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Walking in patients’
          shoes: home blood
         pressure monitoring
                     Ted Eytan, MD MS MPH
                        August 18, 2009

Conflict of Interest: I do not have any financial interest or ties to, and have
not received any honoraria from, pharmaceutical or device manufacturers.
There is no implied or explicit endorsement of any third party products or
services. see: http://www.tedeytan.com/about
Subtitle
Innovation comes in
   many forms!
Why Home Monitoring?
                      Evidence that it is probably as good if not better than
                      office based diagnosis

                      It is likely superior to ongoing monitoring and treatment,
                      especially in chronic conditions

                             42-50% of patients controlled under treatment may
                             have masked hypertension

                      More analysis at http://www.tedeytan.com/tag/
                      hypertension
Sources: Parati G, Stergiou GS, Asmar R, Bilo G, de Leeuw P, Imai Y, Kario K, Lurbe E, Manolis A, Mengden T, O'Brien E, Ohkubo T, Padfield P, Palatini P,
Pickering T, Redon J, Revera M, Ruilope LM, Shennan A, Staessen JA, Tisler A, Waeber B, Zanchetti A, Mancia G. European Society of Hypertension
guidelines for blood pressure monitoring at home: a summary report of the Second International Consensus Conference on Home Blood Pressure
Monitoring [Internet]. J. Hypertens. 2008 Aug ;26(8):1505-1526.[cited 2009 Aug 18 ] Available from: http://www.ncbi.nlm.nih.gov/pubmed/18622223  

Pickering TG, Miller NH, Ogedegbe G, Krakoff LR, Artinian NT, Goff D. Call to Action on Use and Reimbursement for Home Blood Pressure Monitoring. A
Joint Scientific Statement From the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association
[Internet]. Hypertension. 2008 May 22;HYPERTENSIONAHA.107.189010.[cited 2008 May 23 ] Available from: http:/    /hyper.ahajournals.org/cgi/content/
abstract/HYPERTENSIONAHA.107.189010v1  
What did I do?

Performed a home
blood pressure (HBP)
monitoring sequence
on myself

Used social media to
track my progress
(hashtag = #homebp)
and get feedback
The Device
Microlife HomeBP*

Innovative in
promoting accurate
monitoring

  Adherent to ESH/
  AHA guidelines

Perhaps a more
important innovation
than connectivity      *Device was loaned to me and then
                                    returned
The Innovation
Focus: accurate blood
pressure measurement

Coaches and guides
patients : right place,
right time, number of
times

Investment in patient
education, see http://
www.watchbp.com/
patients/correctbp/
Twitterfeed of my experience
What I Learned
Optimal technique is
challenging!

   I needed to SLOW
   DOWN in the morning
   to allow for “resting”
   blood pressure

   Watch OTC meds (eg
   pseudephedrine for
   bad DC allergies!)

Dealing with Travel/time
zones

I CARE about the results
WatchBP Home Software
 Averages readings
 according to
 guidelines

 Includes omission of
 the first day (per
 guideline)

 Physicians can exclude
 specific readings from
 the average
Reactions: A fellow physician
Reactions: Fellow patients
Is it patient centered?

YES, if patients are aware of the evidence
behind accurate measurement.

“At present,HBPM is frequently performed by patients on
their own initiative using devices purchased without medical
advice. This leads to frequent problems, such as the use of
in accurate devices and errors in measurement
methodology. The knowledge of patients about appropriate
cuff size is also minimal.” - ESH Guidelines for Blood
Pressure Monitoring at Home
The Future
“headless” biometric
device? (will we ever
see one?)

Integration with
personal health
record systems and
health systems in
general

Patient participation   Source: http://www.diabeteshealth.com/
in understanding how    read/2009/07/13/6274/diabetes-and-the-
                                        iphone/
accurate HBPM works!
Conclusions
Accuracy takes work

More patient
involvement is better
in health care process
AND design of it

Innovation can happen
in process AND/OR
technology

  Solve problems as close to
  the patient as possible
  More features at the
  expense of accuracy does
  not help patients
Continue the
       Conversation!
Blog: tedeytan.com

Twitter: tedeytan

Articles: delicious.com/tedeytan/homebp

Acknowledgements:
     Wei-Jung Lo, Vice President of Operations,
     Microlife Medical Home Solutions, Inc.

     Fellow patients who watched me learn and
     provided input

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Walking in Patients' Shoes: My Home Blood Pressure Monitoring Experience

  • 1. Walking in patients’ shoes: home blood pressure monitoring Ted Eytan, MD MS MPH August 18, 2009 Conflict of Interest: I do not have any financial interest or ties to, and have not received any honoraria from, pharmaceutical or device manufacturers. There is no implied or explicit endorsement of any third party products or services. see: http://www.tedeytan.com/about
  • 3. Why Home Monitoring? Evidence that it is probably as good if not better than office based diagnosis It is likely superior to ongoing monitoring and treatment, especially in chronic conditions 42-50% of patients controlled under treatment may have masked hypertension More analysis at http://www.tedeytan.com/tag/ hypertension Sources: Parati G, Stergiou GS, Asmar R, Bilo G, de Leeuw P, Imai Y, Kario K, Lurbe E, Manolis A, Mengden T, O'Brien E, Ohkubo T, Padfield P, Palatini P, Pickering T, Redon J, Revera M, Ruilope LM, Shennan A, Staessen JA, Tisler A, Waeber B, Zanchetti A, Mancia G. European Society of Hypertension guidelines for blood pressure monitoring at home: a summary report of the Second International Consensus Conference on Home Blood Pressure Monitoring [Internet]. J. Hypertens. 2008 Aug ;26(8):1505-1526.[cited 2009 Aug 18 ] Available from: http://www.ncbi.nlm.nih.gov/pubmed/18622223   Pickering TG, Miller NH, Ogedegbe G, Krakoff LR, Artinian NT, Goff D. Call to Action on Use and Reimbursement for Home Blood Pressure Monitoring. A Joint Scientific Statement From the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association [Internet]. Hypertension. 2008 May 22;HYPERTENSIONAHA.107.189010.[cited 2008 May 23 ] Available from: http:/ /hyper.ahajournals.org/cgi/content/ abstract/HYPERTENSIONAHA.107.189010v1  
  • 4. What did I do? Performed a home blood pressure (HBP) monitoring sequence on myself Used social media to track my progress (hashtag = #homebp) and get feedback
  • 5. The Device Microlife HomeBP* Innovative in promoting accurate monitoring Adherent to ESH/ AHA guidelines Perhaps a more important innovation than connectivity *Device was loaned to me and then returned
  • 6. The Innovation Focus: accurate blood pressure measurement Coaches and guides patients : right place, right time, number of times Investment in patient education, see http:// www.watchbp.com/ patients/correctbp/
  • 7. Twitterfeed of my experience
  • 8. What I Learned Optimal technique is challenging! I needed to SLOW DOWN in the morning to allow for “resting” blood pressure Watch OTC meds (eg pseudephedrine for bad DC allergies!) Dealing with Travel/time zones I CARE about the results
  • 9. WatchBP Home Software Averages readings according to guidelines Includes omission of the first day (per guideline) Physicians can exclude specific readings from the average
  • 10. Reactions: A fellow physician
  • 12. Is it patient centered? YES, if patients are aware of the evidence behind accurate measurement. “At present,HBPM is frequently performed by patients on their own initiative using devices purchased without medical advice. This leads to frequent problems, such as the use of in accurate devices and errors in measurement methodology. The knowledge of patients about appropriate cuff size is also minimal.” - ESH Guidelines for Blood Pressure Monitoring at Home
  • 13. The Future “headless” biometric device? (will we ever see one?) Integration with personal health record systems and health systems in general Patient participation Source: http://www.diabeteshealth.com/ in understanding how read/2009/07/13/6274/diabetes-and-the- iphone/ accurate HBPM works!
  • 14. Conclusions Accuracy takes work More patient involvement is better in health care process AND design of it Innovation can happen in process AND/OR technology Solve problems as close to the patient as possible More features at the expense of accuracy does not help patients
  • 15. Continue the Conversation! Blog: tedeytan.com Twitter: tedeytan Articles: delicious.com/tedeytan/homebp Acknowledgements: Wei-Jung Lo, Vice President of Operations, Microlife Medical Home Solutions, Inc. Fellow patients who watched me learn and provided input