Hypertension management in managed care: the role of home blood pressure monitoring.
The interest in home blood pressure monitoring (HBPM) has grown with the widespread availability of blood pressure measurement devices, greater patient involvement in self care, and recognition of the limitations of office blood pressure monitoring (OBPM), and the expense and inconvenience of ambulatory blood pressure monitoring. HBPM is inexpensive, reproducible, and easy to learn. It can be helpful in identifying white-coat hypertension and midiagnosis, both of which may result in patients who do not have the disease being treated for hypertension and failure to maintain 24 h control of blood pressure. White-coat hypertension has been reported for about 25% and misdiagnosis for 18% of patients diagnosed with hypertension. In limited research, HBPM has been shown to reduce the number of clinic visits, the number of switches of medication, and the number of antihypertensives prescribed, and to improve control of blood pressure. Moreover, results from one large study suggest that measurements obtained via HBPM are correlated to overall mortality better than are those from OBPM. Although normal limits for blood pressure have been defined for OBPM, they have not yet been defined for HBPM. Research is now under way to confirm the clinical and economic impact of HBPM in the managed-care setting. If current data suggesting the benefit of HBPM are confirmed, the widespread adoption of this technique could improve patient care and reduce the costs of managing hypertension.
Wilson
MD
Health Core, Inc., Newark, Delaware, USA.
Johnson
KA