Measuring and Managing Blood Pressure in a Primary Care Setting: A Pragmatic Implementation Study

Area of Science:

• Cardiology
• Primary Care Medicine
• Hypertension Management

Background:

• Accurate blood pressure measurement is crucial for diagnosing and managing hypertension.
• Automated office blood pressure (AOBP) and home blood pressure measurement (HBPM) offer potential improvements over traditional methods.
• Primary care settings face challenges in implementing these advanced BP assessment techniques.

Purpose of the Study:

• To evaluate the effectiveness and patient/provider acceptance of a combined AOBP/HBPM program in a primary care clinic.
• To identify barriers encountered during the implementation of the AOBP/HBPM program.

Main Methods:

• An AOBP/HBPM program was implemented in a primary care clinic from 2015 to 2016.
• Patients with elevated blood pressure (BP) were enrolled, with those having average home BP ≥ 135/85 mm Hg using HBPM for medication adjustments.
• Patient and staff satisfaction questionnaires were administered.

Main Results:

• The program identified white-coat BP elevation in 35-37% of enrolled patients.
• Subsequent HBPM facilitated BP control in 49% of patients with elevated home BP.
• The program was generally well-received by providers, staff, and patients, though implementation barriers were noted, including technique issues and data submission failures.

Conclusions:

• A clinic-based AOBP/HBPM program effectively detects white-coat hypertension and aids in home blood pressure control.
• The program demonstrates acceptability among patients and staff.
• Identifying and addressing implementation barriers is key to ensuring the sustainability of such programs in primary care.