Home blood pressure monitoring provides more accurate diagnosis and treatment monitoring compared to office-based readings alone. The author performed a home blood pressure monitoring sequence on himself using a validated device. He found that optimal technique is challenging and requires slowing down readings in the morning. Integration of monitoring into personal health records and health systems could improve patient care. More patient involvement and education in the monitoring process leads to better health outcomes.

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

2. Subtitle
Innovation comes in
many forms!

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

11. Reactions: Fellow patients

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