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Third of patients ‘self-monitoring blood pressure’

Up to a third of patients in primary care with hypertension are self-monitoring their blood pressure, suggesting home readings could be incorporated more closely into clinical practice, a new study concludes.

Self-monitoring of blood pressure was particularly common among patients with diabetes who were monitoring their blood glucose, and even among patients who were not self-monitoring, the majority said they would consider doing so.

Researchers sent questionnaires to 1,815 patients who had hypertension, across four GP practices in the West Midlands, between November 2008 and April 2009.

Among the 53% who responded, 31% reported they currently self-monitored blood pressure, with two-thirds monitoring at least once a month. Of participants who did not self-monitor, 58% reported they would consider doing so.

Patients who had diabetes and monitored their blood glucose were five times more likely to monitor their blood pressure that those with diabetes who did not monitor blood glucose.

Study leader Professor Richard McManus, professor of primary care research at the University of Oxford and a GP in Birmingham, conceded the survey could have been affected by response bias.

But Professor McManus, a member of the NICE guideline development group that recommended ambulatory blood pressure monitoring, said: ‘GPs should be aware around a third of their patients with hypertension could be monitoring their own blood pressure and of the opportunities this could bring to daily management.'

Co-author Sabrina Grant, research associate at the University of Birmingham, said the results ‘indicate home blood pressure monitoring is more popular than we might think'.

Dr Chris Arden, a cardiology GPSI in Southampton, said self-monitoring could play an important role, particularly in diagnosis: ‘I've been encouraging patients to purchase their own monitors – and we've got monitors we loan out.'

He said it was an effective use of resources, moving responsibility back to patients and easing pressures on practice time.

Dr Terry McCormack, council member of the Primary Care Cardiovascular Society and a GP in Whitby, Yorkshire, said: ‘What is interesting is the high uptake amongst diabetic patients who already appreciate the advantages of self-monitoring. We do want more people to self monitor but we are not there yet.'

Dr Kathryn Griffith, a cardiology GPSI in York, said: ‘I would agree that 30-50% of my patients have monitors. My concern is that they may have had them for a long time and that they may not be calibrated.'

New NICE hypertension guidance recommends using clinic measurements to monitor response to anti-hypertensive drugs or lifestyle modifications, but suggests using ambulatory blood pressure monitoring or home blood pressure monitoring – in addition to clinic readings - in patients who have a white-coat effect.

International Journal of Hypertension. 2011 online 16 October