User procedure for self-measurement of blood pressure

Objective To review the medical literature regarding the methodology of sel f-measurement of blood pressure and to provide some practical recommendatio ns regarding protocol and procedure for measurement, documentation and anal ysis of data, choice and provision of devices and education of patients and physicians. Procedure and protocol for measurements Technical recommendations regarding measurement of blood pressure do not differ from usual guidelines. Frequen cy of measurement remains a matter of discussion. At the beginning of the s elf-measurements of blood pressure and during the titration phase, there sh ould be a 7-day measurement period with two measurement of blood pressure e ach morning and two measurements in the evening at pre-stipulated times. Fo r long-term observation, a minimum measurement period of 1 week per quarter is required. The minimum number of measurements performed during each peri od should be a total of 12 readings recorded within seven working days. Dep ending on individual needs (e.g, poor compliance) or for pharmacologic stud ies, a higher frequency of readings could be used. Documentation and analysis of data Owing to the lack of reliability of pati ents' diaries, the use of printer-equipped or memory-equipped devices is ad vocated. All the recorded data, except those obtained on the first day, mus t be used for analysis, Choice and provision of devices Self-measurement of blood pressure should b e performed with validated fully automated devices using a brachial cuff. T he preference should be given to apparatus offering the possibility of stor ing and transmitting measurements. Wrist apparatus should be used with caut ion due to the risk of measurement errors if it is used inappropriately, A manual device should be considered for patients suffering from irregular ca rdiac rhythms and patients with large or small arm circumferences, since au tomated devices have not been validated for use in these situations. Reimbu rsement of hypertensive patients using validated devices should be consider ed, so long as they are adequately trained and supervised. Education of patients In a therapeutic perspective, self-measurement of blo od pressure should be performed by trained patients under the supervision o f their practitioner. Teaching must be performed by skilled staff in hypert ension centers and ultimately in general practice. Self-measurement of bloo d pressure is to be recommended for any hypertensive patient who is suffici ently motivated to participate in the treatment of his own hypertension. Pa tients with physical problems or mental disabilities that make them unable to perform or to understand the measuring technique represent the limits of the method. Education of patients must encompass information about hyperte nsion and cardiovascular risk, blood-pressure-measurement procedures, advic e on items of equipment and their proper use, protocols, and interpretation of data. A patient's proficiency must be checked before he or she should b e considered competent at performing the procedure. Annual reevaluation is required. (C) 2000 Lippincott Williams & Wilkins.