Clinical Context

Blood pressure (BP) monitoring outside of the clinic setting is recommended for all patients with hypertension, and a previous study by Margolis and colleagues suggested why this intervention is important. They followed up on a cohort of patients who had been randomly assigned to receive home BP telemonitoring vs no such monitoring for a 1-year period, with adjustments of therapy by pharmacists based on home BP readings. This study found that the home BP monitor was associated with lower BP values through 2 years after randomization.

Margolis and colleagues followed up on this cohort for rates of cardiovascular (CV) events at 5 years, and their results were published in the August 31, 2020 issue of Hypertension.^[1] The odds ratio for CV events in comparing the home BP monitor and control groups was 0.49 (95% CI: 0.21, 1.13). Moreover, the telemonitoring program was found to save approximately $1900 per patient.

Are patients taking the advice regarding ambulatory BP monitoring to heart? The current study by Springer and colleagues addresses this issue.

Study Synopsis and Perspective

Just over 51% of older hypertensive adults regularly check their own BP compared with 48% of persons with blood pressure-related health conditions (BPHCs), according to a 2021 survey of individuals aged 50 to 80 years.

"Guidelines recommend that patients use self-measured blood pressure monitoring (SBPM) outside the clinic to diagnose and manage hypertension," but just 62% of respondents with a BPHC and 68% of respondents with hypertension said that they had received such a recommendation from a physician, nurse, or other healthcare provider (HCP), Melanie V. Springer, MD, and associates said in JAMA Network Open.^[2]

Figure 1.

The prevalence of regular monitoring among persons with hypertension, 51.2%, does, however, compare favorably with an earlier study^[3] showing that 43% of adults aged 18 and older regularly monitored their BP in 2005 and 2008, "which is perhaps associated with our sample's older age," said Springer and associates of the University of Michigan, Ann Arbor, Michigan.

The current study,^[2] they noted, is the first to report "SBPM prevalence in adults ages 50 to 80 years with hypertension or BPHCs, who have a higher risk of adverse outcomes from uncontrolled BP than younger adults." 

The analysis is based on data from the National Poll on Healthy Aging, conducted by the University of Michigan in January 2021 and completed by 2023 individuals.

The frequency of home monitoring varied among adults with BPHCs, as just under 15% reported daily checks, and the largest proportion, about 28%, used their device 1 to 3 times per month. The results of home monitoring were shared with HCPs by 50.2% of respondents with a BPHC and by 51.5% of persons with hypertension, they said in the research letter.

Home monitoring's less-than-universal recommendation by providers and use by patients "suggest that protocols should be developed to educate patients about the importance of SBPM and sharing readings with clinicians and the frequency that SBPM should be performed," Springer and associates wrote.

The study was funded by the AARP), Michigan Medicine, the National Institute of Neurological Disorders and Stroke, and the Department of Veterans Affairs. One investigator has received consulting fees or honoraria from AbilTo, the American Diabetes Association, the Donaghue Foundation, HealthMine, the Kaiser Permanente Washington Health Research Institute, Kansas City Area Life Sciences Institute, Luxembourg National Research Fund, the Robert Wood Johnson Foundation, and SeeChange Health. 

Study Highlights

• Investigators drew study data from the University of Michigan National Healthy Poll on Aging, which was conducted among US residents between the ages of 50 and 80 years in January 2021. 
• The current study by Springer and colleagues focuses on participants who reported that they had hypertension or cardiorenal complications associated with hypertension. The primary outcome was the use of SBPM. 
• Participants were also queried about why or why not they used SBPM and physician attitudes and engagement in SBPM.
• 2583 adults were asked to participate in the survey, and 2023 (78%) did so: 61.6% of these participants had hypertension or a cardiorenal complication, and this body formed the study cohort; 84.2 of these patients had hypertension only.
• The mean age of participants with hypertension or a complication was 64 ± 0.26 years. 51% were men, and 70.9% were White. 12.3% and 11% of participants were Black and Hispanic, respectively.
• 74% of participants with hypertension or a complication owned a SBPM device. The most common reason for not owning a device was not understanding that it was recommended (54%) and that it was too expensive (16%).
• 61.6% of participants said that their healthcare provider had advised them regarding SBPM, but only 47.9% reported regularly monitoring their BP. 

Figure 2. Rates of Owning and Using an SBPM Device

 

• Of participants who monitored BP, 45% reported doing so, on average, less than weekly.
• Age, sex, and race/ethnicity failed to significantly influence the use of SBPM. Better self-perceived mental health was associated with higher rates of monitoring, and a physician recommendation to perform SBPM was associated with an odds ratio of 3.51 (95% CI: 2.43, 5.07) for completing SBPM.
• Half of respondents shared their SBPM readings with an HCP, and 88% of these participants reported receiving feedback on those readings.

Clinical Implications

• A previous study by Margolis and colleagues found that a 12-month program of telemonitoring of home BP values resulted in reduced BP among adults with hypertension at 24 months, as well as a 51% nonsignificant reduction in CV events at 5 years and substantial cost savings per patient.
• In the current study by Springer and colleagues, almost three-quarters of participants with hypertension and/or cardiorenal complications reported owning a SBPM device, but fewer than half regularly monitored their BP. Better self-reported mental health and, especially, a recommendation from a HCP were associated with higher rates of SBPM.

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