It’s reasonable to believe that if you monitor something (such as blood pressure, blood sugar levels, cholesterol levels, or weight), the feedback could provide motivation to make lifestyle improvements and/or adhere to a treatment plan. But you might be thinking, “Just getting on a scale is not going to be enough incentive for most people to lose weight.” That is definitely true. What if they measure it regularly and keep track? Would that make a difference? Many weight loss programs like Weight Watchers use that principle as part of their strategy – weighing in weekly, tracking weekly and overall progress, and looking at problem weeks to determine what made the scale go up and what lifestyle changes might help.
So how does that affect your hypertensive patients? Studies support that patient self-management is critical for the management of any disease. Patients need to have the tools and equipment to monitor their blood pressure on an ongoing basis – not just by the primary care or home health provider.
“For adults with hypertension who are willing and able to monitor their blood pressure at home in conjunction with their health care center, self-monitored blood pressure can be a useful tool to lower blood pressure and possibly lower the risk of cardiovascular events, at least for the short term,” said lead researcher Dr. Ethan Balk from the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center in Boston (HealthDay, 2013). When asked how the home monitoring stabilizes blood pressure, Balk said that reasons are unclear at this time. “Likely reasons are improved monitoring and tailored treatment of blood pressure by both the clinician or nursing staff and the patient, and increased incentives to control one’s diet and increase physical activity,” he said, “but these explanations are purely conjectural” (HealthDay, 2013).
See HHQI’s Cardiovascular Health Part 1 BPIP for more information and resources on patient self-management (pp. 49-51, 62-63). Here are just a few key resources in the BPIP:
- The Mayo Clinic website has an article for patients on “Getting the most out of home blood pressure monitoring” that discusses types of BP monitors, accurate BP measurement, and tips on measurement (BPIP p. 49)
- A clinician research brief that summarizes the AHRQ review “Effectiveness of Self-Measured Blood Pressure Monitoring In the Home” can be found here (BPIP p. 50)
- Blood pressure wallet card (BPIP pp. 62-63)
If you’re thinking about how difficult it is to just get scales in your patients’ homes – let alone blood pressure monitors, here are a couple of tips:
- Get some local pricing of home automated BP monitors (typically around $30-$50)
- Use the Mayo Clinic resource above to have the discussion with the patient and/or family
- Suggest that family buy the monitor as a gift to celebrate more birthdays or holidays together or as a “just because I love you and want to spend more time with you” gift
- Ask local pharmacies if they can provide any discounts or coupons for your patients
- Discharged patients can use community monitors at many local pharmacies and discount stores or visit their primary care provider’s office to get BP checked weekly
At the end of the day, you can’t change what you don’t measure, so getting your hypertensive patients to check their blood pressure regularly is a HUGE first step. Only then can you work together to begin to identify lifestyle changes that can help get their numbers under control.