Advertisement
Canadian Journal of Cardiology

Unreliability of Home Blood Pressure Measurement and the Effect of a Patient-Oriented Intervention

Published:March 11, 2015DOI:https://doi.org/10.1016/j.cjca.2015.03.006

      Abstract

      Background

      Home blood pressure (BP) measurement (HBPM) is recommended for the diagnosis and follow-up of high BP. It is unclear how this aspect of BP monitoring has evolved over the years and whether interventions could influence patient adherence to HBPM guidelines.

      Methods

      After a questionnaire-based cross-sectional study performed in 2010, a passive, multimodal intervention, focused on improving adherence to HBPM guidelines, was implemented. A second study was conducted in 2014 to measure its effect.

      Results

      In 2010 and 2014, 1010 and 1005 patients, respectively, completed the questionnaire. In 2010 and 2014, 82% and 84% of patients, respectively, self-measured their BP. Reporting of HBPM and adherence to recommended procedures was suboptimal. Only 34.0% of patients in 2010 and 31.7% in 2014 brought > 80% of their measurements to their doctor. Only 49.6% in 2010 and 52.9% in 2014 prepared > 80% of the time for HBPM. Only 48.1% in 2010 and 52.1% in 2014 rested for 5 minutes > 80% of the time before HBPM. Only 15% of patients in 2010 and 18% in 2014 were defined as sufficiently compliant with all HBPM procedures. Paired analysis of a subset of 535 patients who participated in the 2010 and 2014 studies showed no clinically significant differences in reliability between the 2 surveys.

      Conclusions

      Adherence to HBPM guidelines was suboptimal in 2010 and still is in 2014 despite a passive, multimodal intervention. Active training in HBPM procedures should be studied. Greater automation could improve HBPM reliability.

      Résumé

      Introduction

      La mesure de la pression artérielle (PA) à domicile (MPAD) est recommandée pour le diagnostic et le suivi de la PA élevée. On ignore de quelle manière cet aspect de la surveillance de la PA a évolué au cours des années et si les interventions pourraient influencer l’observance des lignes directrices de la MPAD par les patients.

      Méthodes

      Après une étude transversale basée sur un questionnaire réalisée en 2010, une intervention multimodale passive mettant l’accent sur l’amélioration de l’observance des lignes directrices en matière de MPAD a été mise en place. Une seconde étude a été menée en 2014 pour mesurer ses effets.

      Résultats

      En 2010 et en 2014, 1010 et 1005 patients, respectivement, ont rempli le questionnaire. En 2010 et en 2014, 82 % et 84 % des patients, respectivement, ont mesuré par eux-mêmes leur PA. Le rapport de la MPAD et de l’observance des procédures recommandées était sous-optimal. Seuls 34,0 % des patients en 2010 et 31,7 % des patients en 2014 ont apporté > 80 % de leurs mesures à leur médecin. Seuls 49,6 % des patients en 2010 et 52,9 % en 2014 se sont préparés > 80 % du temps à la MPAD. Seuls 48,1 % des patients en 2010 et 52,1 % en 2014 se sont reposés durant 5 minutes > 80 % du temps avant la MPAD. Seuls 15 % des patients en 2010 et 18 % en 2014 ont été définis comme étant des patients qui se conformaient suffisamment à toutes les procédures de la MPAD. Les analyses appariées d’un sous-ensemble de 535 patients qui participaient aux études de 2010 et de 2014 n’ont montré aucune différence cliniquement significative dans la fiabilité entre les 2 enquêtes.

      Conclusions

      L’observance des lignes directrices en matière de MPAD qui était sous-optimale en 2010 l’a encore été en 2014 en dépit d’une intervention multimodale passive. Une formation active sur les procédures de la MPAD devrait être étudiée. Une plus grande automatisation pourrait améliorer la fiabilité de la MPAD.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Canadian Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Turnbull F.
        Blood Pressure Lowering Treatment Trialists’ Collaboration. Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials.
        Lancet. 2003; 362: 1527-1535
        • Chobanian A.V.
        • Bakris G.L.
        • Black H.R.
        • et al.
        The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.
        JAMA. 2003; 289: 2560-2572
        • Dasgupta K.
        • Quinn R.R.
        • Zarnke K.B.
        • et al.
        The 2014 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension.
        Can J Cardiol. 2014; 30: 485-501
        • Mancia G.
        • Fagard R.
        • Narkiewicz K.
        • et al.
        2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).
        Eur Heart J. 2013; 34: 2159-2219
        • Bobrie G.
        • Chatellier G.
        • Genes N.
        • et al.
        Cardiovascular prognosis of “masked hypertension” detected by blood pressure self-measurement in elderly treated hypertensive patients.
        JAMA. 2004; 291: 1342-1349
        • Clement D.L.
        • De Buyzere M.L.
        • De Bacquer D.A.
        • et al.
        Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension.
        N Engl J Med. 2003; 348: 2407-2415
        • Hansen T.W.
        • Kikuya M.
        • Thijs L.
        • et al.
        Prognostic superiority of daytime ambulatory over conventional blood pressure in four populations: a meta-analysis of 7,030 individuals.
        J Hypertens. 2007; 25: 1554-1564
        • Ohkubo T.
        • Imai Y.
        • Tsuji I.
        • et al.
        Home blood pressure measurement has a stronger predictive power for mortality than does screening blood pressure measurement: a population-based observation in Ohasama, Japan.
        J Hypertens. 1998; 16: 971-975
        • Mancia G.
        • Facchetti R.
        • Bombelli M.
        • Grassi G.
        • Sega R.
        Long-term risk of mortality associated with selective and combined elevation in office, home, and ambulatory blood pressure.
        Hypertension. 2006; 47: 846-853
        • O’Brien E.
        • Waeber B.
        • Parati G.
        • Staessen J.
        • Myers M.G.
        Blood pressure measuring devices: recommendations of the European Society of Hypertension.
        BMJ. 2001; 322: 531-536
        • Myers M.G.
        • Stergiou G.S.
        Reporting bias: Achilles’ heel of home blood pressure monitoring.
        J Am Soc Hypertens. 2014; 8: 350-357
        • van der Hoeven N.V.
        • van den Born B.J.
        • Cammenga M.
        • van Montfrans G.A.
        Poor adherence to home blood pressure measurement schedule.
        J Hypertens. 2009; 27: 275-279
        • Viera A.J.
        • Cohen L.W.
        • Mitchell C.M.
        • Sloane P.D.
        How and why do patients use home blood pressure monitors?.
        Blood Press Monit. 2008; 13: 133-137
        • Wagner S.
        • Buus N.H.
        • Jespersen B.
        • et al.
        Measurement adherence in the blood pressure self-measurement room.
        Telemed J E Health. 2013; 19: 826-833
        • Bancej C.M.
        • Campbell N.
        • McKay D.W.
        • et al.
        Home blood pressure monitoring among Canadian adults with hypertension: results from the 2009 Survey on Living with Chronic Diseases in Canada.
        Can J Cardiol. 2010; 26: e152-e157
        • Cheng C.
        • Studdiford J.S.
        • Chambers C.V.
        • Diamond J.J.
        • Paynter N.
        The reliability of patient self-reported blood pressures.
        J Clin Hypertens (Greenwich). 2002; 4: 259-264
        • Landert M.
        • Holm D.
        • Steurer J.
        • Bachmann L.
        • Vetter W.
        Manipulation of blood pressure self-monitoring protocol values: a randomized controlled study.
        Praxis (Bern 1994). 2003; 92 ([in German]): 1075-1080
        • Mengden T.
        • Hernandez Medina R.M.
        • Beltran B.
        • et al.
        Reliability of reporting self-measured blood pressure values by hypertensive patients.
        Am J Hypertens. 1998; 11: 1413-1417
        • Myers M.G.
        Reporting bias in self-measurement of blood pressure.
        Blood Press Monit. 2001; 6: 181-183
        • Nordmann A.
        • Frach B.
        • Walker T.
        • Martina B.
        • Battegay E.
        Reliability of patients measuring blood pressure at home: prospective observational study.
        BMJ. 1999; 319: 1172
        • Leblanc M.E.
        • Cloutier L.
        • Veiga E.V.
        Knowledge and practice outcomes after home blood pressure measurement education programs.
        Blood Press Monit. 2011; 16: 265-269
        • Cacciolati C.
        • Tzourio C.
        • Dufouil C.
        • Alperovitch A.
        • Hanon O.
        Feasibility of home blood pressure measurement in elderly individuals: cross-sectional analysis of a population-based sample.
        Am J Hypertens. 2012; 25: 1279-1285