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Patients' experiences and opinions of home blood pressure measurement

Journal of Human Hypertension volume 17, pages 495–503 (2003)Cite this article

Abstract

Regular measurement of the blood pressure (BP) is necessary to monitor the treatment of hypertension, and self-measurement is one technique of obtaining such measurements. The aim of this study was to investigate the experiences of individuals who have carried out home BP measurement. A qualitative method using semistructured interviews was used with 13 subjects. These were adults with hypertension who had previous experience of measuring their own BP, and were recruited to the study from one UK general medical practice. Interviews were recorded and transcribed, and data from the interviews have been analysed using phenomenological principles and identifying ‘meaning units.’ The findings suggest that participants were willing to carry out home measurements and several were pleased to have been asked to be more involved in their own management. All found the technique straightforward. Most noted marked variability in the day-to-day BP measurements. Several exhibited the ‘white coat’ phenomenon (spuriously raised BP in certain settings only). Some participants showed considerable know-ledge of hypertension and its consequences. They reported being aware of their own BP level and whether this was within acceptable limits. They also reported being willing to take further measurements, and to consider adjusting their treatment in the light of these measurements. Other participants showed less knowledge and enthusiasm, and considered the management of hypertension to be the doctor's job. The findings suggest that for some individuals home BP measurement is acceptable. They also help to explain why, for some individuals, it is not. Using the findings, a number of changes to current practice could be made, which might make home measurements more acceptable and easier to perform. As a result, a new proforma for use in everyday practice has been designed. The study shows that there is considerable scope for sharing BP measurement and management decisions in hypertension with patients themselves.

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Acknowledgements

This study has been supported by an NHS Executive Anglia and Oxford Region Primary Care Research and Development Enterprise Award, and by a grant from the NHS Research and Development levy.

We thank Professor Jackie Campbell and Dr Susan Corr of University College Northampton for support and advice, and Verna Kitchener of the Primary Care Research Consortium for Northamptonshire for secretarial help.

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Authors and Affiliations

  1. King Edward Road Surgery, Northampton, UK

    J Rickerby

  2. Primary Care Research Consortium for Northamptonshire, Albany House, Wellingborough, UK

    J Woodward

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  1. J Rickerby
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  2. J Woodward
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Correspondence to J Rickerby.

Appendices

Appendix A

Framework for interviews

There will not be a formal questionnaire for this study.

The aim of a phenomenological study is to discover the views and feelings of the subjects, and to allow them to express them in their own words. For this reason, open-ended questions are used to encourage each subject to explain their own ideas.

A framework of a few main questions will be used:

  • ‘Tell me about your high blood pressure.’

  • ‘How difficult was it to measure your own blood pressure?’

  • ‘How did you feel about measuring your own blood pressure?’

  • ‘What did you think about the results?’

  • ‘Did you discuss the results with your doctor? Was this useful?’

  • ‘How do you feel about your high blood pressure now?’

Subjects' answers may be explored and clarified as necessary.

Data obtained in this way are wide ranging and unstructured, but there is less risk of missing important aspects than when using more structured questioning.

Appendix B

Home blood pressure monitoring

Your doctor would like you to measure your own blood pressure at home for a week. Treatment of your blood pressure may need to be started or adjusted: home readings will help to prove whether this is necessary, or help to avoid unnecessary medication.

Patient's name:

Target average BP level: Usually 140/85 (130/80 if diabetic)

(average=sum of all readings/number of readings)

Use the machine while sitting comfortably with your arm (either arm is OK) resting on a table in front of you and the cuff firmly around the upper arm.

The readings will vary—probably no two will be the same. It is the average level that matters.

Please take readings twice or three times a day for 7 days. Write them in the table below (See Table A1). Ideally please take measurements at home in the mornings and evenings, and if possible one in the middle of the day, at work, if necessary.

The average of these readings should be less than the target level written above.

We suggest that you discuss the results with your doctor afterwards. (See Table A1)

Table 2 Table a1
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Rickerby, J., Woodward, J. Patients' experiences and opinions of home blood pressure measurement. J Hum Hypertens 17, 495–503 (2003). https://doi.org/10.1038/sj.jhh.1001582

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