Clinical Edge

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Managing Blood Pressure in a Primary Care Setting

J Am Board Fam Med; 2018 May-Jun; Doane, et al

An automated office blood pressure (AOBP)/home blood pressure management (HBPM) initiative detected white-coat BP elevation in one-third of patients with elevated office BP and facilitated hypertension control in nearly half of patients with elevated home BP, a recent study found. Researchers implemented an AOBP/HBPM program in a primary care clinic in 2015 to 2016. Patients with elevated BP entered the HBPM program. Patients with average home BP ≥135/85 mm Hg provided HBPM results for medication adjustment. Among the findings:

  • Initial HBPM results in 183 patients with elevated office BP revealed white-coat BP elevation in 35% of untreated patients and in 37% of treated patients.
  • The prevalence of white-coat BP elevation was similar whether enrollment BP was by observed BP or AOBP.
  • Subsequent HBPM facilitated BP control in 49% of patients with elevated home BP.
  • Barriers to implementation included a temporary period of incorrect AOBP technique, patients failing to provide HBPM results, and incorrect HBPM technique.

Citation:

Doane J, Buu J, Penrod MJ, Bischoff M, Conroy MB, Stults B. Measuring and managing blood pressure in a primary care setting: A pragmatic implementation study. J Am Board Fam Med. 2018;31:375-388. doi:10.3122/jabfm.2018.03.170450.

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