title: Self-monitoring blood pressure in patients with hypertension: an internet-based survey of UK GPs.
abstract: BACKGROUND
  Previous research suggests that most GPs in the UK use self-monitoring of blood pressure (SMBP) to monitor the control of hypertension rather than for diagnosis. This study sought to assess current practice in the use of self-monitoring and any changes in practice following more recent guideline recommendations.
  
  
  OBJECTIVE
  To survey the views and practice of UK GPs in 2015 with regard to SMBP and compare them with a previous survey carried out in 2011.
  
  
  METHODS
  Web-based survey of a regionally representative sample of 300 UK GPs.
  
  
  METHODS
  GPs completed an online questionnaire concerning the use of SMBP in the management of hypertension. Analyses comprised descriptive statistics, tests for between-group differences (z, Wilcoxon signed-rank, and χ2tests), and multivariate logistic regression.
  
  
  RESULTS
  Results were available for 300 GPs (94% of those who started the survey). GPs reported using self-monitoring to diagnose hypertension (169/291; 58%; 95% confidence interval (CI) = 52 to 64) and to monitor control (245/291; 84%; 95% CI = 80 to 88), the former having significantly increased since 2011 (from 37%; 95% CI = 33 to 41; P<0.001) with no change in monitoring for control. More than half of GPs used higher systolic thresholds for diagnosis (118/169; 70%; 95% CI = 63 to 77) and treatment (168/225; 75%; 95% CI = 69 to 80) than recommended in guidelines, and under half (120/289; 42%; 95% CI = 36 to 47) adjusted the SMBP results to guide treatment decisions.
  
  
  CONCLUSIONS
  Since new UK national guidance in 2011, GPs are more likely to use SMBP to diagnose hypertension. However, significant proportions of GPs continue to use non-standard diagnostic and monitoring thresholds. The use of out-of-office methods to improve the accuracy of diagnosis is unlikely to be beneficial if suboptimal thresholds are used.
authors: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
authors: Benjamin R
authors: BR
authors: Fletcher
authors: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
authors: Lisa
authors: L
authors: Hinton
authors: School of Psychology, University of Central Lancashire, Preston.
authors: Emma P
authors: EP
authors: Bray
authors: Faculty of Medicine, University of New South Wales, Sydney, Australia.
authors: Andrew
authors: A
authors: Hayen
authors: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
authors: Fd Richard
authors: FR
authors: Hobbs
authors: Primary Care Unit, University of Cambridge, Cambridge.
authors: Jonathan
authors: J
authors: Mant
authors: Norwich Medical School, University of East Anglia, Norwich.
authors: John F
authors: JF
authors: Potter
authors: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
authors: Richard J
authors: RJ
authors: McManus
mesh_terms: D001291:Attitude of Health Personnel; D018660:Blood Pressure Monitoring, Ambulatory; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000517:prevention & control; D020407:Internet; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012648:Self Care / Q000706:statistics & numerical data*; D006113:United Kingdom
keywords: blood pressure monitoring, self; general practice; hypertension