Advocating Home Blood Pressure Monitoring in Improving Hypertension Control in the Philippines

Abstract

High blood pressure (BP) is the most common modifiable cardiovascular risk factor worldwide. Guidelines have been formulated all over the world addressing the issue of hypertension; however, the control rates for hypertension remains discouraging, particularly in the Philippines. In the latest National Nutrition and Health Survey, the prevalence of hypertension in the Philippines is 22.3% and is highest in individuals more than 70 years old. The problem with the survey that measurement was based only on single measurements done in doctors’ clinics.[1] The use of conventional measurement of BP done in the office BP monitoring (OBPM) has been the norm in the diagnosis and management, but this method has downsides, particularly of white coat hypertension and masked hypertension, which are quite common for both untreated and treated hypertensives. The reliability of OBPM is questioned with issues such as the unstandardized setting and conditions of clinics, observer bias and errors, and the small number of readings. There is also a discordance in the measurements of OBPM compared to out-of-office BP (OBP) measurements which could have an effect on the “true underlying BP reading” of the individual.[2] Home BP monitoring (HBPM) refers to the measurement of BP at home, ideally by the individual. It is optimal when the patient is seated at rest at around the same time in the morning and evening, usually a period of 1 week.[2,3] The readings are recorded using a validated, automated BP device and are then conveyed to the physician for interpretation. This method is appealing to most patients and can lead to more awareness and control of their hypertension. HBPM allows standardization of conditions, leading to little measurement variability and reproducibility of readings. Home BP (HBP) measurements can easily identify patients with white coat, masked, and sustained hypertension. HBPM is also widely available and can provide day-to-day BP variability values.[3-5] Despite the several advantages of HBP measurements, it has yet to gain popularity in the Philippines due to the cost of the automated BP machines, lack of patient training, and the preferential use of OBP of physicians. Abstract