The benefits of do-it-yourself blood pressure monitoring

[Monirul Islam]

For treating certain health problems, finding the best drug or combination of drugs at the correct dose often requires some trial and error. High blood pressure is a good example. Because this common problem raises heart attack and stroke risk, the sooner you can get your blood pressure down to a healthy range (130/80 millimeters of mercury [mm Hg] or lower), the better. New research suggests that people could speed things up a bit by taking a more active role in the process (see "Tracking your blood pressure at home: Does it help?").

"The study showed that a period of home blood pressure monitoring — one week per month — was sufficient to guide people to better blood pressure control," says Dr. Paul Conlin, professor of medicine at Harvard Medical School and chief, Medical Service, at the VA Boston Healthcare System.

Tracking your blood pressure at home: Does it help?
British researchers wanted to know whether adding home blood pressure monitoring could improve on standard care for people with high blood pressure. Here's a summary of their findings, which were published in the March 10 issue of The Lancet.

Who: Just over 1,000 adults (average age 67) with poorly controlled blood pressure. Their blood pressure readings averaged about 153/86 mm Hg when the study began.

How: Researchers randomly assigned each participant to one of three groups: standard care (the control group), self-monitoring, or telemonitoring.

When: Those in the control group had their blood pressure measured at their doctors' offices. Those in other two groups also measured their blood pressure at home (twice in the morning and twice at night) for one week every month over the course of one year. The self-monitors mailed their readings to their doctors. The telemonitoring patients texted their results, and got reminders if they didn't transmit their readings as well as alerts to contact their doctors if their readings were very high or very low.

Key findings: By the end of the year, people in the control group had lowered their average systolic (top number) blood pressure to 140 mm Hg. But those in the self-monitoring group and the telemonitoring group had lowered theirs to 137 and 136, respectively.

Target practice
Thanks to the availability of automated, relatively inexpensive blood pressure monitors, people can easily measure their blood pressure at home. More sophisticated devices can send readings wirelessly to a smartphone or another device, so you can then share the results with your physician. The information may help your doctors tweak your drugs and doses more readily than if you wait until your next office visit to see if your current medication regimen is working.

That's why home monitoring might be especially helpful for people newly diagnosed with high blood pressure or those still struggling to reach their targets, says Dr. Conlin. However, he suspects that people who don't do home monitoring will likely reach their blood pressure goal eventually — it just might take an additional six to 12 months to reach your target.

Possible drawbacks
Checking your blood pressure at home might help you feel more engaged and therefore motivated to improve your health. But that's not true for everyone. Some people are reluctant to self-monitor because they're worried their blood pressure will be too high. However, that anxiety often dissipates over time as you get more comfortable with the process, says Dr. Conlin.

Other potential downsides to home monitoring are "treatment fatigue" and data overload. Treatment fatigue refers to the constant reminder (triggered by daily monitoring) that you have a chronic illness, which can wear on people. And if you send your doctor too much data, he or she may not have time to sift through it all. But the new findings addressed these concerns, at least in part: the monitoring was done just one week per month.

DIY medication adjustments?
What about making do-it-yourself drug adjustments, which people with diabetes have done for decades based on home blood sugar testing? We're not quite ready for that step yet, says Dr. Conlin. But it's worth discussing with your physician, he says. For example, if you notice your home blood pressure readings are on the low side and you occasionally feel lightheaded (a symptom of low blood pressure), you might ask about lowering your diuretic dose. "My response would be yes. But be sure to call me in a month to see how things are working," says Dr. Conlin.

Source: Harvard Medical School