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- Current issue May 29,2008
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American Heart Association rapid access journal report:
American Heart Association joint scientific statement
High blood pressure patients advised to use home monitors
DALLAS — People with hypertension should routinely monitor their blood pressure at home to help manage the disease, according to a new joint scientific statement from the American Heart Association, American Society of Hypertension and the Preventive Cardiovascular Nurses' Association.
The statement is published online in Hypertension: Journal of the American Heart Association, the Journal of the American Society of Hypertension and the Journal of Clinical Hypertension and printed in the June issue of Journal of Cardiovascular Nursing.
“High blood pressure is notoriously difficult to treat to goal – many patients fail to reach target levels despite treatment, and studies show home monitoring can help,” said Thomas G. Pickering, M.D., D.Phil., chair of the statement writing group. Blood pressure measurement and tracking could be improved with home monitoring by the patients themselves, in much the way people with diabetes monitor their blood sugar levels with home glucose monitors.”
He said there is strong evidence that the traditional way of measuring blood pressure in adults can be misleading. Studies indicate that between 10 percent and 20 percent of people diagnosed with high blood pressure in the doctor's office actually have the ‘white coat effect,' meaning that their pressures are normal under other conditions, but rise in the medical setting.
“It is also believed that some people with normal blood pressures in their doctors' offices have pressures that spike to potentially dangerous levels in other situations,” said Pickering, director of the Center for Behavioral Cardiovascular Health at Columbia Presbyterian Medical Center in New York, N.Y.
According to the statement, home monitoring is particularly useful in the elderly, in whom both blood pressure variability and the white coat effect are increased, as well as in patients with diabetes, patients with kidney disease and in pregnant women. Many types of home monitors are relatively inexpensive at less than $100.
Pickering noted that because everyone's blood pressure is highly variable during the day, taking one reading at a doctor's office every few months doesn't give a complete picture of a person's condition. Home monitors can take multiple measurements during each session, and can be used at different times of day. Many monitors also store and average blood pressure readings over time, providing crucial data for patients to take to their physicians so they can work as a team to diagnose and treat the condition.
“Home blood pressure monitoring also gives patients the physiologic feedback they need to see regarding blood pressure,” says Nancy Houston Miller, R.N., co-author and former president of the Preventive Cardiovascular Nurses Association. “Rather than 3-4 office blood pressure checks per year, if they measure blood pressure at home in addition to following up with their healthcare provider, patients are likely to achieve goals more quickly and be confident that medicines are working for them.” She also states that nurses and nurse practitioners have a significant role to play in interpreting data from blood pressure devices and educating patients about needed lifestyle interventions and medications.
“We're encouraged by this joint statement on the value of home blood pressure monitoring and confident it will be helpful in reducing the incidence of heart attack, stroke and kidney disease,” said Suzanne Oparil, M.D., president of the American Society of Hypertension.
Hypertension increases the risk of heart attack and stroke and controlling it is essential to reducing that risk. The statement writing group said home blood pressure monitoring is evidence-based healthcare that can improve the quality and lower the cost of caring for the 73 million people with hypertension.
Although earlier American Heart Association guidelines have included home monitors, this is the first statement to have detailed recommendations on their use.
* Patients should purchase oscillometric monitors with cuffs that fit on the upper arm. They should use a proper fitting cuff, and ask a healthcare provider the proper way to use the monitors.
* Wrist monitors are NOT recommended.
* Patients should take two or three readings at a time, one minute apart, while resting in a seated position. The arm should be supported, with the upper arm at heart level, and your feet on the floor (back supported, legs uncrossed). It's important to take the readings at the same time each day, such as morning and evening, or as your healthcare professional recommends.
* Use of a home monitor can confirm suspected or newly diagnosed hypertension and rule out diagnosis for patients whose readings at the doctor's office don't reflect their actual pressures over time.
* Home monitoring can be used to evaluate the response to any type of antihypertensive treatment, and to motivate patients to take their medications regularly.
* The target goal for treatment with a home monitor is less than 135/85 millimeters of mercury (mmHg), or less than 130/80 in high-risk patients.
“I hope this leads to a new era in patient-doctor partnerships,” Pickering said. “I think this is a very healthy trend and with a condition like high blood pressure, it really does depend on the patients remembering to change their lifestyles or remembering to take their pills.”
Only a few of the home blood pressure devices on the market have been subjected to proper validation tests such as the Association for the Advancement of Medical Instrumentation (AAMI) and British Hypertension Society (BHS) protocols. Several devices have failed the tests. An up-to-date list of validated monitors is available on the BHS Web site, http://www.bhsoc.org/default.stm.
Co-authors include Nancy Houston Miller, R.N.; Gbenga Ogedegbe, M.D., M.P.H.; Lawrence R. Krakoff, M.D.; Nancy T. Artinian, Ph.D., R.N.; and David Goff, M.D., Ph.D.
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Editor's note:
The American Heart Association's online Blood Pressure Management center features Microsoft's HealthVault tool, which allows patients to track their blood pressure readings, weight and physical activity. Patients can record data as often as they like, view it online in a chart or table, and easily print it to share with their doctor. The high blood pressure Web site also contains educational information and resources that patients can use to help achieve their blood pressure goal. For information about high blood pressure and access to the Blood Pressure Management Center, visit www.americanheart.org/bptools .
High Blood Pressure Facts
About High Blood Pressure
High blood pressure is the biggest risk factor for stroke, and a major risk factor for heart attack, heart failure and kidney failure. High blood pressure adds to the workload of your heart and arteries. If high blood pressure continues for a long time, your heart and arteries may not work as well as they should. When this happens, your heart becomes strained and blood vessels may become damaged. Changes in the vessels that supply blood to your kidneys and brain may cause these organs to be affected. Your heart, brain and kidneys can handle increased pressure for a long time without any symptoms or ill effects, but that doesn't mean it's not hurting you.
How blood pressure is measured
Blood pressure is written as a fraction of two numbers, the top one representing the pressure when the heart beats (called systolic pressure) and the bottom indicates the pressure between beats (called diastolic pressure).
* Optimal blood pressure is below 120/80 mmHg (millimeters of mercury) for adults.
* Prehypertension is systolic pressure of 120 to 139 mmHg or a diastolic pressure of 80 to 89 mmHg. Blood pressure at this level should be watched carefully.
* High blood pressure is 140/ 90 or higher.
Statistics:
* About 73 million American adults age 20 and older have HBP.
* Nearly one in three U.S. adults has HBP.
* More than 40 percent of African Americans have HBP.
* 28 percent of people with HBP don't know they have it.
* Of all people with HBP: 35.1 percent have it under control and 64.9 percent do not have it under control.
* Among adults age 20 and older in the United States, the following have HBP:
o For non-Hispanic whites, 32.5 percent of men and 31.9 percent of women.
o For non-Hispanic blacks 42.6 percent of men and 46.6 percent of women.
o For Mexican Americans, 28.7 percent of men and 31.4 percent of women.
* About 69 percent of people who have a first heart attack, 77 percent who have a first stroke, and 74 percent who have congestive heart failure have blood pressure higher than 140/90 mm Hg.
Online Tools and Resources:
* Available at www.americanheart.org/bptools
* Patients have access to free online tools and resources to track and manage their blood pressure
* Tools include:
o Blood Pressure Management Center (in alliance with Microsoft HealthVault)
o Heart Profilers (a treatment decision tool)
o Blood Pressure Risk Calculator
o Printable blood pressure tracker