Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jan;18(1):50-58.
doi: 10.1370/afm.2491.

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

Sonal J Patil  1 , Nuha K Wareg  2 , Kelvin L Hodges  2 , Jamie B Smith  2 , Mark S Kaiser  2 , Michael L LeFevre  2
Affiliations

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

Sonal J Patil et al. Ann Fam Med. 2020 Jan.

Abstract

Purpose: Conventional clinic blood pressure (BP) measurements are routinely used for hypertension management and physician performance measures. We aimed to check home BP measurements after elevated conventional clinic BP measurements for which physicians did not intensify treatment, to differentiate therapeutic inertia from appropriate inaction.

Methods: We conducted a pre and post study of home BP monitoring for patients with uncontrolled hypertension as determined by conventional clinic BP measurements for which physicians did not intensify hypertension management. Physicians were notified of average home BP 2-4 weeks after the initial clinic visit. Outcome measures were the proportion of patients with controlled hypertension using average home BP measurements, changes in hypertension management by physicians, changes in physicians' hypertension metrics, and factors associated with home-clinic BP differences.

Results: Of 90 recruited patients who had elevated conventional clinic BP recordings, 65.6% had average home BP measurements that were <140/90 mm Hg. Physicians changed treatment plans for 61% of patients with average home BP readings of ≥140/90 mm Hg, whereas decisions to not change treatment for the remaining patients were based on contextual factors. Substituting average home BP for conventional clinic BP for 4% of patients from 2 physicians' hypertension registries improved the physicians' hypertension control rates by 3% to 5%. Greater body mass index and increased number of BP medications were associated with home BP measurement ≥140/90 mm Hg. Clinic BP levels did not estimate normal home BP levels.

Conclusions: Documented home BP in cases of clinical uncertainty helped differentiate therapeutic inertia from appropriate inaction and improved physicians' hypertension metrics.

Keywords: blood pressure monitoring; clinician inertia; home; hypertension; patient care management/standards; white coat.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Participant flow diagram. BP = blood pressure; PCP = primary care physician.
Figure 2
Figure 2
Blood pressure values. BP = blood pressure.
See this image and copyright information in PMC

References

    1. Burkard T, Mayr M, Winterhalder C, Leonardi L, Eckstein J, Vischer AS. Reliability of single office blood pressure measurements. Heart. 2018; 104(14): 1173–1179. - PubMed
    1. Bhatt H, Siddiqui M, Judd E, Oparil S, Calhoun D. Prevalence of pseudoresistant hypertension due to inaccurate blood pressure measurement. J Am Soc Hypertens. 2016; 10(6): 493–499. - PMC - PubMed
    1. Minor DS, Butler KR, Jr, Artman KL, et al. Evaluation of blood pressure measurement and agreement in an academic health sciences center. J Clin Hypertens (Greenwich). 2012; 14(4): 222–227. - PMC - PubMed
    1. Myers MG, Godwin M, Dawes M, Kiss A, Tobe SW, Kaczorowski J. Measurement of blood pressure in the office: recognizing the problem and proposing the solution. Hypertension. 2010; 55(2): 195–200. - PubMed
    1. Levy J, Gerber LM, Wu X, Mann SJ. Nonadherence to recommended guidelines for blood pressure measurement. J Clin Hypertens (Greenwich). 2016; 18(11): 1157–1161. - PMC - PubMed

Publication types