4 September, 2014    #14

Do-It-Yourself Blood Pressure

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The full title of this recent blood pressure (BP) article released by the Associated Press is:


Do-It-Yourself Blood Pressure Care Can Beat MDs.


This article reports how Home BP results can be used to self-adjust the dosage of BP meds in order to maintain a healthy BP.  However, no specific procedures or instructions are provided.


Trax News is not recommending that you attempt to self-adjust your BP medications without first discussing with your MD or Healthcare Provider.


This article is provided to keep you informed on current trends in BP Technology and use.


Please read my commentary at the end of the article.


Mike Kohut, President, DDMS



Lindsey Tanner, The Associated Press

Published Wednesday, August 27, 2014 10:01AM EDT



CHICAGO -- "Do-it-yourself" blood pressure measurements and medicine changes work better than usual doctor-office care in some patients, a study of older adults in England found.


Those who did their own readings at home and adjusted their medicine as needed had healthier blood pressure levels after a year than those who got standard doctors' care.


Self-care patients weren't completely on their own -- any changes they made were part of a treatment plan previously OK'd by their doctors. But the patients didn't need to consult their doctors every time they increased the dose if it was part of the original treatment plan.


Why self-management worked best is uncertain, but patients who participated were taking more medication than the others and were perhaps more vigilant than doctors treating the usual-care group, the study suggests.


It's possible usual-care doctors had "clinical inertia"(*) -- a phenomenon described in other research showing that physicians often fail to increase blood pressure medication doses even when office measurements show patients' levels are too high, said study author Richard McManus, a professor and researcher at the University of Oxford.


The study was published Tuesday in the Journal of the American Medical Association.


Nearly 1 in 3 U.S. adults have high blood pressure -- measuring 140 over 90 or higher -- but only about half of them have it adequately controlled, according to the Centers for Disease Control and Prevention. High blood pressure rates are similar in England, health surveys there have found.


The study involved 450 patients with previous heart trouble, strokes, diabetes or kidney disease, aged 70 on average, who were followed for a year. About half got usual care; the others did self-care.


Average blood pressure measurements at the study's start were about 143 over 80. At the end, that dropped to about 128 over 74 in the self-care patients and 138 over 76 in the usual-care group.


That difference would be expected to result in a drop in heart problems or other complications, although more research is needed to evaluate long-term benefits, according to a JAMA editorial.


The researchers estimate that if the self-care group's lower levels could be sustained, they'd likely see a 30 per cent reduction in stroke risk compared with the other group.


Self-monitoring blood pressure is common in some countries and in the United Kingdom, and the study notes that blood pressure monitors are widely available there, costing as little as $25 (15 pounds, 18 euros). Similarly priced home blood-pressure monitors are sold in the United States.


Some U.S. centers have tried self-management approaches although more research is needed before a program like the one studied could be widely recommended, said Dr. Laura Svetkey, a hypertension specialist at Duke University.


"I think we're moving in that direction," Svetkey said. "There's tremendous motivation to control health care costs and a parallel trend toward giving patients a bigger role in their decision-making and management."


Most patients studied were white and worked at white-collar or skilled manual labor jobs; whether similar results could be achieved with less skilled or less educated patients isn't known.


For self-care programs to work, patients need to be carefully selected, said Dr. Mary Ann Bauman, a spokeswoman for the American Heart Association. "You have to have compliant, knowledgeable patients," said Bauman, medical director for women's health and community relations at Integris Health, Inc. in Oklahoma City.





(*) Commentary:
 by Michael L. Kohut, President DDMS:


MD Office Blood Pressure (BP) measurements are often highly variable due to patient anxiety and stress associated with the medical office environment.  At best, intermittent BP measurements taken by your MD or Nurse should be viewed as screening tests due to the probability of increased error.  Not the error associated with the actual measured results, but the probability error that those results fail to represent your true Resting BP.  Please see Trax News Article #2: "Don't Forget to Rest for additional information.


Therefore, "Clinical Inertia" may be beneficial to the patient by not implementing BP medication changes based on a few MD Office BP results.  However, home measured BP results, averaged using Resting BP Procedures over several weeks of daily BP measurements, may be acceptable for "Do It Yourself " medication adjustments within an MD approved plan. 


bp Trax is specifically designed to compare the performance of all treatments and medication changes, whether Self or MD directed.


Please discuss with your MD before implementing Self Directed or "Do-It-Yourself" medication adjustments.  As mentioned above, only the average of a set of BP results should be used to adjust medication.





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