Home Blood Pressure Monitoring in Cases of Clinical Uncertainty to Differentiate Appropriate Inaction From Therapeutic Inertia

The Article in Brief

Home Blood Pressure Monitoring in Cases of Clinical Uncertainty to Differentiate Appropriate Inaction From Therapeutic Inertia

Sonal J. Patil , and colleagues

Background Conventional clinic blood pressure measurements are frequently inaccurate, and physicians and patients are often reluctant to intensify hypertension treatment when convinced of falsely elevated readings in clinic. At the same time, clinic readings are routinely used for hypertension diagnosis, management, and physician performance measures. Additionally, there is evidence that BP measured at home, repeatedly, and then averaged provides more accuracy than clinic readings alone.

What This Study Found A pilot study from the University of Missouri concluded that a physician's decision not to intensify hypertension treatment is often a contextually appropriate choice. In two-thirds of cases where physicians did not change treatment for patients with hypertension, patients' blood pressure returned to normal in follow-up readings taken at home. This pre- and post-study tracked 90 patients with hypertension to understand the role that follow-up home blood pressure measures could play in understanding cases of "therapeutic inertia." Sixty-six percent of patients who had a blood pressure reading of 140/90 or higher when they were in the clinic and whose doctors did not change their treatment, had average readings under 140/90 when patients took their blood pressure at home. Additionally, when surveyed after the home blood pressure reading intervention, participants shared that home blood pressure monitoring enhanced their understanding of blood pressure control. Eighty-three percent of participants agreed that they would consider buying a home blood pressure monitor if it was covered by insurance.

Implications

• According to the authors, there are implications for health care quality metrics. Doctors' success rates in controlling hypertension are based solely on clinic blood pressure rates. The authors extrapolated the home blood pressure metrics to show that when home metrics replaced clinical ones, the departmen'�s hypertension control success rates rose from 58% to 86%. They conclude, "Most validated home blood pressure should be accepted and preferred for physician hypertension performance measures."