Home blood pressure monitoring for patients with hypertension

OTCs today

 

Welcome to the 2012 version of the OTCs Today column. We’re taking a new approach this year and basing topics on general monthly health themes, as well as including pertinent information from updates to the 17th edition of the Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care. The Handbook editors will team up to write these columns, and we hope you find the information useful in your practice and the care of your patients.

The focus for January Pharmacy Today is cardiology and cardiovascular health. Many folks’ New Year’s resolutions probably included losing weight, healthier eating, getting in better shape, or generally doing a better job of taking care of themselves. For people with conditions such as hypertension, we hope their resolutions included some aspect of improved blood pressure management through adherence to medications and lifestyle changes.

According to a 2007–08 report of the CDC National Center for Health Statistics, slightly more than 31% of adults 20 years or older have been diagnosed with hypertension. Of these, CDC said that approximately 56% are uncontrolled, suggesting that the prescribed intervention (lifestyle, medication, or both), for whatever reason, was ineffective. A challenge commonly seen in the community setting is that patients often don’t monitor their blood pressure at home, so they’re not obtaining regular feedback to help guide them to be more adherent or to show them the benefits of their efforts. Pharmacists are in a perfect position to educate patients on the benefits of home monitoring and controlling their blood pressure.

The beneficial role of community pharmacists in helping patients manage hypertension has been documented in numerous studies. A meta-analysis of the impact of pharmacists’ interventions on blood pressure reduction showed significant reduction of systolic blood pressure and additional positive effects on diastolic blood pressure, quality of life, and adherence.1

Home blood pressure monitoring could lead to better blood pressure control because of an increase in the number of measurements in different settings.2,3 In fact, it was recently suggested that home blood pressure monitoring provides data at least as important as clinic readings in determining certain outcomes.4

Available devices can be used on the upper arm and forearm/wrist area. Devices designed for use on the upper arm were found to be more accurate than those designed for wrist measurement.5 The Omron HEM-1020 and Omron i-Q132 devices were shown to be accurate and provide valid measurements compared with a traditional mercury sphygmomanometer.6 Pharmacists need to take advantage of an important educational opportunity by instructing patients on the specifics of devices, including correct posture and proper cuff wrapping.6 Features to consider when selecting a product are included in Table 1.

More recently, companies such as Withings and iHealth Lab Inc. have released monitors that are compatible with Apple devices such as the iPhone and iPod Touch. When determining a monitor to recommend, pharmacists should inquire about patients’ interest in the latest technology, as one of the Apple-compatible products may be an ideal fit.

Pharmacists can assist individuals with hypertension in the self-care arena in many ways. In addition to some of the traditional lifestyle recommendations, pharmacists can suggest home monitoring and recommend the most appropriate device to fit each patient. As the most accessible health care providers, we should take the initiative to help coordinate care and evaluate response to therapy for patients with hypertension.

References

  1. Machado M, Bajcar J, Guzzo GC, Einarson TR. Sensitivity of patient outcomes to pharmacist interventions: part II: systematic review and meta-analysis in hypertension management. Ann Pharmacother. 2007;41:1770–81.
  2. Krakoff LR. Home blood pressure for the management of hypertension: will it become the new standard of practice? Expert Rev Cardiovasc Ther. 2011;9:745–51.
  3. Powers BJ, Olsen MK, Smith VA, et al. Measuring blood pressure for decision making and quality reporting: where and how many measures? Ann Intern Med. 2011;154:781–8, W-289–90.
  4. Sheik S, Sinha AD, Agarwal R. Home blood pressure monitoring: how good a predictor of long-term risk? Curr Hypertens Rep. 2011;13:192–9.
  5. Akpolat T, Dilek M, Aydogdu T, et al. Home sphygmomanometers: validation versus accuracy. Blood Press Monit. 2009;14:26–31.
  6. Takahashi H, Yoshika M, Yokoi T. Validation of home blood pressure-monitoring devices, Omron HEM-1020 and Omron i-Q132 (HEM-1010-E), according to the European Society of Hypertension International Protocol. Blood Press Monit. 2011;16:203–7.