Home Blood Pressure Monitoring and Hypertension Status Among US Adults: The National Health and Nutrition Examination Survey (NHANES), 2009-2010

Division of Health and Nutrition Examination Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland.
American Journal of Hypertension (Impact Factor: 2.85). 04/2013; 26(9). DOI: 10.1093/ajh/hpt054
Source: PubMed


Currently, no national prevalence is available on home blood pressure monitoring (HBPM).

This report is based on national-level, cross-sectional data for noninstitutionalized US adults aged ≥18 years (n = 6,001 participants) from the National Health and Nutrition Examination Survey (NHANES), 2009-2010.

Overall, 21.7% of the population reported HBPM in the past year. Using 2010 Census data as a reference, approximately 33 million (14.5%) individuals engaged in monthly or more frequent HBPM. The frequency of HBPM increased with higher age, higher body mass index, higher family income-to-poverty ratio, and a higher number of health-care visits (all, P < 0.05). Adults with health-care coverage engaged in monthly or more frequent HBPM than adults without coverage (16.1% vs. 8.4%; P < 0.05). Among people with hypertension (blood pressure ≥140/90mm Hg or currently taking medication), 36.6% engaged in monthly or more frequent HBPM. Of those with hypertension whom were aware, treated, and controlled, 41.9%, 43.5%, and 42.1%, respectively, engaged in monthly or more frequent HBPM. Adjusting for covariables, those who were aware of, treated for, and controlled their hypertension were more likely to have a higher frequency of HBPM than the reference: unaware, untreated, and uncontrolled (odds ratio (OR) = 3.59; OR = 3.96; and OR = 1.50, respectively).

Approximately 14.5% of adults engaged in monthly or more frequent HBPM. Being aware of hypertension, being pharmacologically treated, and being controlled were associated with an increased frequency of HBPM. Even among these categories of people with hypertension, <50% were using HBPM.

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    • "Only few papers have investigated the availability and use of HBPM [11] [12] [13] [14] [15]. The ownership of HBPM among hypertensive patients ranged between 46% in Turkey [11] and 78% in Canada [12]. "
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    ABSTRACT: Background Home blood pressure monitoring (HBPM) is recommended for hypertensive patients as a tool to improve both blood pressure (BP) control and compliance with treatment. Methods We evaluated the use of HBPM in hypertensive subjects examined during a cross-sectional general population survey (Czech post-MONICA). Models predicting the availability and use of HBPM were constructed using univariate and multivariate logistic regression. Results Of 449 treated hypertensive patients (mean age 63.2 years, 52.1% women), 250 (55.7%) reported that they had a device for BP monitoring available at home. The factors associated with HBPM availability were older age, university education, marital status, longer duration of hypertension and nonsmoking. Of the 250 subjects with HBPM available, 40% used HBPM regularly (at least once a week), and this ratio increased with the number of antihypertensive drugs taken (monotherapy 30%, dual combination 43%, combination of ≥3 drugs 48%; ptrend = 0.028). BP control was similar in those using HBPM regularly and those who used HBPM irregularly or did not use it at all (54.5 vs. 49.7%; p = 0.52). Conclusion HBPM is available to more than a half of treated hypertensive patients from the general population. However, only minority of the patients perform home blood pressure measurement regularly.
    Full-text · Article · Apr 2014 · Cor et vasa
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    ABSTRACT: Home blood pressure measurement (HBPM) is recommended for the diagnosis and follow-up of hypertensive patients. While measurement protocols emphasize a rest period before taking the measurement, this directive has not been supported by any specific study to date. This analysis aimed to determine whether the respect or nonrespect of rest before HBPM could introduce a difference between daytime ambulatory blood pressure measurement (ABPM) and HBPM; whether this rest is observed "in real life" among educated hypertensive patients. In this open, prospective study we compared HBPM, with and without rest, and ABPM among 52 office/clinically controlled hypertensive patients. HBPM was performed during 3 days (French HAS instructions); 24-hour ABPM was performed within 3 days of HBPM. All patients who regularly performed HBPM before the study were asked how they practiced HBPM in real life. There was a differential impact of rest on differences observed in daytime ABPM and HBPM. Systolic HBPM decreased with rest, while diastolic HBPM did not significantly increase. HBPM systolic BP (SBP) without rest was not significantly different from daytime ABPM SBP (P = 0.27). HBPM SBP without rest was lower than daytime and 24-hour systolic ABPM. Diastolic HBPM after rest was not significantly different from daytime diastolic ABPM (P = 0.09). None of the 38 patients who regularly performed HBPM were compliant with a period of rest before beginning the measurements. Rest before HBPM induces a bias that underestimates SBP vs. daytime ABPM and perhaps complicates patient adherence to HBPM protocols.
    No preview · Article · Feb 2014 · American Journal of Hypertension
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    ABSTRACT: Several evidences have supported the benefits of home blood pressure monitoring (HBPM) in improving hypertension awareness and control. However, little was known about the use of HBPM by hypertensive patients in primary care in China. A cross-sectional questionnaire survey on HBPM use was conducted on 1915 hypertensive patients in Xinzhuang County Hospital in Shanghai, and the factors related to regular use of HBPM were also determined. Overall, 1011 of the 1915 participants engaged in using HBPM, among whom 786 individuals used HBPM more than once a month. Of the 1011 HBPM users, 25.42% chose a mercury sphygmomanometer, 33.55% used wrist-cuff electronic devices, and 46.5% selected arm-cuff electronic devices. In addition, 73% of HBPM users reported HBP readings to their general practitioners. Compared with the less frequent users, patients who used HBPM daily were likely to report their blood pressure (BP) values to the doctors depending on notebook or mechanical memory than on their own memories (P<0.001). Moreover, patients with college education were 2.7 times more likely than those with middle school education or less to engage in frequent HBPM use (odds ratio=2.71, 95% confidence interval=2.03-3.61). This local community survey showed that ∼40% of hypertension patients used HBPM frequently in primary care in China. However, certain patients chose the improper BP monitoring device or questionable reporting methods. Therefore, the use of arm-cuff electric devices with multiple memory storage or a home BP telemonitoring system should be promoted by health education targeted at hypertensive patients.
    No preview · Article · Jun 2014 · Blood pressure monitoring
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