Heart Disease and Stroke Prevention: Self-Measured Blood Pressure Monitoring Interventions for Improved Blood Pressure Control When Used Alone

Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends self-measured blood pressure monitoring interventions to improve blood pressure outcomes in patients with high blood pressure.

The CPSTF has related findings for self-measured blood pressure monitoring interventions when combined with additional support (recommended).

The full CPSTF Finding and Rationale Statement and supporting documents for Heart Disease and Stroke Prevention: Self-Measured Blood Pressure Monitoring Interventions for Improved Blood Pressure Control are available in The Community Guide Collection on CDC Stacks.

Intervention

Self-measured blood pressure monitoring interventions support and promote the use of personal blood pressure measurement devices in the management and treatment of high blood pressure. Patients are trained to use validated, and usually automated, blood pressure measurement devices on a regular basis in familiar settings, typically their homes. Patients share blood pressure readings with their healthcare providers during clinic visits, by telephone, or electronically. These measurements are monitored and used in treatment decisions to improve blood pressure control.

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review published in 2013 (Uhlig et al., 52 studies, search period through February 2013). Twenty-six (28 study arms) of the included studies evaluated the effectiveness of self-measured blood pressure monitoring interventions when used alone to manage high blood pressure.

Study Characteristics

Studies were done in the United States (10 studies), Western Europe (9 studies), Canada (3 studies), Australia (2 studies), and Brazil (2 studies).
In 23 studies, interventions were delivered in outpatient, general practice, or primary care settings.
Included studies represented both men (median: 44.0%; 24 studies) and women (median: 55.0%; 24 studies).
Study populations included adults ages 18 years and older (median: 56.6 years; 23 studies).
Six studies reported race/ethnicity with study populations mainly identifying as white. One study included a study population with more than 75% identifying as African American.
All 26 evaluated interventions provided patients with blood pressure monitors and training, with patients measuring their blood pressure at home.
Twenty interventions provided patients with fully automated blood pressure monitor devices.
Patients’ blood pressure readings were delivered to healthcare providers during medical visits as self-recorded readings (16 studies), through electronic transmissions sent directly from blood pressure devices to central databases that providers could access (2 studies), or by mail (3 studies).

Summary of Results

The systematic review included 26 studies with 28 study arms.

Blood Pressure Outcomes
- Proportion of patients with blood pressure at goal: median increase of 6.9 percentage points (median duration: 6 months; 13 study arms)
- Change in mean systolic blood pressure: median reduction of 3.2 mmHg (median duration: 9 months; 18 study arms)
- Change in diastolic blood pressure: median reduction of 1.3 mmHg (median duration: 6 months; 21 study arms)
- Results were statistically significant at 6 months and continued to be favorable at 12 months, although they were smaller in magnitude and not statistically significant.
Other Outcomes
- No studies reported sickness or death outcomes.
- Findings were inconsistent for medication adherence, health-related quality-of-life, and patient satisfaction outcomes.

Summary of Economic Evidence

The economic review included 8 studies (search period through March 2015). Monetary values are reported in 2014 U.S. dollars.

There was not enough evidence to determine cost-effectiveness of the interventions when used alone. However, the averted cost of medication and outpatient visits exceeded the intervention cost.
No studies reported the effect of the intervention on worksite productivity or provided a full assessment for cost-benefit analysis.
The median intervention cost was $60 per person (7 studies).
Five of six total cost estimates were negative (median: -$72 per person) over a median follow-up period of 12 months, indicating the intervention is cost-saving.

Applicability

Based on results for interventions in different settings and populations, findings are applicable to the following:

Adults with high blood pressure
Women and men
Outpatient, general practice, and primary care settings

Evidence Gaps

The effectiveness of blood pressure monitoring interventions that require patients to provide their own blood pressure monitoring devices. In all of the included studies, blood pressure monitoring devices were provided to patients.
How often patients should measure their blood pressure, and how often clinicians should monitor patients’ self-measured blood pressure readings.
The role of telemedicine in self-measured blood pressure monitoring interventions, and how it affects patient-provider interaction and medication management.
The effectiveness of self-measured blood pressure monitoring interventions among various subgroups including racial/ethnic minorities, low-income populations, patients with comorbidities, and children.
Long-term benefits of self-measured blood pressure monitoring interventions that last longer than 12 months, including effects on rates of sickness and death.
The effectiveness of self-measured blood pressure monitoring interventions in community and worksite settings, and whether they strengthen community-clinical linkages.
The intervention cost when the cost of devices and software used in self-measured blood pressure monitoring interventions are distributed over the duration of their use.
Returns on investment in self-measured blood pressure monitoring interventions, based on the monetized value of benefits including reduced mortality and averted productivity losses.

Implementation Considerations and Resources

Million Hearts released two action guides on self-measured blood pressure monitoring interventions based on findings from Uhlig et al. (2013):

The following considerations for implementation are drawn from information provided in these actions guides.

Implementers need to consider the type of blood pressure monitor patients use. The action guides suggest monitors with an automated upper arm cuff.
Programs that require patients to provide their own blood pressure monitors should have patients bring them into their doctors’ offices now and then to ensure proper use and function.
Some patients may not be able to afford their own blood pressure monitor. In 2015, the cost of an automated blood pressure device ranged from $50 to $100. Insurance benefits for blood pressure monitors vary by payer.
Although face-to-face office visits remain an important form of interaction between patients and clinicians, healthcare providers may incorporate other forms of care such as electronic and phone communication that could make care more effective, timely, and efficient.
Reimbursement mechanisms for telemedicine, which could be a large component of some blood pressure monitoring interventions, should be considered.

Crosswalks

Healthy People 2030 icon Healthy People 2030 includes the following objectives related to this CPSTF recommendation.