Article

Why it is Important to Measure Blood Pressure at Home Rather than Just at the Clinic?

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Abstract

Hypertension is a major cause of mortality worldwide. out-of-office/clinic blood pressure (BP) measurements (ambulatory BP monitoring [ABPM] and home BP monitoring [HBPM]) are superior to office/clinic measurements for the accurate diagnosis and risk-stratification of hypertensive patients. ABPM is able to provide additional information regarding prognostically important circadian rhythm abnormalities. HBPM is the preferred choice of patients. When used in conjunction with telemonitoring, it has the potential to improve treatment compliance and overcome treatment inertia resulting in better BP control. Challenges remain in implementation of universal HBPM monitoring.

Support: The publication of this article was funded by Omron Healthcare Singapore Pte Ltd.

Keywords

Ambulatory blood pressure monitoring (ABPM), home blood pressure monitoring (HBPM),

Disclosure:The author has no conflicts of interest to declare.

Received:

Accepted:

DOI:https://doi.org/10.15420/apc.2011:3:1:41

Correspondence Details:Azani Mohamed Daud, Gleneagles Hospital, 282-286 Jalan Ampang, Kuala Lumpur 50450, Malaysia. E: docazani@yahoo.com

Copyright Statement:

The copyright in this work belongs to Radcliffe Medical Media. Only articles clearly marked with the CC BY-NC logo are published with the Creative Commons by Attribution Licence. The CC BY-NC option was not available for Radcliffe journals before 1 January 2019. Articles marked ‘Open Access’ but not marked ‘CC BY-NC’ are made freely accessible at the time of publication but are subject to standard copyright law regarding reproduction and distribution. Permission is required for reuse of this content.

Hypertension has been shown to be a major cause of death worldwide.1 A clear relationship exists between hypertension (HTN) and cardiovascular (CV) events, with an increase in risk of total mortality, mortality due to heart disease, stroke, chronic kidney disease (CKD) and heart failure (HF) as well as morbidity associated with non-fatal CV disease.2 Despite there being clear demonstrable CV benefits from blood pressure (BP) reduction in large clinical trials,3-5 BP control remains poor worldwide6 and mortality due to hypertension rates are high.

BP exhibits a circadian pattern.7 BP tends to be lowest between 2 and 4am, with systolic and diastolic readings approximately 13 and 17% lower than daytime values. After 4am there is an 'early morning surge' in BP readings, reaching a peak at about 6am. There is then a gradual decline towards the evening, followed by lower readings at night. The 'early morning surge' is associated with an increase in CV events8,9 including acute myocardial infarction, ischaemic and haemorrhagic stroke and sudden cardiovascular death.10,11 An office/clinic BP reading only offers an instantaneous reading or snapshot of a patients BP in a day and cannot give a true reflection of BP readings throughout the day or abnormalities in the circadian rhythms.

However, in the past most clinical studies have used conventional cuff BP measurements at clinic/office visits to measure BP and still demonstrated CV outcome benefits. With better understanding of circadian BP changes, should we be looking at BP measurement away from the clinic/office in order to improve patient outcomes?

This article aims to outline the options available for clinicians in daily practice and the potential benefits of adopting out-of-office/clinic BP measurements in clinical practice with regards to accurate diagnosis of hypertension, risk stratification and how these techniques may be utilised to improve BP control and CV outcomes.

Options Available for Out-of-office/Clinic Blood Pressure Measurements
Ambulatory Blood Pressure Monitoring

Ambulatory BP monitoring (ABPM) is an automated technique utilising a cuff that is usually attached to a small monitor/recorder worn on a belt. Multiple BP measurements are taken at regular intervals (15-30 minutes) over a 24-48 hour period. The data are downloaded to a computer at the end of the recording period for interpretation and action by the physician. There are also newer devices worn at the wrist that have been well validated and found to give accurate BP readings12 and these are now commercially available.

ABPM is more accurate than office BP readings,5 which are associated with white-coat hypertension (WCH) and, hence, false-positive diagnoses of hypertension.13,14 It is far superior to office readings in risk stratification and predicting CV events15 and provides a more reliable and more accurate representation of overall BP than office-based measurements.16,17

There are limitations of ABPM that need to be considered. These include set-up costs that are not inconsiderable, including equipment purchase and staff training.18 During the recording period, patients may experience complications including uncomfortable cuff pressure, sleep disturbance, petechiae and bruising.19 Should 24 hour on-call personnel be made available for patients who experience these possible complications, this will add further to the cost of providing an ABPM service. Variations in BP readings may occur due to readings being taken during activity, for example, exercise and driving or when taken in the presence of arrhythmias, e.g. atrial fibrillation.1,9 For an ABPM recording to be considered acceptable, at least 85% of readings must be deemed suitable for inclusion in the analysis.1,9 Although ABPM has clear benefits in terms of diagnosis and prognostication, the practical limitations do not make it the ideal tool for regular BP monitoring.

Home Blood Pressure (Self) Monitoring

Home blood pressure (self) monitoring (HBPM) is performed using commercially available monitors by patients themselves. There are currently three types of monitors available.

The cuff-arm monitors that are available are mostly fully automated and patients only need to place the cuff correctly around the arm and press a button to activate the machine to inflate the cuff and take BP readings, although some machines require manual inflation. Most machines also have a memory function allowing serial BP readings to be stored for later review.

Wrist monitors are also available. It is important that the wrist is held at the same level as the heart when readings are taken to minimise errors. Although finger monitors are also available, they are not currently recommended for HBPM due to inaccuracies.20

It is very important that HBPM monitors have been independently validated for accuracy according to international protocols. Dedicated websites listing devices which have been validated are readily accessible (for example: www.dableducational.org/, www.bhsoc.org/blood_pressure_list.stm and www.hbprca.com.au/ validated-bp-monitors-in-australia). Currently, there are fewer validated wrist monitors than arm monitors.

BP values obtained using HBPM are similar to ABPM and substantially lower than office-based values.21 The technique has proven reproducibility - in a study using standard deviation of the differences as a measure, home BP had the most superior reproducibility, followed by ABPM and office/clinic measurements.22 This may be due to HBPM readings being taken under less variable circumstances.

Patients find HBPM more convenient and it is therefore preferred over ABPM.23,24 In the US, there has been a steady increase in HBPM use over the past few years.25 Forty seven per cent of patients in this poll reported that a physician had recommended the use of a home monitor. Of those who had received no recommendation from their physician, 46% had also bought monitors. An important pre-requisite for HBPM is patient education and training26 and HBPM should be instituted under medical supervision.

Potential Benefits of Out-of-office/Clinic Blood Pressure Measurements in Clinical Practice
White Coat Effect and White Coat Hypertension

The white coat effect (WCE) is defined as the difference between office BP and the BP measured at home or during the day by ABPM. This phenomenon has been attributed to anxiety, a hyperactive alerting response or a conditioned response.27

WCH is defined as high BP occurring only in a medical care setting. It is the major reason why office/clinic BP readings are higher than out-of-office/clinic BP readings28 and has been reported in as many as 20% of patients in whom hypertension has been diagnosed by office BP.18-20 Studies comparing office BP and ABPM have shown that WCH has a relatively benign prognosis.29,30 Obtaining a correct diagnosis is important to ensure that unwarranted treatment is avoided31 and patients are not put at a disadvantage regarding employment prospects or for insurance purposes.32

In the Treatment of Hypertension Based on Home or Office Blood Pressure (THOP) study, using ABPM as a benchmark, the sensitivity and specificity of HBPM in detecting WCH was found to be 68.4 and 88.6%, respectively.33 In the Ohasama study, HBPM had a superior predictive value over office BP in demonstrating that patients with WCH had a relatively low risk.34 HBPM is thus suitable for identifying patients suspected of WCH.

Masked Hypertension

This condition is the opposite of WCH, where clinic BP levels are normal (<140/90) and home BP levels are high (>135/85).35 It is also known as reverse white-coat hypertension or isolated home or isolated ambulatory hypertension. The prevalence has been found to increase with age, being 5% in hypertensives below 70 years of age and rising to 16.6% in those above 80 years of age.36 Other studies have found prevalence of 42 and >50%, depending on study population.37,38 It is important that this condition is diagnosed as it confers the same CV risk as sustained hypertension.39,40

No significant difference in prevalence of masked hypertension was demonstrated whether ABPM or HBPM was used36 and HBPM can be used to identify such patients.

Resistant Hypertension

In this condition, blood pressure remains above the goal despite the use of three antihypertensive drugs of different classes at optimal doses. Up to 30% of patients with resistant hypertension have controlled BP when assessed by 24-hour ABPM41 or HBPM42 and it would be appropriate for either of these techniques to be used when assessing patients presenting with apparent resistant hypertension.

Day-to-night Blood Pressure Variability

As has been previously mentioned, BP follows a circadian pattern, with night-time BP values between 10 and 20% lower than daytime values.43,44 The prognostic significance of this difference between day- and night-time BP was demonstrated in the Ohasama study, where patients were divided into four categories based on the quantum of difference.

'Extreme dippers' were those whose decline in nocturnal blood pressure was 20% or more of daytime BP, 'dippers' were those whose decline was between 10 and 20%, 'non-dippers' had a BP decline of between 0 and 10% and 'inverted dippers' had no nocturnal BP decline. Over a mean follow-up period of about five years, the highest mortality risk was in inverted dippers followed by non-dippers, whereas there was no difference between dippers and extreme dippers.44

The importance of day-to-night variation in BP in relation to CV mortality has also been born out in other studies.45,46 ABPM would be the modality of choice to detect and classify nocturnal BP decline. HBPM would not be useful as BP readings would not be taken when asleep.

Early Morning Surge

In addition to the nocturnal lowering of BP, there is a 'morning surge' in BP that is associated with an increase in CV events,8,9 including acute myocardial infarction, ischaemic and haemorrhagic stroke and sudden cardiovascular death.10,11 Clinical trials have shown differences in early morning surge BP control between different agents within the same antihypertensive class47 as well as differing antihypertensive classes.48 Use of ABPM will allow identification of patients who experience a morning surge and allow selection of suitable antihypertensive regimes to overcome this.48

Although HBPM (as opposed to ABPM) would not be considered a suitable modality for providing information regarding nocturnal BP decline (dipper status) or early morning BP surge (both of which have prognostic significance), it has been shown that HBPM is superior to office/clinic BP readings in assessing overall risk of CV morbidity and mortality33,49,50 as well as predicting target end organ damage.17,51,52

Improvements in Blood Pressure Control

As was previously alluded to, despite there being ample evidence that BP reduction has significant CV benefits,3-5 BP control remains poor worldwide6 and hypertension has remained a major cause of death worldwide.1 Can HBPM be utilised to improve BP control?

A previous meta-analysis of 18 randomised clinical trials showed small improvements in BP readings (2.2/1.9mmHg) in patients with HBPM compared with usual care.53 These findings have been supported by a recently published meta-analysis by Agarwal of 37 randomised controlled trials showing similar reductions in BP (2.7/1.7) in patients in whom HBPM was utilised compared with those in whom HBPM was not utilised.54

One possible way in which HBPM may improve BP control is through improvement in medication adherence. A meta-analysis of 11 randomised controlled trials revealed that the majority of the trials reported a significant improvement in medicine adherence attributable to HBPM, the greatest effects being seen in trials employing other concurrent adherence-enhancing measures.54 Recent studies have shown that HBPM in conjunction with telemonitoring of readings by the physician improves treatment compliance.55,56 These findings are supported by Agarwal's meta-analysis, which also showed a significant reduction in BP readings with HBPM utilisation, the effect being more pronounced when concomitant telemonitoring was utilised compared with HBPM alone.53

Another possible reason why hypertensive patients do not achieve targets is therapeutic inertia, i.e. the failure to intensify therapy either by increasing the dosage of current medications or adding different agents in order to achieve BP goals.57,58 This phenomenon is not confined to management of hypertension alone but other chronic diseases such as diabetes and hyperlipidaemia.59 An innovative approach incorporating detailed patient education, patient self-titration of treatment according to BP readings obtained via self-monitoring with HBPM combined with data transmitted via tele-transmission to a core centre for monitoring demonstrated that this approach was feasible, well accepted by patients and physicians and safe.60 Moreover, both office and HBPM BP readings were significantly lower at the end of the study period. Agarwal's meta-analysis further supports these findings, showing that HBPM overcomes therapeutic inertia with resultant greater changes in antihypertensive medications.53

Patient Acceptance

Experience from clinical studies show that HBPM is preferred to ABPM and well accepted by patients.5,24,60 However, initial enthusiasm might not always be matched by long term sustainability, with evidence that only 50% of patients preferring to continue with HBPM with telemonitoring after one year.61

Physician Acceptance

There is evidence that HBPM is well-accepted by physicians in clinical studies.60 The percentage of patients reporting their physicians recommending HBPM increased by 12% over a five-year period.25 HBPM with or without telemonitoring will still require the resources and time of a physician in reviewing data and advising necessary changes to treatment.

Differences in payments for healthcare delivery systems need to be taken into consideration. Physicians practicing in a fee-for-service system (mainly private practice) may be reluctant to replace office/clinic visits self monitoring with or without telemonitoring unless these can be charged as a service. On the other hand, physicians under a high volume, capitation fee system and those working in busy, high-volume public hospitals may embrace these changes as they have the potential to reduce clinic loads.

Costs

The obvious cost involved is in the purchase of the monitors. In the US, HBPM is more commonly used by older and more affluent patients.38 In patients who do not own monitors, 14% gave expense as the reason. A very similar 14.3% of patients reported they could not afford to purchase monitors in a developed Asian country.6 Other costs involved include validation of machines, education and training of patients in correct usage of HBPM, data transmission if telemonitoring is practiced and cost of physicians reporting the data.

A joint scientific statement calling for the use and reimbursement of HBPM systems is recommending that purchase of HBPM equipment should be reimbursable in the US, as should the providers for services related to HBPM.63

Conclusion

ABPM and HBPM are both superior to office BP measurements in the overall management of hypertension. HBPM is the preferred choice of patients and, despite shortcomings, has the potential to significantly improve BP control. Used appropriately, out of office/clinic BP measurement will enhance the management of hypertensive patients.

References

  1. Ezzati M, Lopez AD, Rodgers A, et al., Comparative Risk Assessment Collaborating Group. Selected major risk factors and global and regional burden of disease, Lancet, 2002;360:1347-60.
  2. Chobanian AV, Bakris GL, Black HR, et al., Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program Coordinating Committee. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, Hypertension, 2003;42:1206-52.
  3. Neal B, MacMahon S, Chapman N, Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. Blood Pressure Lowering Treatment Trialists' Collaboration, Lancet, 2000;356:1955-64.
  4. Dahlof B, Sever PS, Poulter NR, et al., Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial, Lancet, 2005;366:895-906.
  5. Floras JS, Ambulatory blood pressure: facilitating individualized assessment of cardiovascular risk, J Hypertens, 2007;25:1565-8.
  6. Kearney PM, Whelton M, Reynolds K, et al., Worldwide prevalence of hypertension: a systematic review, J Hypertens, 2004;22:11-9.
  7. Pickering TG, Shimbo D, Haas D, Ambulatory blood pressure monitoring, N Eng J Med, 2006;354:2368-74.
  8. Millar-Craig MW, CN Bishop, Raftery EB, Circadian variation of blood-pressure, Lancet, 1978;1:795-7.
  9. White WB, Cardiovascular risk and therapeutic intervention for the early morning surge in blood pressure and heart rate, Blood Press Monit, 2001;6:63-72.
  10. Muller JE, Tofler GH, Stone PH, Circadian variation and triggers of onset of acute cardiovascular disease, Circulation, 1989;79:733-43.
  11. White WB, Circadian variation of blood pressure: clinical relevance and implications for cardiovascular chronotherapeutics, Blood Press Monit, 1997;2:47-52.
  12. Kim-Gau Nga, Choon-Meng Tinga, Joon-Hock Yeob, et al., Progress on the development of the MediWatch ambulatory blood pressure monitor and related devices, Blood Press Monit, 2004;9:149-65.
  13. Pickering TG, Gerin W, Schwartz AR, What is the white-coat effect and how should it be measured?, Blood Press Monit, 2002;7:293-300.
  14. Stergiou GS, Skeva II, Baibas NM, Kalkana CB, et al., Diagnosis of hypertension using home or ambulatory blood pressure monitoring: comparison with the conventional strategy based on repeated clinic blood pressure measurements, J Hypertens, 2000;18:1745-51.
  15. Hansen TW, Kikuya M, Thijs L, et al., Prognostic superiority of daytime ambulatory over conventional blood pressure in four populations: a meta-analysis of 7,030 individuals, J Hypertens, 2007;25:1554-64.
  16. Sakuma M, Imai Y, Nagai K, et al., Reproducibility of home blood pressure measurements over a 1-year period, Am J Hypertens, 1997;10(Pt 1):798-803.
  17. Kleinert HD, Harshfield GA, Pickering TG, et al., What is the value of home blood pressure measurement in patients with mild hypertension?, Hypertension, 1984;6:574-8.
  18. Aylett MJ, Ambulatory or self blood pressure measurement? Improving the diagnosis of hypertension, Fam Pract, 1994;11:197-200.
  19. McGrath BP, Ambulatory blood pressure monitoring, Med J Aust, 2002;176:588-92.
  20. dable® Educational Trust, Available at: www.dableducational.org/ (accessed on 14 December 2010).
  21. Mancia G, Sega R, Bravi C, et al., Ambulatory blood pressure normality: results from the PAMELA study, J Hypertens, 1995;13:1377-90.
  22. Stergiou GS, Baibas NM, Gantzarou AP, et al., Reproducibility of home, ambulatory, and clinic blood pressure: implications for the design of trials for the assessment of antihypertensive drug efficacy, Am J Hypertens, 2002;15(Pt 1):101-4.
  23. Herpin D, Pickering T, Stergiou G, et al., Consensus conference on self-blood pressure measurement. Clinical applications and diagnosis, Blood Press Monit, 2000;5:131-5.
  24. Carney S, Gillies A, Garvey L, et al., Direct comparison of repeated same-day self and ambulatory blood pressure monitoring, Nephrology, 2005;10:151-6.
  25. The 2006 Gallup Study of the Hypertension Market. Princeton, NJ:Multi-Sponsor Surveys Inc; 2006.
  26. European Society of Hypertension Practice Guidelines for home blood pressure monitoring, J Human Hypertension, 2010;24:779-85.
  27. Hond ED, Celis H, Fagard R, et al., THOP Investigators. Selfmeasured versus ambulatory blood pressure in the diagnosis of hypertension, J Hypertens, 2003;21:717-22.
  28. Ohkubo T, Kikuya M, Metoki H, et al., Prognosis of 'masked' hypertension and 'white-coat' hypertension detected by 24-hour ambulatory blood pressure monitoring 10-year follow-up from the Ohasama study, J Am Coll Cardiol, 2005;46:508-15.
  29. Verdecchia P, O'Brien E, Pickering T, et al., European Society of Hypertension Working Group on Blood Pressure Monitoring. When can the practicing physician suspect white coat hypertension? Statement from the Working Group on Blood Pressure Monitoring of the European Society of Hypertension, Am J Hypertens, 2003;16:87-91.
  30. Pater C, Beyond the evidence of the new hypertension guidelines. Blood pressure measurementÔÇöis it good enough for accurate diagnosis of hypertension? Time might be in, for a paradigm shift (I), Curr Control Trials Cardiovasc Med, 2005;6:6.
  31. O'Brien E, Coats A, Owens P, et al., Use and interpretation of ambulatory blood pressure monitoring: recommendations of the British Hypertension Society, BMJ, 2000;320:1128-34.
  32. Ohkubo T, Imai Y, Tsuji I, et al., Home blood pressure measurement has a stronger predictive power for mortality than does screening blood pressure measurement: a population-based observation in Ohasama, J Hypertens, 1998;16:971-5.
  33. McKay DW, Myers MG, Bolli P, Chockalingam A, Masked hypertension: a common but insidious presentation of hypertension, Can J Cardiol, 2006;22:617-20.
  34. Helvaci MR, Seyhanli M, What a high prevalence of white coat hypertension in society!, Intern Med, 2006;45:671-4.
  35. Bobrie G, Gen├¿s N, Vaur L, et al., Is 'isolated home' hypertension as opposed to ÔÇ£isolated officeÔÇØ hypertension a sign of greater cardiovascular risk?, Arch Intern Med, 2001;161:2205-11.
  36. Oikawa T, Obara T, Ohkubo T, et al., J-HOME Study Group. Characteristics of resistant hypertension determined by self-measured blood pressure at home and office blood pressure measurements: the J-HOME study, J Hypertens, 2006;24:1737-43.
  37. Bobrie G, Genès N, Vaur L, et al., Is 'isolated home' hypertension as opposed to 'isolated office' hypertension a sign of greater cardiovascular risk?, Arch Intern Med, 2001;161:2205-11.
  38. Bj├Ârklund K, Lind L, Zethelius B, et al., Isolated ambulatory hypertension predicts cardiovascular morbidity in elderly men, Circulation, 2003;107:1297-302.
  39. Brown MA, Is resistant hypertension really resistant?, Am J Hypertens, 2001;14:1263-9.
  40. Denolle T, Waeber B, Kjeldsen S, et al., Self-measurement of blood pressure in clinical trials and therapeutic applications, Blood Press Monit, 2000;5:145-9.
  41. Weber MA, Drayer YM, Makamura DK, Wyle FA, The circadian blood pressure pattern in ambulatory normal subjects, Am J Cardiol, 994;45:115-9.
  42. Mancia G, Parati G, Ambulatory blood pressure monitoring and organ damage, Hypertension, 2000;36:894-900.
  43. Ohkubo T, Imai Y, Tsuji I, et al., Relation between nocturnal decline in blood pressure and mortality, Am J Hypertens, 997;10:1201-7.
  44. Mancia G, Bombelli M, Facchetti R, et al., Long-term prognostic value of blood pressure variability in the general population: results of the Pressioni Arteriose Monitorate e Loro Associazioni Study, Hypertension, 2007;49:1265-70.
  45. Boggia J, Li Y, Thijs L, et al., Prognostic accuracy of day versus night ambulatory blood pressure: a cohort study, Lancet, 2007;370:1219-29.
  46. Brunner HR Arakawa K, Antihypertensive Efficacy of Olmesartan Medoxomil and Candesartan Cilexetil in Achieving 24-Hour Blood Pressure Reductions and Ambulatory Blood Pressure, Goals Clin Drug Invest, 2006;26(4):185-13.
  47. White WB, Sica DA, et al., Preventing Increases in Early-Morning Blood Pressure, Heart Rate, and the Rate-Pressure Product With Controlled Onset Extended Release Verapamil at Bedtime, Am Heart J, 2002;144(4).
  48. Ohkubo T, Asayama K, Kikuya M, et al., Prediction of ischaemic and haemorrhagic stroke by self-measured blood pressure at home: the Ohasama study, Blood Press Monit, 2004;9:315-20.
  49. Mancia G, Facchetti R, Bombelli M, et al., Long-term risk of mortality associated with selective and combined elevation in office, home, and ambulatory blood pressure, Hypertension, 2006;47:846-53.
  50. Abe H, Yokouchi M, Saitoh F, et al., Hypertensive complications and home blood pressure: comparison with blood pressure measured in the doctor's office, J Clin Hypertens, 1987;3:661-9.
  51. Jula A, Puukka P, Karanko H, Multiple clinic and home blood pressure measurements versus ambulatory blood pressure monitoring, Hypertension, 1999;34:261-6.
  52. Cappuccio FP, Kerry SM, Forbes L, Donald A, Blood pressure control by home monitoring: meta-analysis of randomised trials (published correction appears in, BMJ, 2004;329:499), BMJ, 2004;329:145.
  53. Agarwal R, Bills JE, Hecht TJW, Light RP, Role of home blood pressure monitoring in overcoming therapeutic inertia and improving hypertension control: a systematic review and meta-analysis, Hypertension, 2011;57:29-38.
  54. Ogedegbe G, Schoenthaler A, A systematic review of the effects of home blood pressure monitoring on medication adherence, J Clin Hypertens, 2006;8:174-80.
  55. Parati G, Omboni S, Albini F, et al., Home blood pressure telemonitoring improves hypertension control in general practice. The TeleBPCare study, Hypertens, 2009;27:198-203.
  56. McManus RJ, Mant J, Bray EP, et al., Telemonitoring and selfmanagement in the control of hypertension (TASMINH2): a randomised controlled trial, Lancet, 2010;376:163-72.
  57. Okonofua EC, Simpson KN, Jesri A, et al., Therapeutic inertia is an impediment to achieving the Healthy People 2010 blood pressure control goals, Hypertension, 2006;47:345-51.
  58. Redo┬┤n J, Coca A, Lazaro P, et al., Factors associated with therapeutic inertia in hypertension: validation of a predictive model, J Hypertens, 2010;28:1770-7.
  59. Rodondi N, Peng T, Karter AJ, et al., Therapy modifications in response to poorly controlled hypertension, dyslipidemia, and diabetes mellitus, Ann Intern Med, 2006;144:475-84.
  60. Bobrie G, Postel-Vinay N, Delonca J, Corvol P, for the SETHI Investigators Self-Measurement and Self-Titration in Hypertension A Pilot Telemedicine Study, Am J Hypertension, 2007;20:1314-20.
  61. Port K, Palm K, Viigimaa M, Daily usage and efficiency of remote home monitoring in hypertensive patients over a oneyear period, J Telemed Telecare, 2005;11(Suppl. 1):343-6.
  62. Tan NC, Khin LW, Pagi R, Home blood-pressure monitoring among hypertensive patients in an Asian population, J Human Hypertension, 2005;19:559-64.
  63. Thomas G, Pickering NHM, Gbenga O, et al., Artinian and David Goff Call to Action on Use and Reimbursement for Home Blood Pressure Monitoring: A Joint Scientific Statement From the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association, Hypertension, 2008;52;10-29.
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