Self-Measured Blood Pressure

Hypertension is a common, long-term health condition, particularly prevalent among older adults. Untreated or undertreated hypertension leads to increased cardiovascular morbidity and mortality, as well as increased consumption of health care resources; however, long-term adherence to lifestyle modification and medication remains a challenge. Self-measured blood pressure monitoring (SMBP) has been suggested as one method that may improve adherence to blood pressure (BP) treatment and consequently improve outcomes. SMBP refers to the regular self-measurement of a patient's BP at home or otherwise outside the office or clinic, as a supplement or alternative to those obtained in a health care setting. While patient self participation in chronic disease management appears to be a promising means of improving adherence, the sustainability and clinical effect of this strategy, as well as its impact on health care utilization, remain uncertain. The current Future Research Needs (FRN) project was launched upon the completion of an Agency for Healthcare Research and Quality (AHRQ) Comparative Effectiveness Review (CER) on SMBP, and builds on the evidence gaps identified in that review. The present report describes the development of a stakeholder-prioritized list of research needs for that topic, along with a measured consideration of the advantages and disadvantages of various potential research designs, in order to help researchers and funders develop future research proposals or solicitations. This report identifies five high-priority future research needs with regards to SMBP, as determined by a stakeholder panel. They are: 1. What are the effects of SMBP on BP, medication adherence rates, satisfaction, and clinical event outcomes, after longer followup periods of 2 to 5 years or longer? 2. Which patients may be more likely to benefit from using SMBP? 3. What is the best prescription or protocol for SMBP (when, how often, and how frequently)? How do different prescriptions for SMBP compare regarding acceptance by patients, adherence with SMBP, and effect on BP control? 4. What is the role of additional support? What particular components of additional support should be further evaluated? 5. What is the effect of SMBP on resource utilization? What is the cost-effectiveness of SMBP?