Get on top of home BP monitoring now



– Home BP monitoring has proved its worth, and it’s now time to integrate it into health care and get insurers to pay for it, according to Hayden Bosworth, PhD, a population health sciences professor and health services researcher at Duke University, Durham, N.C.

The devices are on the shelves of pharmacies and discount stores nationwide, sometimes for less than $50, but what to do with them in the clinic hasn’t been worked out. It’s likely patients are soon going to want help interpreting the results, if they aren’t already, but a leap in technology has left clinicians and payors scratching their heads.

There’s more than enough evidence of benefit. Dr. Bosworth has been involved with several trials of home BP monitoring with good results. He was one of the many authors on a recent meta-analysis that found when patients check their BP at home, it can lead to a “clinically significant” reduction “which persists for at least 12 months” (PLoS Med. 2017 Sep 19;14[9]:e1002389).

“Are we talking about efficacy or proof of concept? I think we are beyond that. Now we have to think about how we put it into the system, how do we integrate it, what’s the best way of delivery. I think that’s where the future is,” he said in an interview at the joint scientific sessions of the American Heart Association Council on Hypertension, AHA Council on Kidney in Cardiovascular Disease, and American Society of Hypertension.

Home monitoring came up far more often at this year’s joint sessions than in 2017, which might indicate growing interest, but reimbursement remains a challenge. American Medical Association staff said at this year’s meeting that they are working with the Centers for Medicare & Medicaid Services for coverage of the devices and their use. It seemed likely to them.

In the meantime, Dr. Bosworth had some useful advice for those who are thinking about incorporating home BP monitoring into their practices.

He shared his tips on how to pick out a device – there’s actually a journal called Blood Pressure Monitoring that can help – as well as his thoughts on how often people should monitor themselves and what to do with the numbers.

He envisions a future when patients routinely check their BP at home; it’s even possible they could adjust their medications based on the results, much like diabetes patients track their blood glucose and adjust their insulin. It’s been shown to work in Britain (JAMA. 2014 Aug 27;312[8]:799-808).

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