Home Blood Pressure Monitoring in Cases of Clinical Uncertainty to Differentiate Appropriate Inaction From Therapeutic Inertia

• Published in: Annals of family medicine 2020-01, Vol.18 (1), p.50-58
• Main Authors: Patil, Sonal J, Wareg, Nuha K, Hodges, Kelvin L, Smith, Jamie B, Kaiser, Mark S, LeFevre, Michael L
• Format: Article
• Language: English
• Subjects: Aged; Blood pressure measurement; Blood Pressure Monitoring, Ambulatory; Care and treatment; Evaluation; Female; Health Knowledge, Attitudes, Practice; Home care; Home medical tests; Humans; Hypertension; Hypertension - diagnosis; Hypertension - drug therapy; Male; Methods; Middle Aged; Office Visits; Original Research; Practice Patterns, Physicians; Primary health care; Qualitative Research; Quality management; Uncertainty
• ISSN: 1544-1709; 1544-1717
• DOI: 10.1370/afm.2491

Conventional clinic blood pressure (BP) measurements are routinely used for hypertension management and physician performance measures. We aimed to check home BP measurements after elevated conventional clinic BP measurements for which physicians did not intensify treatment, to differentiate therapeutic inertia from appropriate inaction. We conducted a pre and post study of home BP monitoring for patients with uncontrolled hypertension as determined by conventional clinic BP measurements for which physicians did not intensify hypertension management. Physicians were notified of average home BP 2-4 weeks after the initial clinic visit. Outcome measures were the proportion of patients with controlled hypertension using average home BP measurements, changes in hypertension management by physicians, changes in physicians' hypertension metrics, and factors associated with home-clinic BP differences. Of 90 recruited patients who had elevated conventional clinic BP recordings, 65.6% had average home BP measurements that were