Hypertension
Olivia C. Welter, PharmD
Do health care providers need to standardize their approach when educating patients on home BP measurement? Based on their findings, authors of a research article in the January 2025 issue of the American Heart Association’s (AHA) journal Hypertension think so.
The study by Clapham and colleagues investigated whether Australian patients followed AHA’s home BP measurement guideline recommendations accurately. Of 350 middle-aged patients, 90% reported measuring their BP while seated, and 77% said they position the BP cuff on their bare arm rather than over clothing. This indicates that most patients understand generally how to position themselves and their BP cuff to obtain an accurate BP reading.
However, only 15% of surveyed patients measured their BP in both the morning and evening, and only one-third of study participants reported receiving home BP measurement education. Patients generally indicated that they only received vague verbal instructions on appropriate home BP measurement from a health care provider.
Based on the results of the study, authors concluded that without appropriate education by a health care provider, patients may take their BP at inappropriate times with improper positioning, which can increase the likelihood of elevated BP readings.
Guidelines
To ensure accurate BP measurements at home, AHA recommends that patients avoid smoking, exercising, and consuming caffeinated or alcoholic beverages 30 minutes prior to home BP measurement. Additionally, AHA directs patients to sit upright with uncrossed legs and their arm resting comfortably on a flat surface at heart level while the reading is being taken. AHA instructs patients to wrap the BP cuff just above the bend of the elbow on bare skin and suggests taking two separate BP readings 1 minute apart both in the morning before taking any medication and in the evening just before going to sleep.
AHA offers resources, including infographics, to help patients better understand the proper methods for home BP measurement. AHA also created a template BP recording log, in partnership with the American Medical Association (AMA), that gives patients an easy way to sufficiently track their BP readings and share them with their provider.
Pharmacists can direct patients to the AHA website or provide printed materials to ensure patients can appropriately access these resources.
Pharmacists’ role
When a patient is directed by their health care provider to use a home BP monitor, they often visit their pharmacy to purchase a device. Because of this, pharmacists can play a critical role in ensuring patients are obtaining accurate BP measurements at home, starting with selecting an appropriate device.
AMA offers a list of validated BP devices that meet the highest standard for accuracy. Pharmacists can review this list to ensure their pharmacy stocks only validated devices that they can confidently recommend to patients. When a patient purchases a BP monitor, pharmacists can then provide patient education on how to appropriately use the device at home and share their BP readings with their health care provider.
Additionally, pharmacists in some states may be able to implement a remote BP monitoring service to manage their patients’ BP.
An abstract by Bitton and colleagues published in Hypertension in October 2024 found positive outcomes when pharmacists were involved in BP management. In the study, up to 74% of adults with treatment-resistant hypertension successfully lowered their BP through a program that combined remote patient monitoring via Bluetooth BP devices and pharmacist interventions. The study also found that 65% of participating patients directly interacted with a pharmacist via telehealth to discuss hypertension management, and these interactions were associated with a 1.3 mm Hg per month decline in systolic BP. ■