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ABPM ‘less acceptable’ to patients than home monitoring

Patients find ambulatory blood pressure monitoring (ABPM) less acceptable than home self-monitoring, research has revealed.

Overall, around one in four patients found ABPM problematic, with home self-monitoring reported as more acceptable than either clinic measurement or ABPM.

NICE intends to include an indicator for use of ABPM for confirming new diagnoses of hypertension in 2014/2015, but GPs have raised concerns that some patients cannot undertake ABPM and need to be offered home monitoring as an alternative.

To explore individuals’ experiences with different forms of blood pressure monitoring, researchers recruited 822 patients, from 28 practices, of whom 63% had hypertension. Each participant underwent clinic, 24-hour ABPM and self-monitoring (over a week) before completing a validated acceptability questionnaire.   

The team created a 13-item ‘problem’ score from the questionnaire, in which a score below four was deemed more acceptable than unacceptable, as well as analysing the responses qualitatively.

Across all ethnic groups, patients reported home self-monitoring was the most acceptable method, with a mean score of 2.1, which was significantly more acceptable than both clinic monitoring, with a mean score of 2.4, and ABPM, with a mean score of 2.9.

Patients reported ABPM disturbed their sleep, work and usual activities of daily living. South Asian and African Caribbean groups found monitoring less acceptable in general than did white patients, and reported ABPM in particular caused them embarrassment and ‘creating an impression of a medical problem’, which researchers said could be related to patients not wanting family members to worry about them.

Presenting the findings, Dr Shelia Greenfield from University of Birmingham, said: ‘If it’s not acceptable to patients then all the guidelines in the world will not make any difference.’

‘The message is, know your patient and talk to them, to decide which is the best approach to monitoring blood pressure for them,’ Dr Greenfield said.

‘It is important to explore lifestyle and cultural factors, for example work, daily activities and family, with all patients when discussing which modality is best for them.’

NICE guidance introduced in 2011 recommended use of ABPM to confirm the diagnosis of hypertension, to help cut-down on over-treatment of a significant number of people who are misdiagnosed because their blood pressure is temporarily raised when measured in the clinic – the so-called ‘white coat’ effect.

NICE now wants to incentivise this through QOF but it remains unclear whether this will allow scope for offering home monitoring as an alternative, for patients unwilling or unable to use the ambulatory monitoring equipment.

Speaking to Pulse, co-investigator Professor Richard McManus pointed out that 75% of people are still likely to be able to perform ABPM, and trials show measurements performed this way correlate best with outcomes.

He said: ‘In my view it is best to get people doing ambulatory monitoring if they can be persuaded to do it, as it is the most accurate method for diagnosis.

‘But for longer term monitoring, home monitoring may be more suitable for some patients.’

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