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Delay BP Treatment Until At-Home Measurement

Oct 23, 2015

Accuracy in patient blood pressures necessary before beginning pharmacotherapy.

Often, hypertension treatment is initiated based solely on readings from visits to the medical office. However, a new recommendation from the USPSTF is encouraging that practice to change. The USPSTF is a group of healthcare professionals that reviews published evidence to make practice recommendations to improve preventative care.

The USPSTF has recently published a statement advising healthcare professionals to delay hypertension treatment until the condition can be confirmed by readings outside of the practice setting. The recommendation came about because the USPSTF found evidence suggesting that the benefit of confirming hypertension outside of the medical office outweighs the risks that a delay in treatment would present. A pattern of high blood pressure readings is important for hypertension confirmation because of the variable nature of blood pressure. At a medical office, many people get “white coat hypertension” – a phenomenon in which fear or anxiety associated with being in a medical setting causes an increase in blood pressure. Furthermore, numerous other factors such as stress, diet, mood, and physical activity can change blood pressure moment to moment. Hypertension screening should still occur regularly in the medical office or clinic setting, but the confirmation should come from ambulatory monitoring or home monitoring results.

Home blood pressure monitoring is the use of an automatic cuff to measure blood pressure at home. These cuffs can be purchased at drug stores and range from $20 to over $100 in cost depending on the manufacturer, model, and features. It should be performed at least once or twice a day at a consistent time to demonstrate a pattern. Wrist machines are not preferred due to their inaccuracy compared to cuffs. Ambulatory blood pressure monitoring – the use of a portable device to continuously measure blood pressure over a 12- to 24-hour period – is preferred over home blood pressure monitoring. It is the preferred method because not all commercially available home monitors have been validated for accuracy.

Practice Pearls:

  • The USPSTF recommends that healthcare professionals confirm hypertension diagnoses with ambulatory or home readings before initiating treatment.
  • Many patients are diagnosed with hypertension and begin pharmacotherapy with sporadic readings only recorded in the practice setting. These readings may not provide an accurate picture of a patient’s blood pressure status due factors that cause blood pressure to change.
  • Ambulatory blood pressure monitoring is preferred over home blood pressure monitoring; home devices may not be validated for accuracy.

“Screening for High Blood Pressure in Adults: U.S. Preventative Services Task Force Recommendation Statement.” Ann Intern Med. Published online 12 October 2015 doi:10.7326/P15-9036; Iris Shai, R.D., Ph.D., City; Oct. 12, 2015, Annals of Internal Medicine, online