Utility Of Blood Pressure Monitoring Outside Of The Clinic Setting

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.

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?

Pfenninger and Fowler’s Procedures for Primary Care, 3rd Edition is a comprehensive, "how-to" resource offering step-by-step strategies for nearly every medical procedure that can be performed in an office, hospital, or emergency care facility by primary care clinicians. . Designed for everyday practice, the outline format allows speedy reference while the detailed text and clear illustrations guide you through each procedure. The new edition of this best-selling book features full-color illustrations and easy access to the complete contents and illustrations, patient forms, and more online at www.expertconsult.com. Understand how to proceed, step by step, thanks to detailed text and illustrations. Locate critical information at a glance with numerous boxes and tables. Use the book for years with minimal wear and tear thanks to its sturdy cover. Patient education handouts to educate, save time, and reduce liability Coding guidelines included This best selling text now includes full color photos and new sections on Aesthetic and Hospitalist Procedures in addition to an update of all the previous procedures discussed in prior editions! Access the complete contents and illustrations online, download patient education handouts and consent forms, view lists of device manufacturers, and more at www.expertconsult.com. Offer your patients a variety of cosmetic procedures using lasers and pulsed-light devices (including individual chapters on procedures for hair removal, photorejuvenation, , skin tightening and skin resurfacing, and tattoo removal), botulinum toxin, as well as new coverage of cosmeceutical skin care, tissue fillers, and photodynamic therapy. Master new procedures such as maggot treatment for chronic ulcers, endovenous vein closure, stress echo, insertion of the contraceptive capsule (Implanon) and tubal implant (Essure), musculoskeletal ultrasound, no-needle/no-scalpel vasectomy, procedures to treat acute headaches, and more. Don’t worry! All the more basic office procedures are still included...with improved and updated discussions! Pfenninger and Fowler provide the latest and most comprehensive information on medical procedures that allow primary care physicians to more effectively treat their patients.