for how to use it.

The researchers found: 

• By their third office visit, nearly 67 percent of patients had their blood pressure controlled.

• Nearly 60 percent of patients had blood pressure control by their sixth visit.

Champion attributed the decline from the third to sixth visit to providers' adjusting blood pressure medications based on information from home blood pressure monitoring. Patients only had to see their doctors a few times to settle on the ideal medication amount, he explained.

At the end of the intervention, patients' systolic blood pressures had decreased an average 16.9 mmHg and diastolic blood pressures fell an average 6.5 mmHg. In the six months after the intervention, nearly 80 percent of the participants achieved blood pressure under control using the Healthcare Effectiveness Data and Information Set (HEDIS) 2018 standards. Using the 2017 American Heart Association/American College of Cardiology guidelines, 72 percent of patients achieved hypertension control.

According to the researchers, each kit (including the monitor) cost an average $38.50; yet, the cost savings from the intervention were substantial. The intervention reduced needed office visits by 1.2 office visits per participant per year and significantly reduced emergency department and medication costs.

Home monitoring helps providers better understand patients' everyday blood pressure numbers in a cost-saving way that doesn't increase the burden on patients or providers, Champion pointed out.

Source: American Heart Association