Less than half of the 100 million-plus American adults with hypertension have their blood pressure (BP) under control, according to the most recent data from the American Heart Association (AHA). With a need for better BP control in patients, a South Florida practice turned to a self-measured blood pressure (SMBP) pilot program to improve the accuracy of hypertension diagnosis and help patients adhere to treatment.
The new hypertension guideline from the American College of Cardiology and the AHA calls for greater emphasis on self-monitoring for high blood pressure diagnosis and treatment. Because knowing the BP of a patient outside the clinic setting is more predictive of future cardiovascular events than their in-office blood pressure, Community Health of South Florida Inc. (CHI) in Miami piloted the Target: BP SMBP program. CHI has 11 primary care clinics in South Florida, and was honored in 2017 as a Target: BP Recognition Program participant.
After conclusion of the pilot, physicians were more confident in their ability to accurately diagnose high blood pressure and saw an increase in BP control.
“We did an average of their blood pressures and it was improved compared to what they were getting at the center,” said Carine Astree, a care coordinator at CHI.
When a patient takes their BP measurement at home, it can better predict cardiovascular morbidity and mortality rather than a single, routine office visit. These out-of-office BP measurements help to confirm the diagnosis of hypertension in patients. In some studies, up to 35 percent of patients with elevated office BP measurements have normal BP when measured outside of the office. This phenomenon is known as white-coat hypertension.
Another benefit of SMBP is the ability to diagnose masked hypertension. Masked hypertension, which occurs in up to 30 percent of patients, is when BP is normal in a clinical setting but high when measured outside of the office.
Using SMBP can help prevent misclassification of blood pressure, confirm a diagnosis and encourage patients to participate in the management of their condition.
Engaged patients improve care
A series of SMBP measurements taken over longer periods of time provide a more accurate picture of a patient’s BP than a single BP measured in a doctor’s office. SMBP also helps to more accurately assess whether or not a patient’s BP is controlled. This enables the physician to determine the effectiveness of treatment.
When patients use SMBP monitoring, they are more likely to adhere to treatment. This includes both pharmacologic and nonpharmacological treatment, such as healthy lifestyle changes.
“The patient is engaged in the whole process,” said Elizabeth Philippe, MD, chief of family medicine at CHI. She is also the associate graduate medical education director of CHI’s Teaching Health Center.
“It helped them by being able to take their blood pressure at home to understand the numbers and to see how it can help with the outcome,” she added.
“Self-measured blood pressure can really make a difference in increased awareness—not just for the patients, but their families as well,” said Saint Anthony Amofah, MD, chief medical officer at CHI. He is also the chief academic officer for the Brodes H. Hartley Jr. Teaching Health Center at CHI, as well as the medical director of Health Choice Network.
“We have to multiply the effect of what we learned in the small pilot, and the more patients that can be touched, the better the chances,” Dr. Amofah said.
Personalize care workflows
For the SMBP pilot, CHI focused on using care coordinators to help with patient consent, education, checking out and returning the machines, and documenting BP data.
However, with so many different sites in their network, Dr. Amofah believes it is important to re-examine how they can “personalize the existing workflow and have care teams across the organization be involved in it.” This is so teams do not have to wait for care coordinators, who are limited.
“We know that those patients, their families and the communities that we serve would also have the benefit of the appreciation of the importance of this. So implementation in all the sites becomes very crucial,” he said.
Improving the care provided to patients with hypertension can benefit from a team-based approach, which includes training to enhance the care team’s knowledge of SMBP, educating patients and embedding SMBP into workflows.
With the success of the pilot, CHI aims to “extend the service to all patients so they can all be accurate in self-measured blood pressure at home to assist the physician in the overall control of hypertension,” said Dr. Philippe.
The Target: BP SMBP program provides a host of positive benefits for patients. Proper communication with patients and a system for managing and interpreting SMBP measurements are required for the program to be effective. Learn how SMBP can help improve the diagnosis and management of patients with high blood pressure to improve blood pressure control.