Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
Department of Family and Community Medicine, University of Missouri, Columbia, Missouri.
Ann Fam Med. 2020 Jan;18(1):50-58. doi: 10.1370/afm.2491.
Conventional clinic blood pressure (BP) measurements are routinely used for hypertension management and physician performance measures. We aimed to check home BP measurements after elevated conventional clinic BP measurements for which physicians did not intensify treatment, to differentiate therapeutic inertia from appropriate inaction.
We conducted a pre and post study of home BP monitoring for patients with uncontrolled hypertension as determined by conventional clinic BP measurements for which physicians did not intensify hypertension management. Physicians were notified of average home BP 2-4 weeks after the initial clinic visit. Outcome measures were the proportion of patients with controlled hypertension using average home BP measurements, changes in hypertension management by physicians, changes in physicians' hypertension metrics, and factors associated with home-clinic BP differences.
Of 90 recruited patients who had elevated conventional clinic BP recordings, 65.6% had average home BP measurements that were <140/90 mm Hg. Physicians changed treatment plans for 61% of patients with average home BP readings of ≥140/90 mm Hg, whereas decisions to not change treatment for the remaining patients were based on contextual factors. Substituting average home BP for conventional clinic BP for 4% of patients from 2 physicians' hypertension registries improved the physicians' hypertension control rates by 3% to 5%. Greater body mass index and increased number of BP medications were associated with home BP measurement ≥140/90 mm Hg. Clinic BP levels did not estimate normal home BP levels.
Documented home BP in cases of clinical uncertainty helped differentiate therapeutic inertia from appropriate inaction and improved physicians' hypertension metrics.
常规诊所血压（BP）测量通常用于高血压管理和医生绩效评估。我们旨在检查常规诊所 BP 升高但医生未加强治疗的患者的家庭 BP 测量值，以区分治疗惰性与适当的不作为。
我们对常规诊所 BP 测量值未加强高血压管理的未控制高血压患者进行了家庭 BP 监测的前后研究。在初始诊所就诊后 2-4 周，医生会收到平均家庭 BP 的通知。主要结局指标是使用平均家庭 BP 测量值控制高血压的患者比例、医生改变高血压管理的情况、医生高血压指标的变化以及与家庭-诊所 BP 差异相关的因素。
在 90 名接受常规诊所 BP 升高的患者中，65.6%的患者平均家庭 BP 测量值<140/90mmHg。对于平均家庭 BP 读数≥140/90mmHg 的 61%患者，医生改变了治疗计划，而对于其余患者不改变治疗的决定则基于背景因素。从 2 名医生的高血压登记处中，将 4%患者的平均家庭 BP 代替常规诊所 BP，可使医生的高血压控制率提高 3%至 5%。较高的体重指数和更多的 BP 药物与家庭 BP 测量值≥140/90mmHg 相关。诊所 BP 水平不能估计正常的家庭 BP 水平。
在临床不确定的情况下记录家庭 BP 有助于区分治疗惰性与适当的不作为，并改善医生的高血压指标。
