May 23, 2008
AHA Recommends Home Blood Pressure Monitoring
The American Heart Association on Thursday endorsed the use of in-home monitors for all Americans with high blood pressure.
Experts say that checking blood pressure a few times a year during visits to the doctor is not enough. Regular home monitoring is more accurate to keep tabs on high blood pressure, which is the leading cause of heart attacks, strokes and death in the U.S.
"We need new approaches. Our current approach is simply not working," said Dr. David Goff, a preventive medicine specialist at Wake Forest University and a member of the panel that wrote the advice.
Only a third of people with high blood pressure now have it under control.
May is Blood Pressure Management Month, and the AHA has drawn up a plan for those who need to keep track of their blood pressure levels at home.
Doctors say that more detailed home checks would allow them to create more effective treatments to control high blood pressure, just as diabetics adjust their insulin levels by regularly monitoring blood sugar.
Other experts agreed with the report's findings, but also said that the case would be even stronger if the authors had no financial ties to monitor companies. For example, a leading device maker pays more than $300,000 a year to co-sponsor the heart association's blood pressure Web site.
"This is not as clean a recommendation as it could be" because of the industry ties, said Dr. Sidney Wolfe of the consumer group Public Citizen. Still, home monitors are "an excellent idea," Wolfe said.
High blood pressure occurs when blood pulses too forcefully through vessels, which can damage the heart. It is more common in older people, and it leads to about 7 million deaths in the United States each year.
Readings of 140 over 90 are considered high at the doctor's office; 135 over 85 if taken at home.
"So often we rely on a single measurement in the office and it's so arbitrary," said Dr. Allen Taylor of Walter Reed Army Medical Center, a prominent researcher not involved in the new advice.
Patients with high blood pressure often have to take a combination of medications in order to keep it under control. Home monitors can help, by giving a better picture of pressure variations and the response to a drug.
A person may need less medication because his or her blood pressure was irregularly high during a recent visit to the doctor's office. Although the opposite is usually true. People need more or different drugs.
More readings can also encourage patients to curb their intake of high blood pressure-causing foods and beverages.
Experts suggest taking two or three readings at a time, one minute apart, while sitting with the arm supported. Readings should be taken at the same time each day, such as morning and evening, for a week.
Twelve readings are recommended for doctors to make treatment decisions, and this can be repeated as often as a doctor feels necessary, depending on how stable the condition is.
"It's a great idea," said Dr. Joseph Drozda of St. John's Mercy Medical Center in Chesterfield, Mo. He is a high blood pressure expert for the American College of Cardiology. "If you're graphically seeing where your blood pressure is all the time, it keeps it real to you," especially if you're not having symptoms, he said.
However, there is not much evidence that home monitoring will cut heart attacks, strokes and deaths more than regular checkups will.
Many blood pressure drugs have been approved without evidence they lower deaths, said Dr. William White, a blood pressure specialist at the University of Connecticut and a reviewer of the new advice.
"We don't have direct evidence that it will reduce heart attacks and strokes but we have reason to believe that it will," said Heart Association president Dr. Daniel Jones, dean of the University of Mississippi School of Medicine.
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