Home-Test Program Helps Cut Blood Pressure

Tracking blood pressure at home and having a pharmacist adjust medicines can improve blood pressure control, a new study finds. The study included 450 adults with blood pressure that was hard to control. They were randomly divided into 2 groups. People in 1 group received a home blood pressure monitor. They talked with a pharmacist about how to use it. They also got advice on how to lower blood pressure with diet, exercise and other lifestyle changes. Then they regularly took blood pressure readings for 6 months. The monitor transmitted results to a pharmacist, who adjusted medicines if needed. The second group just received usual care from their doctors. After 6 months, nearly 72% of those in the home testing group had their blood pressure under control, compared with 45% in the usual-care group. The program stopped, but researchers kept track of people through the 1-year mark. By that point, 72% of the home testing group and 57% of the usual-care group had good control. The Journal of the American Medical Association published the study. HealthDay News wrote about it July 2.

By Howard LeWine, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

About 75 million Americans have hypertension. That's high blood pressure, with average readings of 140/90 or higher. If not reduced to a normal range, high blood pressure greatly increases your risk of:

• Stroke
• Heart attack
• Heart failure
• Kidney damage

Yet only one-half of people who have been diagnosed with high blood pressure have it treated adequately.

Your blood pressure changes from hour to hour, sometimes even minute to minute. All kinds of things influence your blood pressure. Examples include the time of day, watching an exciting show on television, eating a meal, listening to soothing music and being stressed. And, for many people, getting your blood pressure checked in the doctor's office makes it shoot up.

Since your blood pressure jumps around so much, can two to four readings per year by your doctor determine how best to treat high blood pressure? You are more likely to get accurate readings by checking your blood pressure at home. And more accurate readings will help you and your health care team to keep your readings in the normal range.

Those are conclusions of this study and of many others that used a team approach and home readings for blood pressure management. In this study, the researchers recruited pharmacists to be part of the team, along with nurses. Doctors were not directly involved in blood pressure management.

The basic model in this study and prior studies has these main features:

• Home blood pressure recorded using an electronic device several times per week
• Blood pressure taken at different times of the day
• Record keeping that includes the time of day blood pressure was measured
• Regular contact with a health care professional, often weekly or every other week at the start of the study
• Several roles for the health care professional, including:
  • Reinforcing the importance of weight control, diet and exercise
  • Recommending changes in drug treatment, if needed

What Changes Can I Make Now?

If you have high blood pressure, a home blood pressure monitor is a great investment. Check with your health insurance company. It might be covered, or at least you might get a discount.

When buying a blood pressure monitor, get one that fits on the upper arm. The wrist and finger models are less accurate. The cost is between $40 and $100. The devices are available at drugstores and medical specialty shops, as well as through catalogs and on the Internet.

Here are some tips to get you started with your home monitor:

• If you smoke or drink coffee, wait at least 30 minutes after having a cigarette or cup of coffee before taking your blood pressure.
• Sit quietly for a few minutes before beginning.
• After taking your blood pressure, relax for a minute. Then take it again.
• At first, take your blood pressure twice a day for a week. The best times of day are early in the morning, before you have taken your blood pressure pills, and again in the evening.
• Don't panic if one or two readings are higher than usual. Blood pressure changes throughout the day, sometimes from minute to minute. It's the trend that's important.

Arrange to take the monitor to your doctor's office to check its accuracy and your technique. Ask your doctor how home blood pressure readings can be used in your care.

What Can I Expect Looking to the Future?

Given the shortage of primary care doctors and high rates of high blood pressure, home monitoring with advice from health professionals other than doctors will become the norm. We will need to continue to study different models of high blood pressure care.

For example, can we develop action plans for high or low blood pressure readings, similar to what is now standard in asthma care? Self-adjustment of medicines, with backup from nurses or other health professionals, could be very effective and reduce costs.