CME Program for Family Physicians Ambulatory BP Monitoring Brian Gore, MD CCFP Dip Epid. Part III New BP Measurement Strategies.

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Presentation transcript:

CME Program for Family Physicians Ambulatory BP Monitoring Brian Gore, MD CCFP Dip Epid. Part III New BP Measurement Strategies

New BP Measurement Strategies

Approved Digital OBP Devices

Professional Digital OBP Omron 907

Professional Digital OBP BpTru

Pharmacy Blood Pressure Units

Accuracy of a Pharmacy-Based Vita-Stat Device in Measuring BP: inconsistent results and not recommended for treatment decisions Myers, Magharious, Boyle, Lewis CCS Ottawa, Oct, 1998

Home Blood Pressure Readings

Recommended Home Devices (ranking:) Recommended Home Devices (ranking:) 1. Omron HEM-711AC 2. Omron HEM-712C 4. Life Source UA-767 BHS 2001, 2002 Consumer Report’s, June 2003

Omron models HEM-711AC

Life Source models UA-767

Benefits: Better predictors of disability and LVM* Better predictors of disability and LVM* Closer correlation to ABPM* Closer correlation to ABPM* Readings in a variety of situations Readings in a variety of situations Patient participation in their own care Patient participation in their own care Improved compliance Improved compliance *(CMAJ, 1988) *(CMAJ, 1988)

Risks: Inaccurate readings and reporting* Inaccurate readings and reporting* Increased anxiety* Increased anxiety* Reliability, standardization of equipment Reliability, standardization of equipment No outcome studies No outcome studies

SELF BP “REPORTING”

SELF-BP “REPORTING” Blood Pressure (mmHg) day Stored Data Patient Diary Mengden et al. Am. J. Hypertens. 1998, 11:

HYPERTENSION CARE TODAY MONTH COMPLIANCE VISIT VISIT BLOOD PRESSURE Mengden et al. ISH 18th meeting, Chicago P21.02

HBP with Telecommunication

HBP Telecommunicators MonitoringCentreDOCTOR     DOCTOR       AUTOMATIC DATA TRANSMISSION MANUAL DATA TRANSMISSION INDIVIDUAL THRESHOLDS SET-UP

VIRTUAL HYPERTENSION CLINIC VISIT REMINDINGS FOR PILL INTAKE AND BP MEASUREMENT MONTH  TELEMEDICAL VISITS  VISIT

TensioCare ® report

RCT trials in tele-BP monitoring Friedmann et al. (1996)133 uncontrolled HT “Better BP control, especially in noncompliant patients” Artinian et al. (2001)26 Afro-American HT “The best BP reduction was achieved in the tele-BP monitoring group” Roth et al. (1999) 10 NT/20 HT patients “WCT did not contaminate the tele-transmitted BP measurements” Rogers et. al. (2001)121 uncontrolled HT “The telecommunication service was efficacious in reducing the MAP of patient with established essential hypertension”

Emerging Standards in BP Measurement

Better OBP technology for screening l ABPM for diagnostic/therapeutic challenges l Tele-HBP to ensure treatment effectiveness and compliance during Rx induction l Approved HBP devices for compliance and WCH/WCE issues The Emerging BP Measurement Standards to Improve CV Outcomes