One person dies every 33 seconds in our country from cardiovascular disease. This American Heart Month, NACHC shines a light on Self-Measured Blood Pressure (SMBP) monitoring to save lives.
When NACHC’s Million Hearts® team learned 90.8% of Community Health Center patients with hypertension experienced care delays or disruptions, including a lack of follow-up, lack of blood pressure (BP) assessment, and missed medication refills during the pandemic, they vowed to turn things around.
To prevent life-threatening problems, particularly for Black and African Americans diagnosed with hypertension, NACHC invested in making home blood pressure devices available to patients, expanded outreach and care coordination, extended time for medication refills, and improved care delivery options. Supported by the Centers for Disease Control and Prevention, NACHC directed a multiyear, multifaceted Million Hearts® quality improvement project with these strategies.
NACHC’s Million Hearts® project emphasizes the use of SMBP and increased treatment intensification for adult Black/African American patients diagnosed with uncontrolled hypertension.
This work continues to provide us with valuable lessons from health centers.
What have we learned about blood pressure control?
We learned that when health centers added SMBP to their hypertension care process, different strategies would emerge depending on the health center’s capacity and environment. Universal lessons about SMBP protocol were captured, however, and these were packaged into the SMBP Implementation Toolkit.
This Toolkit had been instrumental for health centers across the country during the pandemic and served as the “go-to” resource for the HRSA/American Heart Association National Hypertension Control Initiative. Across the board, SMBP with clinical support is more predictive of cardiovascular disease events and improved outcomes than office-based blood pressure measurement. Also, when providers support SMBP, patients quickly adopt its use (Meador, et.al. Self-Measured Blood Pressure Monitoring During the COVID-19 Pandemic: Perspectives From Community Health Center Clinicians. Journal for Healthcare Quality).
To support SMBP monitoring, the need for a place to document SMBP data in EHRs surfaced as a priority. NACHC successfully advocated for average BP to become a required data element in the U.S. Core Data and Information set, version 4. This is a significant and exciting step toward interoperability for average blood pressure documentation.
Why pay attention to SMBP?
Self-measured blood pressure (SMBP), or home BP monitoring, enables patients to take their own BP when they’re not at the provider’s office. Most SMBP guidelines recommend a schedule where BP is taken twice in the morning and evening for at least 3 but ideally 7 days (>12 measurements) to generate an average blood pressure.
SMBP for patients with clinical support is a cost-effective strategy and fits within value-based care models for diagnosis and care management. This practice also falls in line with the 2020 U.S. Surgeon General’s Call to Action to Control Hypertension including SMBP to improve BP control, especially for special populations like women with hypertension during pregnancy.
Here’s what Meg Meador, MPH, C-PHI, CPHQ, Director of the Million Hearts® program at NACHC, said when asked what she believes will truly improve cardiovascular care for health center patients:
“I’d like to see a breakthrough in medication intensification with combination therapy – according to the literature, that one intervention could get us to 80% control in the nation. – And I’d like to see SMBP adopted as a standard tool for hypertension diagnosis and management.
Meg Meador, MPH, C-PHI, CPHQ, National Association of Community Health Centers
The health centers we worked with were able to improve blood pressure control in African American populations by an average of 13.2% in two years. That’s significant. We must set tough goals to challenge the status quo.”
NACHC receives Heart Healthy Stroke Free Award
In November 2023, the National Forum for Heart Disease & Stroke Prevention (National Forum) recognized NACHC with the Heart Healthy Stroke Free Award for leading innovative programs in partnership with health centers around the country. The National Forum noted NACHC’s efforts to help health centers empower high-risk patients to learn about SMBP monitoring and train care teams to implement a range of evidence-based interventions that reduce disparities and improve cardiovascular health.
While SMBP is just one tool within a larger hypertension management “toolbox”, it’s an important tool more health centers can take advantage of. Learn more about SMBP at the Million Hearts SMBP Forum.
If You’re Interested in SMBP for Your Patients, We Have Resources for You:
- Making SMBP Work for Your Patients: Tips for Community Health Centers (Video)
- Integrating SMBP into Hypertension Management: A Clinician Success Story (Video)
- Self-Measured Blood Pressure Monitoring (SMBP) Implementation Toolkit (PDF)
- Choosing a Home Blood Pressure Monitor Comparison (PDF)
- Self-Measured Blood Pressure Monitoring During the COVID-19: The Journal for Healthcare Quality (JHQ) (lww.com) (Journal Publication)
For more information, contact the NACHC Million Hearts® team at nachcmillionhearts@nachc.org