Heart Disease and Stroke Prevention: Self-Measured Blood Pressure Monitoring Interventions for Improved Blood Pressure Control When Combined with Additional Support

The systematic review included 25 studies with 29 study arms.

• Blood Pressure Outcomes
  • Proportion of patients with blood pressure at goal: median increase of 5.3 percentage points (median duration: 9 months; 18 study arms)
  • Change in mean systolic blood pressure: median reduction of 4.6 mmHg (median duration: 12 months; 26 study arms)
  • Change in diastolic blood pressure: median reduction of 2.3 mmHg (median duration: 9 months; 28 study arms)
  • Results demonstrated consistent and meaningful improvements in blood pressure that were sustained at 12 months when compared with usual care.
• Other Outcomes
  • One study conducted over a five year period reported lower death rates among patients receiving self-measured blood pressure monitoring combined with educational sessions compared with patients receiving usual care.
  • Findings were inconsistent for outcomes measuring medication adherence, health-related quality-of-life, or patient satisfaction.

The economic review included 16 studies (search period through March 2015): 8 studies of self-measured blood pressure monitoring with additional support, and 8 studies of self-measured blood pressure monitoring with team-based care. All monetary values are reported in 2014 U.S. dollars.

• Economic evidence indicates self-measured blood pressure monitoring interventions are cost-effective when they are used with either additional support or within team-based care.
• No studies reported the effect of the intervention on worksite productivity.
• No studies provided a full assessment for cost-benefit analysis.
• Intervention Cost
  • The cost of interventions that added patient support included the cost of self-measured blood pressure monitoring alone plus the cost of web- or phone-based support.
    • The median intervention cost per person was $174 (7 studies)
  • The cost of interventions used within team-based care included the cost of self-measured blood pressure monitoring alone plus the labor cost of staff engaged in team care.
    • The median intervention cost per person was $732 per year (6 studies)
• Intervention Cost and Healthcare Cost
  • The intervention cost plus the change in healthcare cost equals the total cost of the intervention.
    • Healthcare cost is defined as the cost for medication, outpatient visits, hospital inpatient stays, and emergency room visits.
    • When the estimated total cost is positive, the intervention is cost-increasing; when it is negative, the intervention is cost-saving.
  • Self-measured blood pressure monitoring with additional support:
    • Five of six total cost estimates were positive (median: $44 per person) over a median follow-up period of 9 months, indicating the intervention was cost-increasing.
  • Self-measured blood pressure monitoring interventions within team-based care:
    • All seven estimates of total cost were positive (median: $430 per person per year) over a median follow-up period of 18 months, indicating the intervention was cost-increasing.
• Cost-Effectiveness
  • Two methods from the literature (Mason et al., 2005; McEwan et al., 2006) were used to translate reductions in systolic blood pressure to quality-adjusted life year (QALY) saved. An intervention is considered cost-effective if cost per QALY saved is less than $50,000.
  • Four studies of self-measured blood pressure monitoring with additional support indicated cost-effectiveness (medians of $2800 and $4000 per QALY saved).
  • Four studies of self-measured blood pressure monitoring used within team-based care indicated cost-effectiveness (medians of $7500 and $10,800 per QALY saved)

• Adults with high blood pressure
• Adults with both high blood pressure and diabetes
• Women and men
• Outpatient, general practice, and primary care settings

• The effectiveness of blood pressure monitoring interventions that require patients to provide their own blood pressure monitoring devices. In all of the included studies, blood pressure monitoring devices were provided to patients.
• How often patients should measure their blood pressure, and how often clinicians should monitor patients’ self-measured blood pressure readings.
• The effectiveness and costs of different types of additional support provided to determine whether one form of additional support is more effective than another.
• The role of telemedicine in self-measured blood pressure monitoring interventions, and how it affects patient-provider interaction and medication management.
• The effectiveness of self-measured blood pressure monitoring interventions among various subgroups including racial/ethnic minorities, low-income populations, patients with comorbidities, and children.
• Long-term benefits of self-measured blood pressure monitoring interventions lasting longer than 12 months, including effects on rates of sickness and death.
• The effectiveness self-measured blood pressure monitoring interventions in community and worksite settings and whether they strengthen community-clinical linkages.
• The intervention cost when the costs of devices and software used in self-measured blood pressure monitoring interventions are distributed over the duration of their use.
• Returns on investment in self-measured blood pressure monitoring interventions, based on the monetized value of benefits including reduced deaths and avoided productivity losses.

• Studies were done in the United States (13 studies), Western Europe (7 studies), Canada (3 studies), Australia (1 study), and South Korea (1 study). Interventions were delivered mainly in outpatient, general practice, or primary care settings (23 studies).
• In 19 of the studies, interventions were delivered in outpatient, general practice, or primary care settings.
• Included studies reported an even distribution of men (median: 47.5%; 24 studies) and women (median: 52.5%; 24 studies).
• Study populations included adults ages 18-64 years old (median: 57.2 years; 20 studies) and adults 65 years and older (median: 70.8 years; 3 studies).
• Thirteen studies reported race/ethnicity with study populations mainly identifying as white/Caucasian. Three studies included populations with more than 75% identifying as African American.
• Four studies that targeted populations with both high blood pressure and diabetes observed greater improvements in blood pressure outcomes compared to overall findings.
• All 25 of the included studies provided patients with blood pressure monitors and training, and patients measured their blood pressure at home.
• Fifteen studies provided patients with fully automated blood pressure monitor devices.
• Patients’ blood pressure readings were delivered to healthcare providers during medical visits as self-recorded readings (10 studies), through electronic transmissions sent directly from blood pressure devices to central databases that providers could access (9 studies), or by mail (2 studies).
• More than half of included studies used a team-based care arrangement where primary care providers worked alongside other healthcare professionals such as nurses and pharmacists to improve coordination of care and support for patients (14 studies).

Community Preventive Services Task Force. Self-Measured Blood Pressure Monitoring Improves Outcomes: Recommendation of the Community Preventive Services Task Force. American Journal of Preventive Medicine. 2017;53(3):e115–8.

Chattopadhyay SK, Jacob V, Mercer SL, Hopkins DP, Elder RW, Jones CD, Community Preventive Services Task Force. Community Guide Cardiovascular Disease Economic Reviews: Tailoring Methods to Ensure Utility of Findings. American Journal of Preventive Medicine. 2017;53(6S2):S155–63. Available at: http://www.sciencedirect.com/science/article/pii/S0749379717303227?via%3Dihub.

Shantharam SS, Mahalingam M, Rasool A, et al. Systematic Review of Self-Measured Blood Pressure Monitoring With Support: Intervention Effectiveness and Cost. American Journal of Preventive Medicine. 2022;62(2):285−98.

Effectiveness Review

Analytic Framework

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Economic Review

No content is available for this section.

Effectiveness Review

A summary evidence table for this Community Guide review is not available because the CPSTF finding is based on the following published systematic review:

Uhlig K, Patel K, Ip S, et al. Self-measured blood pressure monitoring in the management of hypertension. Annals of Internal Medicine 2013, 159(3):185-194.

Economic Review

• Summary Economic Evidence Table – SMBP with Additional Support
• Summary Economic Evidence Table – SMBP with Team-Based Care

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Effectiveness Review

Artinian NT, Flack JM, Nordstrom CK, et al. Effects of nurse-managed telemonitoring on blood pressure at 12-month follow-up among urban African Americans. Nurs Res 2007;56(5):312-22.

Artinian NT, Washington OG, Templin TN. Effects of home telemonitoring and community-based monitoring on blood pressure control in urban African Americans: a pilot study. Heart Lung 2001;30(3):191-9.

Binstock ML, Franklin KL. A comparison of compliance techniques on the control of high blood pressure. Am J Hypertens 1988;1(3 Pt 3):192S-4S.

Bosworth HB, Olsen MK, Grubber JM, et al. Two self-management interventions to improve hypertension control: a randomized trial. Ann Intern Med 2009;151(10):687-95.

Bosworth HB, Powers BJ, Olsen MK, et al. Home blood pressure management and improved blood pressure control: results from a randomized controlled trial. Arch Intern Med 2011;171(13):1173-80.

Dejesus RS, Chaudhry R, Leutink DJ, Hinton MA, Cha SS, Stroebel RJ. Effects of efforts to intensify management on blood pressure control among patients with type 2 diabetes mellitus and hypertension: a pilot study. Vasc Health Risk Manag 2009;5:705-11.

Earle KA, Istepanian RS, Zitouni K, Sungoor A, Tang B. Mobile telemonitoring for achieving tighter targets of blood pressure control in patients with complicated diabetes: a pilot study. Diabetes Technol Ther 2010;12(7):575-9.

Earp JA, Ory MG, Strogatz DS. The effects of family involvement and practitioner home visits on the control of hypertension. Am J Public Health 1982;72(10):1146-54.

Friedman RH, Kazis LE, Jette A, et al. A telecommunications system for monitoring and counseling patients with hypertension. Impact on medication adherence and blood pressure control. Am J Hypertens 1996;9(4 Pt 1):285-92.

Gran B. Non-pharmacological methods reduce drug use in the treatment of hypertension. A two-year trial in general practice. Scand J Prim Health Care 1991;9(2):121-8.

Green BB, Cook AJ, Ralston JD, et al. Effectiveness of home blood pressure monitoring, Web communication, and pharmacist care on hypertension control: a randomized controlled trial. JAMA 2008;299(24):2857-67.

Haynes RB, Sackett DL, Gibson ES, et al. Improvement of medication compliance in uncontrolled hypertension. Lancet 1976;1(7972):1265-8.

Johnson AL, Taylor DW, Sackett DL, Dunnett CW, Shimizu AG. Self-recording of blood pressure in the management of hypertension. Can Med Assoc J 1978;119(9):1034-9.

Magid DJ, Ho PM, Olson KL, et al. A multimodal blood pressure control intervention in 3 healthcare systems. Am J Manag Care 2011;17(4):e96-103.

Marquez Contreras E, Martel Claros N, Gil Guillen V, et al. [Control of therapeutic inertia in the treatment of arterial hypertension by using different strategies]. Aten Primaria 2009;41(6):315-23.

McManus RJ, Mant J, Bray EP, et al. Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomised controlled trial. Lancet 2010;376(9736):163-72.

Muhlhauser I, Sawicki PT, Didjurgeit U, Jorgens V, Trampisch HJ, Berger M. Evaluation of a structured treatment and teaching programme on hypertension in general practice. Clin Exp Hypertens 1993;15(1):125-42.

Parati G, Omboni S, Albini F, et al. Home blood pressure telemonitoring improves hypertension control in general practice. The TeleBPCare study. J Hypertens 2009;27(1):198-203.

Park MJ, Kim HS, Kim KS. Cellular phone and Internet-based individual intervention on blood pressure and obesity in obese patients with hypertension. Int J Med Inform 2009;78(10):704-10.

Pierce JP, Watson DS, Knights S, Gliddon T, Williams S, Watson R. A controlled trial of health education in the physician’s office. Prev Med 1984;13(2):185-94.

Rinfret S, Lussier MT, Peirce A, et al. The impact of a multidisciplinary information technology-supported program on blood pressure control in primary care. Circ Cardiovasc Qual Outcomes 2009;2(3):170-7.

Rudd P, Miller NH, Kaufman J, et al. Nurse management for hypertension. A systems approach. Am J Hypertens 2004;17(10):921-7.

Sawicki PT, Muhlhauser I, Didjurgeit U, Baumgartner A, Bender R, Berger M. Intensified antihypertensive therapy is associated with improved survival in type 1 diabetic patients with nephropathy. J Hypertens 1995;13(8):933-8.

Shea S. The Informatics for Diabetes and Education Telemedicine (IDEATel) project. Trans Am Clin Climatol Assoc 2007;118:289-304.

Zillich AJ, Sutherland JM, Kumbera PA, Carter BL. Hypertension outcomes through blood pressure monitoring and evaluation by pharmacists (HOME study). J Gen Intern Med 2005;20(12):1091-6.

Additional Studies Linked to Included Studies

Shea S, Weinstock RS, Starren J, et al. A randomized trial comparing telemedicine case management with usual care in older, ethnically diverse, medically underserved patients with diabetes mellitus. J Am Med Inform Assoc 2006;13(1):40-51.

Shea S, Weinstock RS, Teresi JA, et al. A randomized trial comparing telemedicine case management with usual care in older, ethnically diverse, medically underserved patients with diabetes mellitus: 5 year results of the IDEATel study. J Am Med Inform Assoc 2009;16(4):446-56.

Economic Review

SMBP with Additional Support

Bondmass M, Bolger N, Castro G, Avitall B. The effect of home monitoring and telemanagement on blood pressure control among African Americans. Telemedicine Journal 2000;6(1):15-23.

Fishman PA, Cook AJ, Anderson ML, Ralston JD, Catz SL, et al. Improving BP control through electronic communications: an economic evaluation. American Journal of Managed Care 2013;19(9):709-16.

Friedman RH, Kazis LE, Jette A, Smith MB, Stollerman J, et al. A telecommunications system for monitoring and counseling patients with hypertension. Impact on medication adherence and blood pressure control. American Journal of Hypertension 1996;9(4 Pt 1):285-92.

Kaambwa B, Bryan S, Jowett S, Mant J, Bray EP, et al. Telemonitoring and self-management in the control of hypertension (TASMINH2): a cost-effectiveness analysis. European Journal of Preventive Cardiology 2014;21(12):1517-30.

Madsen LB, Christiansen T, Kirkegaard P, Pedersen EB. Economic evaluation of home blood pressure telemonitoring: a randomized controlled trial. Blood Pressure 2011;20(2):117-25.

Parati G, Omboni S, Albini F, Piantoni L, Giuliano A, et al. Home blood pressure telemonitoring improves hypertension control in general practice. The TeleBPCare study. Journal of Hypertension 2009;27(1):198-203.

Stoddart A, Hanley J, Wild S, Pagliari C, Paterson M, et al. Telemonitoring-based service redesign for the management of uncontrolled hypertension (HITS): cost and cost-effectiveness analysis of a randomised controlled trial. BMJ Open 2013;3(5).

Trogdon JG, Larsen B, Larsen D, Salas W, Snell M. Cost-effectiveness evaluation of a collaborative patient education hypertension intervention in Utah. Journal of Clinical Hypertension 2012;14(11):760-6.

SMBP with Team-Based Care

Artinian NT, Washington OG, Templin TN. Effects of home telemonitoring and community-based monitoring on blood pressure control in urban African Americans: a pilot study. Heart & Lung: The Journal of Acute and Critical Care 2001;30(3):191-9.

Billups SJ, Moore LR, Olson KL, Magid DJ. Cost-effectiveness evaluation of a home blood pressure monitoring program. American Journal of Managed Care 2014;20(9):e380-7.

Bosworth HB, Olsen MK, Grubber JM, Neary AM, Orr MM, et al. Two self-management interventions to improve hypertension control: a randomized trial. Annals of Internal Medicine 2009;151(10):687-95.

Bosworth HB, Powers BJ, Olsen MK, McCant F, Grubber J, et al. Home blood pressure management and improved blood pressure control: results from a randomized controlled trial. Archives of Internal Medicine 2011;171(13):1173-80.

Fishman PA, Cook AJ, Anderson ML, Ralston JD, Catz SL, et al. Improving BP control through electronic communications: an economic evaluation. American Journal of Managed Care 2013;19(9):709-16.

Johannesson M, Aberg H, Agreus L, Borgquist L, Jonsson B. Cost-benefit analysis of non-pharmacological treatment of hypertension. Journal of Internal Medicine 1991;230(4):307-12.

Maciejewski ML, Bosworth HB, Olsen MK, Smith VA, Edelman D, et al. Do the benefits of participation in a hypertension self-management trial persist after patients resume usual care? Circulation Cardiovascular Quality and Outcomes 2014;7(2):269-75.

Margolis KL, Asche SE, Bergdall AR, Dehmer SP, Groen SE, et al. Effect of home blood pressure telemonitoring and pharmacist management on blood pressure control: a cluster randomized clinical trial. JAMA 2013;310(1):46-56.

Palmas W, Shea S, Starren J, Teresi JA, Ganz ML, et al. Medicare payments, healthcare service use, and telemedicine implementation costs in a randomized trial comparing telemedicine case management with usual care in medically underserved participants with diabetes mellitus (IDEATel). Journal of the American Medical Informatics Association 2010;17(2):196-202.

Reed SD, Li Y, Oddone EZ, Neary AM, Orr MM, et al. Economic evaluation of home blood pressure monitoring with or without telephonic behavioral self-management in patients with hypertension. American Journal of Hypertension 2010;23(2):142-8.

Shea S, Weinstock RS, Starren J, Teresi J, Palmas W, et al. A randomized trial comparing telemedicine case management with usual care in older, ethnically diverse, medically underserved patients with diabetes mellitus. Journal of the American Medical Informatics Association 2006;13(1):40-51.

Shea S, Weinstock RS, Teresi JA, Palmas W, Starren J, et al. A randomized trial comparing telemedicine case management with usual care in older, ethnically diverse, medically underserved patients with diabetes mellitus: 5 year results of the IDEATel study. Journal of the American Medical Informatics Association 2009;16(4):446-56.

Wang V, Smith VA, Bosworth HB, Oddone EZ, Olsen MK, et al. Economic evaluation of telephone self-management interventions for blood pressure control. American Heart Journal 2012;163(6):980-6. The following papers were linked:

• Bosworth et al., 2009 and Reed et al., 2010
• Bosworth et al., 2011, Wang et al., 2012, and Maciejewski, et al. 2014
• Palmas et al., 2010, Shea et al., 2006, and Shea et al., 2009

• Best Practices for Cardiovascular Disease Prevention Programs: A Guide to Effective Health Care System Interventions and Community-Clinical Links
  Developed by CDC’s Division for Heart Disease and Stroke Prevention

McGrath D, Meador M, Wall HK, et al. Self-measured blood pressure telemonitoring programs: a pragmatic how-to guide. American Journal of Hypertension 2023;36(8):417-27.

Wall HK, Wright JS, Jackson SL, Daussat L, Ramkissoon N, et al. How do we jump-start self-measured blood pressure monitoring in the United States? Addressing barriers beyond the published literature. American Journal of Hypertension 2022;35(3): 244-55.

The CPSTF findings are based on evidence from a systematic review published in 2013 (Uhlig et al., 52 studies). Uhlig and colleagues searched MEDLINE (inception to 8 February 2013) and the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (fourth quarter 2012) without language restriction.

Effectiveness Review

The full search strategy reported below is included in the publication:

Uhlig K, Patel K, Ip S, et al. Self-measured blood pressure monitoring in the management of hypertension: A systematic review and meta-analysis. Ann Intern Med. 2013; 159:185-194.

Economic Review

This literature search was performed to provide studies on the economics of self-measured blood pressure monitoring interventions for the treatment and control of high blood pressure.

Six bibliographic databases were searched during March 2015, using the terms listed below. The following databases were searched: Medline, Cochrane (trials, systematic reviews, and economic evaluations), EconLit, and the Centre for Reviews and Dissemination. Years of publication from 1970 March, 2015 were covered, and the types of documents retrieved by the searched included journal articles, books, book chapters, reports, and conference papers.

Search terms and search strategies were adjusted to each database, based on controlled and uncontrolled vocabularies and search software. Once the literature search was completed, Community Guide staff reviewed the citations using inclusion and exclusion criteria to narrow down the publications to be included.

Database: Medline (OVID) (Includes Medline In-Process)

Date Searched: 3/25/2015
Results: 855/841 after duplicates removed
Search Strategy:

1. exp blood pressure monitoring, ambulatory/
2. exp blood pressure monitors/
3. exp blood pressure/
4. exp hypertension/
5. exp self care/
6. ((blood pressure or hypertens$) and self and (measure$ or monitor$ or care or manage$)).mp.
7. randomized controlled trial.pt.
8. controlled clinical trial.pt.
9. randomized controlled trials/
10. random allocation/
11. double-blind method/
12. single-blind method/
13. clinical trial.pt.
14. clinical trials.mp. or exp clinical trial/
15. (clinic$ adj25 trial$).tw.
16. ((singl$ or doubl$ or trebl$ or tripl$) adj (mask$ or blind$)).tw.
17. placebo$.tw.
18. Placebos/
19. random$.tw.
20. trial$.tw.
21. (randomized contro$l trial$l or clinical control$ trial$).mp.
22. (latin adj square).tw.
23. comparative study.tw. or comparative study.pt.
24. exp evaluation studies/
25. follow-up studies/
26. prospective studies/
27. (control$ or prospectiv$ or volunteer$).tw.
28. Cross-Over Studies/
29. exp cohort studies/ or exp prospective studies/ or exp retrospective studies/ or exp epidemiologic studies/ or exp case-control studies/
30. (cohort or retrospective or prospective or longitudinal or observational or follow-up or followup or registry).af.
31. case-control.af. or (case adj10 control).tw.
32. ep.fs.
33. (home adj20 blood pressure).mp.
34. exp telemedicine/
35. exp self-examination/
36. exp blood pressure/
37. exp hypertension/
38. (cost or costs or economic or economics).mp.
39. exp Economics/
40. exp “Costs and Cost Analysis”/
41. 3 or 4
42. 5 and 41
43. 1 or 2 or 6 or 42
44. 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 or 24 or 25 or 26 or 27 or 28
45. 29 or 30 or 31 or 32
46. 44 or 45
47. 43 and 46
48. 44 or 45 or 47
49. 33 and 48
50. 34 or 35
51. 36 or 37
52. 50 and 51
53. 48 and 52
54. 47 or 49 or 53
55. 38 or 39 or 40
56. 54 and 55

Database: Cochrane Central Register of Controlled Trials

Date Searched: 3/25/2015
Results: 220/69 after duplicates removed
Search Strategy:

#1
(hypertension or “blood pressure”) and (self or telemedicine):ti,ab,kw or (hypertension or “blood pressure”) near/20 home:ti,ab,kw or “ambulatory blood pressure monitoring”:ti,ab,kw in Trials (Word variations have been searched)
#2
cost or costs or economic*
#3
#1 and #2

Database: Cochrane Database of Systematic Reviews

Date Searched: 3/25/2015
Results: 24/17 after duplicates removed
Search Strategy:

#1
(hypertension or “blood pressure”) and (self or telemedicine):ti,ab,kw or (hypertension or “blood pressure”) near/20 home:ti,ab,kw or “ambulatory blood pressure monitoring”:ti,ab,kw
#2
cost or costs or economic*
#3
#1 and #2

Database: Cochrane Economic Evaluations

Date Searched: 3/25/2015
Results: 27/26 after duplicates removed
Search Strategy:

#1
(hypertension or “blood pressure”) and (self or telemedicine):ti,ab,kw or (hypertension or “blood pressure”) near/20 home:ti,ab,kw or “ambulatory blood pressure monitoring”:ti,ab,kw

Database: EconLit (EBSCOhost)

Date Searched: 3/25/2015
Results: 53/45 after duplicates removed
Search Strategy:

Search modes – Boolean/Phrase
S6
S4 OR S5
S5
(S1 AND S2)
S4
(S1 AND S3)
S3
TX ambulatory
S2
TX self OR TX home OR TX telemedicine
S1
TX “blood pressure” OR TX hypertension

Database: Centre for Reviews & Dissemination University of York

Date Searched: 3/15/205
Results: 293/241 after duplicates removed
Search Strategy:

Any Field: “blood pressure” or hypertension
AND
Any Field: self or home or ambulatory
AND
Any Field: cost or costs or economic*

CDC. Self-measured blood pressure monitoring: action steps for public health practitioners. Atlanta (GA): Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2013.

Mason JM, Freemantle N, Gibson JM, New JP. Specialist nurse-led clinics to improve control of hypertension and hyperlipidemia in diabetes: economic analysis of the SPLINT trial. Diabetes Care 2005;28(1):40-6.

McEwan P, Peters JR, Bergenheim K, Currie CJ. Evaluation of the costs and outcomes from changes in risk factors in type 2 diabetes using the Cardiff stochastic simulation cost-utility model (DiabForecaster). Curr Med Res Opin 2006;22(1):121-9.

Uhlig K, Patel K, Ip S, et al. Self-measured blood pressure monitoring in the management of hypertension. Annals of Internal Medicine 2013, 159(3): 185-194.

Million Hearts released two action guides on self-measured blood pressure monitoring interventions based on findings from Uhlig et al. (2013):

• Self-Measured Blood Pressure Monitoring: Action Steps for Public Health Practitioners
• Self-Measured Blood Pressure Monitoring: Action Steps for Clinicians

The following considerations for implementation are drawn from information provided in these actions guides.

• Implementers need to consider the type of blood pressure monitor patients use. The action guides suggest monitors with an automated upper arm cuff.
• Programs that require patients to provide their own blood pressure monitors should have patients bring them into their doctors’ offices now and then to ensure proper use and function.
• Some patients may not be able to afford their own blood pressure monitor. In 2015, the cost of an automated blood pressure device ranged from $50 to $100. Insurance benefits for blood pressure monitors vary by payer.
• The type and cost of additional support with self-measured blood pressure monitoring varied among included studies, making it difficult to determine whether one form of support was more effective than another. The action guides note the following elements of successfully monitoring support for self-measured blood pressure provided across the evaluated interventions:
  • Delivery by trained healthcare providers (e.g., pharmacists, nurse practitioners, physician assistants, health educators)
  • Regular patient communication of blood pressure readings to providers
  • Establishing a patient/provider “feedback loop” in which provider support and advice are personalized based on patients’ reported information
• Although face-to-face office visits remain an important form of interaction between patients and clinicians, healthcare providers may incorporate other forms of care such as electronic and phone communication that could make care more effective, timely, and efficient. Reimbursement mechanisms for telemedicine, which could be a large component of some blood pressure monitoring interventions, should be considered.

CDC’s Division for Heart Disease and Stroke Prevention developed Best Practices for Cardiovascular Disease Prevention Programs: A Guide to Effective Health Care System Interventions and Community-Clinical Links to help communities select and implement successful interventions. The guide summarizes the effectiveness and economic evidence behind eight strategies, including self-measured blood pressure monitoring interventions to prevent cardiovascular disease. For each strategy, the guide offers information on implementation, such as settings where the strategies have been successful, resources available to support implementation, and policy considerations. “Stories from the Field” feature specific settings where strategies have been successfully implemented.

Healthy People 2030

Healthy People 2030 includes the following objectives related to this CPSTF recommendation.

• Improve cardiovascular health in adults — HDS-01
• Increase control of high blood pressure in adults — HDS-05
• Increase the proportion of adults who use IT to track health care data or communicate with providers — HC/HIT-07