Self Measured Blood Pressure Monitoring Comparative Effectiveness

High blood pressure (BP), or hypertension, is a common, long-term health condition, particularly among older adults. Untreated or ineffectively treated hypertension leads to increased cardiovascular morbidity and mortality, and increased consumption of health care resources, thus levying high human and financial costs to society. In adults, hypertension is defined as a persistently elevated BP equal to or greater than 140/90 mmHg. In children, the diagnosis is made from an average of three or more BP readings greater than the 95th percentile for age, sex, and height. The Seventh Joint National Committee (JNC 7) guideline recommends a BP goal of 140/90 mmHg or less in the general population and a lower threshold of 130/80 mmHg or less in patients with diabetes mellitus or chronic kidney disease. The World Health Report 2002 estimates that over 1 billion people have high BP and that hypertension is responsible for 4.5 percent of the global disease burden. Within the U.S., about 76.4 million adults are affected. Despite improvements in the quality of health care and life expectancy, it is expected that the prevalence of hypertension will continue to rise worldwide. The World Health Organization ranks high BP as the third highest risk factor for burden of disease, highlighting the contribution of hypertension directly and indirectly to the development of numerous diseases. Hypertension has been identified as a major risk factor for cardiovascular disease, and is an important modifiable risk factor for coronary artery disease, stroke, peripheral vascular disease, congestive heart failure, and chronic kidney disease. High BP directly results in 7 million deaths every year. Effective management of BP has been shown to dramatically decrease the incidence of stroke, heart attack, and heart failure. However, hypertension is usually a lifelong condition, and long-term adherence to lifestyle modification and medication treatment remains a challenge in the management of hypertension. Thus an increasing focus has been placed on developing strategies that can improve adherence and result in satisfactory BP control with the goal of improving health outcomes for hypertensive patients. One such proposed method is self-measured blood pressure (SMBP) monitoring. SMBP refers to the regular self-measurement of a patient's BP at home or elsewhere outside the office or clinic setting. However, while patient self-participation in chronic disease management appears promising, the sustainability and clinical impact of this strategy remain uncertain. The primary objective of this review is to evaluate whether the use of SMBP monitoring influences outcomes in adults and children with hypertension, and to what extent these changes in outcomes can be attributable to the use of self-monitoring devices alone or the use of SMBP plus additional support or attention. The intention of this report is to inform physicians' decisionmaking as to whether to encourage the use of SMBP monitoring alone or along with additional support, and to assist health care policymakers and payers with decisions regarding coverage and promotion of SMBP monitoring. Key Questions include: 1. In people with hypertension (adults and children), does self-measured blood pressure (SMBP) monitoring, compared with usual care or other interventions without SMBP, have an effect on clinically important outcomes? 2. In trials of SMBP monitoring, how do clinical, surrogate, and intermediate outcomes (including SMBP monitoring adherence) vary by the type of additional support provided? 3. How do different devices for SMBP monitoring compare with each other (specifically semiautomatic or automatic vs. manual) in their effects on clinical, surrogate, and intermediate outcomes (including SMBP monitoring adherence)? 4. In trials of SMBP monitoring, how does achieving BP control relate to clinical and surrogate outcomes? 5. How does adherence with SMBP monitoring vary by patient factors?

Hypertension remains a leading cause of disability and death worldwide. Self-monitoring of blood pressure by patients at home is currently recommended as a valuable tool for the diagnosis and management of hypertension. Unfortunately, in clinical practice, home blood pressure monitoring is often inadequately implemented, mostly due to the use of inaccurate devices and inappropriate methodologies. Thus, the potential of the method to improve the management of hypertension and cardiovascular disease prevention has not yet been exhausted. This volume presents the available evidence on home blood pressure monitoring, discusses its strengths and limitations, and presents strategies for its optimal implementation in clinical practice. Written by distinguished international experts, it offers a complete source of information and guide for practitioners and researchers dealing with the management of hypertension.

Hypertension is one of the leading causes of death in the United States, affecting nearly one in three Americans. It is prevalent in adults and endemic in the older adult population. Hypertension is a major contributor to cardiovascular morbidity and disability. Although there is a simple test to diagnose hypertension and relatively inexpensive drugs to treat it, the disease is often undiagnosed and uncontrolled. A Population-Based Policy and Systems Change Approach to the Prevention and Control Hypertension identifies a small set of high-priority areas in which public health officials can focus their efforts to accelerate progress in hypertension reduction and control. It offers several recommendations that embody a population-based approach grounded in the principles of measurement, system change, and accountability. The recommendations are designed to shift current hypertension reduction strategies from an individual-based approach to a population-based approach. They are also designed to improve the quality of care provided to individuals with hypertension and to strengthen the Center for Disease Control and Prevention's leadership in seeking a reduction in the sodium intake in the American diet to meet dietary guidelines. The book is an important resource for federal public health officials and organizations, especially the Center for Disease Control and Prevention, as well as medical professionals and community health workers.

Under the motto “Healthcare Technology for Developing Countries” this book publishes many topics which are crucial for the health care systems in upcoming countries. The topics include Cyber Medical Systems Medical Instrumentation Nanomedicine and Drug Delivery Systems Public Health Entrepreneurship This proceedings volume offers the scientific results of the 6th International Conference on the Development of Biomedical Engineering in Vietnam, held in June 2016 at Ho Chi Minh City.

This User’s Guide is a resource for investigators and stakeholders who develop and review observational comparative effectiveness research protocols. It explains how to (1) identify key considerations and best practices for research design; (2) build a protocol based on these standards and best practices; and (3) judge the adequacy and completeness of a protocol. Eleven chapters cover all aspects of research design, including: developing study objectives, defining and refining study questions, addressing the heterogeneity of treatment effect, characterizing exposure, selecting a comparator, defining and measuring outcomes, and identifying optimal data sources. Checklists of guidance and key considerations for protocols are provided at the end of each chapter. The User’s Guide was created by researchers affiliated with AHRQ’s Effective Health Care Program, particularly those who participated in AHRQ’s DEcIDE (Developing Evidence to Inform Decisions About Effectiveness) program. Chapters were subject to multiple internal and external independent reviews. More more information, please consult the Agency website: www.effectivehealthcare.ahrq.gov)

A practical handbook written for the practising physician, 'Stroke Medicine' provides an up-to-date, and easily accessible source of information on all aspects of stroke care from acute care, through to rehabilitation and secondary prevention.

This book constitutes the proceedings of the Second International Conference on Security-Enriched Urban Computing and Smart Grid, held in Hualien, Taiwan, in September 2011. The 35 revised full papers presented together with two invited papers were carefully reviewed and selected from 97 submissions. Among the topics covered are the internet of things, mobile networks, wireless networks, service-oriented computing, data-centric computing, voice over IP, cloud computing, privacy, smart grid systems, distributed systems, agent-based systems, assistive technology, social networks, and wearable computing.