Improved Blood Pressure Control and Lessons Learned from Pilot Projects to Implement Home Self-Monitoring of Blood Pressure

BACKGROUND:  Approximately 30% of U.S. adults have high blood pressure (BP), half of which is not controlled. Even modest elevations of BP increase risk of heart disease and stroke. We reviewed 2 pilot projects in Alabama to determine if home self-monitoring of BP improved BP control.

METHODS:  Adults recruited through community-based coalitions (CC, n=39) or a rural county health department (HD, n=18) were provided a home BP monitor, instructed in its use, and weekly reported BP readings to health mentors over 5–9 months. Mean systolic BP (sBP) of the last 3 recorded BPs was compared to mean of the first 3 readings to determine change in sBP. Questionnaires were administered to HD participants to describe whether they continued to monitor BP after the pilot period and what factors they found affected BP readings.

RESULTS: Mean sBP decreased 6.1 mmHg (3.9%, p<0.001) among CC participants and decreased 6.7 mmHg (4.6%, p=0.02) among HD participants. Among those with an initial mean sBP≥140, mean sBP decreased 11.6 mmHg (7.3%, p=0.001) for CC and 17.0 mmHg (11.7%, p=0.001) for HD participants with 47% of CC and 85.7% of HD participants achieving final mean sBP <140. All survey respondents indicated they had better understanding of factors affecting BP, and 80% continued to monitor BP after the pilot period. Common triggers noted for BP elevations included diet, medication, and behavioral factors. Barriers to implementation included reliability of initial monitors and privacy concerns. 

CONCLUSIONS:  Home BP monitoring significantly reduced sBP, particularly among participants with initial sBP ≥140, reducing final sBP among a majority of those to <140. Participants were able to identify modifiable triggers of BP elevation and most continued home monitoring. Lessons learned are being implemented at other sites. Self-monitoring of BP can improve BP control and potentially reduce risk of hypertension-related health complications. The findings and conclusions in this abstract are those of the authors and do not necessarily reflect the official position of the Centers for Disease Control and Prevention.