Self-measured Blood Pressure Monitoring: Using a Validated Device is Key to Accurate Measurement
Using a clinically accurate validated device for blood pressure monitoring is important in the battle against uncontrolled hypertension.
Uncontrolled Hypertension Remains a Clinical and Public Health Challenge
Approximately, 46% of US adults (108 million adults) have hypertension, defined as ≥130/80 mm Hg.1 Of US adults with hypertension, less than a quarter (21.6%) have controlled blood pressure (BP) [<130/80 mm Hg]2. Despite the burden and costs associated with uncontrolled hypertension and the availability of effective therapies and evidence-based interventions to control BP, hypertension control (<140/90 mm Hg) has worsened from 53.8% (2013-2014) to 43.7% (2017-2018).3
Self-measured Blood Pressure Monitoring (SMBP) with Clinical Support Improves Hypertension Control
Self-measured blood pressure monitoring (SMBP), also known as home blood pressure monitoring with clinical support, is one of the effective interventions, or “best practices”4 to improve hypertension control.5,6 SMBP monitoring allows patients diagnosed with hypertension to play an active role in managing their own condition. However, SMBP requires the use of a home BP measurement device by patients in their homes several times a week.
Increasing Demand for Home Blood Pressure Devices
During the COVID-19 pandemic, the demand for home BP devices has never been higher. More patients have been advised by healthcare providers to purchase home BP devices to self-monitor their condition and enhance telehealth visits. Public health and social distancing measures have been recommended to limit the spread of COVID-19. As a result, fewer in-person visits for hypertension assessments are occurring and SMBP that includes clinical support such as web-based services, one-one-counseling, and educational classes delivered remotely can improve hypertension outcomes.7 However, cardiovascular nurses and healthcare providers should be prepared to advise patients on selecting validated home BP devices and be aware of other key considerations in the selection of home BP devices.
Importance of Accuracy of Home Blood Pressure Measurement Devices
All BP devices are not created equal. Accurate BP measurement is critical for the diagnosis and management of hypertension.8 Obtaining an accurate BP measurement begins with using a validated BP measurement device. Inaccurate home BP devices could result in under- or over-treatment of hypertension.9,10 Thus, the proper equipment must be selected to ensure that BP readings reflect a patient’s actual BP. Beyond selecting proper equipment, incorrect positioning, where the arm and cuff are positioned above the heart during the measurement may lead to falsely low BP. Conversely, if the arm and cuff are positioned below the heart, BP could be falsely elevated.8
Selecting a Validated Device for Blood Pressure Monitoring
The proliferation of different types of home BP devices, including upper arm devices and wrist BP devices, may leave many patients [and clinicians] confused about which devices are validated. Cardiovascular nurses often provide clinical support to patients diagnosed with hypertension, and patients may pose the question: “Which home BP device should I use?” Although local drugstores and online stores sell various brands of BP devices, patients should be advised to select only validated devices for blood pressure monitoring. All devices are cleared by the Food and Drug Administration (FDA) prior to being sold on the US market, but not all are validated for accuracy through an independent review process.
The US Blood Pressure Validated Device Listing (VDL™) is the first U.S. list of BP measurement devices developed to assist providers and patients in identifying BP devices that have been validated for clinical accuracy. The American Medical Association (AMA) enlisted the National Opinion Research Center (NORC) at the University of Chicago to assist in the design and management of an independent process to determine which BP devices available in the U.S. meet AMA’s established criteria (VDL™ Criteria) to validate clinical accuracy. An Independent Review Committee consisting of physicians with expertise in BP measurement and management assesses whether a BP device meets the VDL Criteria for validation of clinical accuracy, resulting in the VDL –a formal list of validated BP devices, including office, home, ambulatory, and kiosk devices.
Similarly, STRIDE BP a joint initiative between the European Society of Hypertension, International Society of Hypertension, and World Hypertension League, is an international scientific non-profit organization that also publishes information on validated BP devices. Devices listed on the STRIDE BP website meet established international protocols.
Other Considerations in the Selection of a Validated Home Blood Pressure Device
Below are some tips that cardiovascular nurses can share with patients:
- Select an automated monitor, which has a cuff that inflates itself.
- Select a BP device that goes around the upper arm. Wrist and finger devices are not currently listed on the VDL.
- Ensure that the cuff fits the arm. Review the device for information on the range of the cuff size before purchasing the device. If the cuff of the BP device is too small, the BP reading will be overestimated. Likewise, if the cuff is too large, BP readings will be underestimated.
- Select a device that is easy to use. Look for a BP device with a digital readout that is large and bright enough for you to see clearly, and one that also shows your pulse rate. In the case of visual impairment, select a device that has voice commands.
- Select a Blue-tooth enabled BP device which can be synced with a smartphone to transfer the BP readings or to an electronic health record system.
Using a validated device for blood pressure monitoring is important, but PCNA also has clinical or patient education resources to help you with blood pressure control.
- Blood pressure patient education booklet: How Do you Measure Up?
- Measuring Tape for Blood Pressure Cuff
- Patient education fact sheet: High Blood Pressure
- Free on-demand CE course: New Hypertension Guidelines: Matching Risks and Treatments
- Centers for Disease Control and Prevention (CDC). Hypertension Cascade: Hypertension Prevalence, Treatment and Control Estimates Among US Adults Aged 18 Years and Older Applying the Criteria From the American College of Cardiology and American Heart Association’s 2017 Hypertension Guideline—NHANES 2013–2016. US Department of Health and Human Services. 2019.
- Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW, American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation. 2021; 143: e254-e743.
- Muntner P, Hardy ST, Fine LJ, Jaeger BC, Wozniak G, Levitan EB, Colantonio LD. Trends in Blood Pressure Control Among US Adults With Hypertension, 1999-2000 to 2017-2018. JAMA. 2020; .
- Centers for Disease Control and Prevention (CDC). Self-Measured Blood Pressure Monitoring With Clinical Support. Accessed August, 20, 2020.
- Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. Ann Intern Med. 2013; 159: 185-194.
- Shimbo D, Artinian NT, Basile JA, – Krakoff LR, Margolis KL, Rakotz MK, Wozniak GD. Self-Measured Blood Pressure Monitoring at Home: A Joint Policy Statement From the American Heart Association and American Medical Association. Circulation. 2020.
- Omboni S, McManus RJ, Bosworth HB, Chappell LC, Green BB, Kario K, Logan AG, Magid DJ, Mckinstry B, Margolis KL, Parati G, Wakefield BJ. Evidence and Recommendations on the Use of Telemedicine for the Management of Arterial Hypertension: An International Expert Position Paper. Hypertension. 2020; 76: 1368-1383.
- Muntner P, Einhorn PT, Cushman WC, Whelton PK, Bello NA, Drawz PE, Green BB, Jones DW, Juraschek SP, Margolis KL, Miller ER,3rd, Navar AM, Ostchega Y, Rakotz MK, Rosner B, Schwartz JE, Shimbo D, Stergiou GS, Townsend RR, Williamson JD, Wright JT, Jr, Appel LJ, 2017 National Heart, Lung, and Blood Institute Working Group. Blood Pressure Assessment in Adults in Clinical Practice and Clinic-Based Research: JACC Scientific Expert Panel. J Am Coll Cardiol. 2019; 73: 317-335.
- Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN, Jones DW, Kurtz T, Sheps SG, Roccella EJ. Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Circulation. 2005; 111: 697-716.
- Muntner P, Shimbo D, Carey RM, Charleston JB, Gaillard T, Misra S, Myers MG, Ogedegbe G, Schwartz JE, Townsend RR, Urbina EM, Viera AJ, White WB, Wright JT,Jr. Measurement of Blood Pressure in Humans: A Scientific Statement From the American Heart Association. Hypertension. 2019; 73: e35-e66.