Studies show the benefits of self-monitoring

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Our service BloodPressureDB is used to record and manage the blood pressure readings you take at home or on the go blood pressure readings. These can be sent to your treating physician in a summarized form using the PDF report.

How valuable your readings and our service are for adjusting and monitoring high blood pressure is shown by several studies. Including self-measurements in treatment decisions makes those decisions easier and allows for more tailored medication prescriptions. It also usually helps reach the target blood pressure faster.

How important good blood pressure control is becomes clear when you consider the risk of complications such as heart attack and stroke, to name just two. Unfortunately, worldwide only about 30 percent of known people with hypertension have their blood pressure well controlled. In Germany the rate is regrettably even lower.

1. US study from 2022

Dr. Beverly Green from the Washington Permanente Medical Group in Seattle and her team compared measurements taken in clinics with home measurements and measurements at public blood pressure stations such as pharmacies. All participants also had 24-hour measurements done for comparison. The study included 500 patients.

The results showed that clinic readings tended to be slightly too low and station readings slightly too high. Home measurements performed best. These were done as recommended in the guidelines by the Hypertension League and as the BloodPressureDB app guides you to do.

2. Study from the Nephrology Center Göttingen

A study by the Nephrology Center Göttingen showed a significant improvement in blood pressure control using telemetric technology compared with care in a specialized hypertension clinic, although the clinic also achieved high success rates. For the study, some patients were equipped with a telemetry unit (blood pressure monitor and a Bluetooth-capable mobile phone) and were asked to measure and record their blood pressure in the morning. However, not all measured values were transmittedonly those above a previously set alarm threshold. These alert rules were specifically developed for this study and represent an innovation worldwide.

Blood pressure was checked using a 24-hour measurement at the start and at the end of the three-month study. The target blood pressure was reached during this time in 54 percent of the telemetry group. In comparison, only 35 percent of the control group achieved this result.

The study lead, Dr. Egbert Schulz, attributes this success not only to better adherence to therapy but above all to optimized treatment made possible by the automatically transmitted, reliably patient-measured Blutdruckdaten.

3. English study published in February 2018

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An English study with nearly 1,200 participants also demonstrated the benefit of home self-measurement (especially with telemetric data transmission as is possible with BloodPressureDB).

The study ran for twelve months. Participants were divided into three groups.

One groupthe control groupcontinued to have their blood pressure checked only at the doctors office as before. Another groupthe intervention groupmeasured their blood pressure at home in the morning and evening with a suitable device and handed the data to their GP at the end of each week. The third groupthe telemetry groupalso performed home self-measurements. In addition, their data were sent telemetrically or via SMS in summarized form (similar to the BloodPressureDB PDF report) to the GP. The GP was asked to review the values monthly. The system also triggered alerts for missing or extreme blood pressure readings.

At the end of the study period, the systolic values of participants who measured their blood pressure at home were significantly lower than those whose blood pressure was only checked in the clinic.

The telemetry group had the greatest success. Blood pressure reductions in the telemonitoring group were slightly larger than in the intervention group. Above all, they were achieved earlier than in the comparison groups. Compared with the control groupthose whose blood pressure was only measured in the clinicthe clear advantage was already seen after six months.

One key reason for this development was also seen as better adjustment of medication dose or combination. This is partly possible because home self-measurements eliminate, for example, the "white-coat effect" in the doctors office. That effect leads to higher readings in the clinic caused by (possibly unconscious) tension, compared with everyday life. For this reason, the researchers recommend setting target blood pressure values for home self-measurements that are 5 mmHg below the values used in the clinic.

4. US pilot study

In this study, 2,550 participants were given blood pressure monitors for home use. Up to that point they had persistent (i.e., inadequately controlled) high blood pressure. For the study they monitored their blood pressure in daily life in addition to regular doctor visits. Their measured values were sent online or in printed form to their treating physicians. The doctors were involved in the study and knew that the participants had received a home monitor and had been trained to use it. By the third clinic visit, 67 percent of participants had managed to get their blood pressure under control. By the sixth visit that figure had dropped to 60 percent. This was because some participants reached their target blood pressure fairly quickly after including home measurements in treatment decisions. Medication could thus be adjusted successfully and quickly, so that some clinic visits could be reduced or omitted.

After six months nearly 80 percent of all participants had reached their target blood pressure. According to the strict guidelines of the American Heart Association (AHA), blood pressure was well controlled in 72 percent of participants at the end of the six months. On average the systolic blood pressure fell by 16.9 mmHg and the diastolic by 6.5 mmHg. Self-measurement saved each participant an average of one to two doctor visits per year.

5. Meta-analysis of 52 studies on this topic

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The Annals of Internal Medicine published the results of a meta-analysis. The researchers analyzed a total of 52 prospective comparative studies on antihypertensive therapy. They compared conventional treatmentwithout additional monitoringwith therapy supported by self-measurements. Participants sometimes received support in the form of counseling, training, or instruction.

After six months, the self-monitoring group showed a significant improvement in blood pressure compared with the conventionally treated group. Unfortunately this advantage was less clear after twelve months. However, if participants who measured their blood pressure at home also received support as described above, the significant benefit remained even after twelve months.

Overall, this meta-analysis also supports the benefit of independent blood pressure self-measurement. The risk of over- or under-dosing medication is reduced, and the regular measurements give the doctor a better basis for individually adjusting medication.

6. Japanese study from November 2022

A study published in Hypertension in February 2023 compared the ability of 24-hour blood pressure monitoring and regular home blood pressure measurements (morning and evening) to predict cardiovascular events. It showed that regular home measurements represented the risk of cardiovascular disease slightly better than the long-term (24-hour) blood pressure measurement.

These studies make clear how much patients themselves can contribute to achieving the most effective treatment. Self-measurement is an important tool for managing and monitoring high blood pressure. The benefit increases further with telemetric transmission of the values, as is possible with BloodPressureDB. In this way a rise or an excessive drop in blood pressure can be detected very quickly and the medication dose adjusted.

7. Swedish study published in July 2023

In this study scientists had over 5,000 participants measure their blood pressure at home three times in the morning and three times in the evening for one week. It was important that this was done in the study with the same device that was also used to measure blood pressure in the clinic. Masked hypertension was found in one out of every 20 participants. Other risk factors for cardiovascular disease examined in the study, such as elevated fasting blood sugar, lower HDL cholesterol, and certain inflammatory markers, were also detectable in these participants. The researchers conclude that home-measured blood pressure values are a better indicator of cardiovascular risk than clinic measurements.

8. Study on visit-to-visit variability

A study published in March 2023 examined the influence of blood pressure fluctuations between doctor visits. In English this is called visit-to-visit variability, or VVV for short. It shows how much blood pressure can vary between two clinic visits. These natural fluctuations make it harder to assess the effect of medications or other measures. The study looked at 537,218 patients with 7,721,864 measurements. It concluded that four clinic visits would be needed to determine whether a medication that lowers blood pressure by 10 mmHg is actually effective.

Our recommendation

Correct measurement is very important for good blood pressure control. Our app BloodPressureDB helps with this. Clear instructions guide you through guideline-based measurement. The app can also remind you if you wish. These features are fully available in the free version as well.

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Sources:

This article comes from BloodPressureDB – the leading app since 2011 that helps hundreds of thousands monitor their blood pressure every day. Our content is based on carefully researched, evidence-based data and is continuously updated (as of 06/2024).

Author Horst Klier has been intensively involved with high blood pressure since 2002 initially from personal experience and, since 2009, as the developer of BloodPressureDB. Thanks to his app and specialist platform used by millions as well as numerous publications, he is now regarded as a recognised blood pressure expert. As the author of several health guides and professional articles, he makes complex information understandable and practical.