New Study Shows Importance of Blood Pressure Monitoring Between Physician Visits

Home blood pressure monitoring aids in cardiovascular management.

Nearly half of U.S. adults have high blood pressure, also called hypertension, and just one in four have the condition under control. More information is coming forward on the importance of blood pressure monitoring between physician office visits to effectively treat and manage the condition. The additional readings can be critical in preventing unexpected cardiovascular events and other health conditions.  

High blood pressure is a strong indicator of the likelihood of a heart attack or stroke. The higher the systolic reading, the higher the chance of a heart attack or stroke. The challenge, for patients and physicians, is knowing their blood pressure readings in-between office visits, a critical step in the accuracy and effectiveness of treatment plans. If patients do keep a home blood pressure log, the challenge for the physician may be the consistency and accuracy of the home log which can affect treatment. 

The American Heart Association (AHA) published a study by Yale New Haven in Connecticut addressing the concerns of what has been termed ‘visit-to-visit variability,’ which is the variation in systolic and diastolic blood pressure between physician visits, and the impact on a patient’s health. Blood pressure consists of two numbers: Systolic (the top number) and diastolic (the bottom number). The AHA published the following guidelines when it comes to reading blood pressure:

AMA Blood Pressure Graphic
American Heart Association Blood Pressure Categories

The team at Yale New Haven Health analyzed 7.7 million blood pressure measurements for 537, 218 adults. The average age was 53 years old and individuals experienced an average of 13 outpatient visits over a period of two years and four months. The individual’s visit-to-visit variability was carefully reviewed with the general knowledge that individuals with a variability of 10 to 15 mmHG may be at a higher risk for blocked arteries or peripheral artery disease, diabetes, kidney disease, and heart problems.  

The study revealed a wide variation in average blood pressure readings. For those within the normal range, systolic levels only showed a variation of 6.3 mmHG between two consecutive office visits. This was relatively low compared to a concerning variation of those in elevated and high ranges, and those in the extremely high range. A difference of 12 mmHG was recorded between two consecutive visits for those in the elevated and high ranges, and among those categorized with extremely high blood pressure (above 180 mmHG systolic) levels varied considerably averaging a difference of 32.3 mmHG. These dramatic variations are cause for concern and can lead to serious health conditions, leaving the healthcare provider completely in the dark when it comes to the care of their patient.

“This study enforces the overwhelming importance of home blood pressure monitoring,” notes Dr. Irina Koyfman, population health officer, RPM Healthcare. “Home monitoring with clinical supervision can be the solution in assisting providers. It can help to develop appropriate treatment plans, determine if treatment plans are effective, and assist patients quickly in between physician office visits. It is also important to note that taking blood pressure readings at the physician’s office may not reveal the true picture of one’s health and can produce what is termed ‘white coat syndrome,’ where the blood pressure presents higher during your visit, or a ‘masked hypertension,’, where BP is artificially lower.” 

The Yale New Haven analysis determined that if a person with high blood pressure was given medication to lower systolic levels by 10 mmHg, during an office visit, it would take four follow-up visits to be 80 percent certain that a patient’s systolic blood pressure had been lowered. 

“It is important to not only pay attention to elevated blood pressure, but also to lower blood pressure” explains Koyfman. “An RPM patient who, during their routine phone check-in with our nurse, shared they felt lightheaded a few times in the past few weeks. Our nurse looked at the RPM blood pressure log and noticed that on the days when the patient felt lightheaded, their blood pressure was low. Interestingly, it was not low enough to warrant an alert, so without the home monitoring technology and clinical supervision, no one would have noticed it. The physician was alerted, the data was shared, and the patient’s blood pressure medication was lowered accordingly. Home monitoring and the additional support of a clinician may have prevented this patient from falling due to dizziness, the additional benefit of remote patient monitoring program.” 

Blood pressure monitoring with home monitoring equipment is essential and goes above the episodic office visit evaluation in giving healthcare providers the full picture of a patient’s overall health and can lead to more appropriate and effective treatment plans.  

For additional information on the study, visit the American Heart Association.

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