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. 2023 Jul;46(7):1638-1649.
doi: 10.1038/s41440-023-01259-1. Epub 2023 Apr 11.

Current realities of home blood pressure monitoring from physicians' perspectives: results from Asia HBPM survey 2020

Tzung-Dau Wang  1 , Takayoshi Ohkubo  2 , Ma Lourdes Bunyi  3 , Veerendra Melagireppa Chadachan  4 , Yook Chin Chia  5   6 , Kazuomi Kario  7 , Cheol-Ho Kim  8   9 , Hung-Ju Lin  10 , Noriko Matsushita  11 , Sungha Park  12 , Ebtehal Salman  13 , Apichard Sukonthasarn  14 , Jam Chin Tay  4 , Hoang Anh Tien  15 , Isha Tomar  16 , Yuda Turana  17 , Huynh Van Minh  18 , Narsingh Verma  19 , Gurpreet Singh Wander  20 , Ji-Guang Wang  21 , Yi Zhou  21 , Yutaka Imai  22
Affiliations

Current realities of home blood pressure monitoring from physicians' perspectives: results from Asia HBPM survey 2020

Tzung-Dau Wang et al. Hypertens Res. 2023 Jul.

Abstract

Uncontrolled hypertension is a significant problem in many parts of Asia. Effective management is essential to reduce the burden of hypertension. Home blood pressure monitoring (HBPM) is a promising tool that can aid in the diagnosis and management of hypertension. Experts from 11 countries/regions in Asia conceptualized a large-scale survey to examine the current realities of HBPM. A cross-sectional survey was conducted among health care professionals from China, India, Indonesia, Japan, Malaysia, the Philippines, Singapore, South Korea, Taiwan, Thailand, and Vietnam between November 2019 and June 2021. Physicians' responses were summarized using descriptive statistics. A total of 7945 physicians participated in the survey. Among all respondents, 50.3% and 33.5% viewed HBPM as highly recognized by physicians and patients in their country/region, respectively. Lack of understanding of HBPM and concern with the accuracy and reliability of HBPM devices were identified as key barriers to HBPM recognition. Nearly all physicians (95.9%) reported recommending HBPM to their patients; however, they reported less than 50% of their patients measured home blood pressure (HBP). Among physicians who recommended HBPM, only 22.4% and 54.1% cited HBP diagnostic threshold values and timing of taking antihypertensive drugs that were consistent with available guidelines, respectively. The survey reveals that the recognition of HBPM as a valuable tool to diagnose and manage hypertension is suboptimal in most parts of Asia. Despite high recommendation of HBPM to hypertensive patients by physicians, there are considerable discrepancies between guidelines recommendations and practice realities. The recognition of HBPM as a valuable tool for the diagnosis and management of hypertension is suboptimal among both physicians and patients in Asia. A clear and consistent guidance for proper HBPM practice and use of validated and calibrated HBP monitors are among the top priorities to support the integration of HBPM into daily patient care. HBPM: home blood pressure monitoring, HBP: home blood pressure.

Keywords: Asia; Home blood pressure monitoring; Hypertension.

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Conflict of interest statement

T-D.W. has received research grants and honoraria from Omron Healthcare Co. Ltd. T.O. has received grants from Omron Healthcare Co. Ltd. M.L.B. has received honoraria from Omron Philippines. Y.C.C. has received speaker honorarium and sponsorship from Boeringher-Ingelheim, Pfizer, Omron, and Servier and Xepa-Sol to attend conferences and seminars, and investigator-initiated research and educational grants from Pfizer, Omron, and Viatris. K.K. has received grants from Omron Healthcare, Fukuda Denshi, and A&D Co. C.H.K. received honoraria from Omron Korea. N.M. is an employee of Omron Healthcare Singapore Pte. Ltd. S.P. has received honoraria from Pfizer, Boryoung, Hanmi, Daewoong, Donga, Celltrion, Servier and Daiichi Sankyo, and Daewon, and research grants from Daiichi Sankyo. E.S. is an employee of Omron Healthcare Co. Ltd. I.T. is an employee of Omron Healthcare India Private Ltd. J-G.W. has received grants from Novartis and Omron, and lecture and consulting fees from Merck, Novartis, Servier and Viatris. All other authors have no relevant relationships to disclose.

Figures

None
The recognition of HBPM as a valuable tool for the diagnosis and management of hypertension is suboptimal among both physicians and patients in Asia. A clear and consistent guidance for proper HBPM practice and use of validated and calibrated HBP monitors are among the top priorities to support the integration of HBPM into daily patient care. HBPM: home blood pressure monitoring, HBP: home blood pressure.
Fig. 1
Fig. 1
HBPM recognition in Asia (A) among physicians upon answering the question [11) Do you think that the significance of HBPM is well recognized by physicians in your country?] (B) among patients upon answering the question [12) Do you think that the significance of HBPM is well recognized by patients with hypertension in your country?]. Results for patients are based on physicians’ perspective. HBPM home blood pressure monitoring
Fig. 2
Fig. 2
HBPM usage in Asia (A) among physicians upon answering the question [8) Do you recommend HBPM to your patients with hypertension?] B among patients upon answering the question [9) What percentage of your patients with hypertension measures their own BP (HBP)? and 10) What percentage of your patients with hypertension have HBPM devices?]. *Exclude “impossible to select either” option. Percentage of patients calculated based on number of doctors who responded to question 9 and 10. Results for patients are based on physicians’ perspective. HBP home blood pressure; HBPM home blood pressure monitoring
Fig. 3
Fig. 3
Perceived barriers to HBPM moderate/low recognition in Asia (A) by physicians (n = 3647) upon answering moderately or poorly to question [11) Do you think that the significance of HBPM is well recognized by physician in your country?] (B) by patients (n = 4931) upon answering moderately or poorly to question [12) Do you think that significance of HBPM is well recognized by patients with hypertension in your country?]. Results for patients are based on physicians’ perspective. HBPM home blood pressure monitoring
Fig. 4
Fig. 4
Awareness of hypertension reference values among physicians (A) by HBP upon answering the question [23) Please indicate the reference values of hypertension for HBP with your own view.] (B) by CBP upon answering the question [24) Please indicate the reference values of hypertension for CBP with your own view]. CBP clinic blood pressure; HBP, home blood pressure
Fig. 5
Fig. 5
Instructions to measure HBPM given by physicians. upon answering question [20) Please select your instruction to your patients regarding HBPM in the morning] (A) Time of rest before measurement. B HBPM relative to taking antihypertensive medications. C Micturition. D Upon answering timing of measurement in the evening to question [21) Please select your instruction to your patients regarding HBPM in the evening.]. *‘All’ data does not include Japan. †Multiple answers and ‘before/after bathing’ option not shown – before bathing 12.8%, after bathing 3.5%. HBPM home blood pressure monitoring
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