Knowing your numbers to help keep your blood pressure in check

The Bottom Line

  • High blood pressure is a common condition that puts people at increased risk of serious conditions like heart attack, stroke, and even death. Detection, diagnosis, and treatment follow-though are challenges. 
  • Blood pressure screening done in community settings can help detect high blood pressure in adults. 
  • Self-monitoring may help people with high blood pressure lower their blood pressure by keeping them on top of their medication and providing health professionals with useful information for tailoring diagnosis and treatment plans.

Why worry about high blood pressure? Defined as a blood pressure above 140/90 mmHg (1-3), it affects nearly one in four Canadian adults (1;4) and is the leading preventable risk factor for heart disease (1;2;5;6). If left untreated, it increases the risk of serious conditions like heart attack, stroke, heart failure, kidney damage, and vision loss (2;6-8).

Most people recognize it’s important to keep their blood pressure within a healthy range. Unfortunately, some folks may not know they have high blood pressure, or struggle to access services for treatment. This is because blood pressure screening often occurs at routine visits with a primary health care provider, which excludes people who do not, or cannot, regularly visit such providers (3). Even those who know their blood pressure is high may struggle to take their medication as prescribed or may not participate in the follow-up care that allows their health care provider to develop effective individualized treatment plans (2;9-11).

How can these barriers to effective blood pressure management be overcome? Two systematic reviews explored whether community-based screening not done by a physician (blood pressure screening that occurs outside of a traditional healthcare setting, such as at a pharmacy or mobile health unit) (3) and self-monitoring (when a person checks their own blood pressure) (9) are potential solutions.

What the research tells us

When it comes to detecting high blood pressure, community-based screening can be a successful approach. This type of screening can also include a referral to healthcare services, which may lead to a new diagnosis of high blood pressure or new treatment in some cases. It is, however, not yet clear which types of community-based screening are most effective, and there is a need for further research in this area (3). For those who face barriers to accessing routine primary healthcare services, community-based screening could be a helpful first step in helping to identify high blood pressure.

When it comes to managing high blood pressure, self-monitoring may help people take their medication as prescribed, thereby aiding in lowering blood pressure. Even better, when blood pressure measurements are forwarded to a physician, physicians may be able to adjust treatment plans to individual patients’ needs to achieve better blood pressure management. Self-monitoring, however, does not appear to improve lifestyle habits such as diet and exercise. With that said, more research is needed to establish the most effective self-monitoring practices and strategies for lowering blood pressure (9).

The bottom line…know your numbers! Community-based screening and self-monitoring can be important approaches to overcoming the barriers to effective blood pressure diagnosis and management, providing an avenue towards better health outcomes for people with high blood pressure.

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  1. Statistics Canada. Risk factors for hypertension in Canada. [Internet] 2019. [cited 2020 June 8]. Available from https://www150.statcan.gc.ca/n1/pub/82-003-x/2019002/article/00001-eng.htm
  2. Musini VM, Tejani AM, Bassett K, et al. Pharmacotherapy for hypertension in adults 60 years or older. Cochrane Database Syst Rev. 2019; 6:CD000028. doi: 10.1002/14651858.CD000028.pub3.
  3. Fleming S, Atherton H, McCartney D, et al. Self-screening and non-physician screening for hypertension in communities: A systematic review. Am J Hypertens. 2015; 28(11):1316-1324. doi: 10.1093/ajh/hpv029.
  4. Padwal RS, Bienek A, McAlister FA, et al. Epidemiology of hypertension in Canada: An update. Can J Cardiol. 2016; 32(5):687-694. doi: 10.1016/j.cjca.2015.07.734.
  5. Tanuseputro P, Manuel DG, Leung M, et al. Risk factors for cardiovascular disease in Canada. Can J Cardiol. 2003; 19(11):1249-1259. 
  6. Aronow WS. Treating hypertension and prehypertension in older people: When, whom and how. Maturitas. 2015; 80(1):31-36. doi: 10.1016/j.maturitas.2014.10.001.
  7. Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics—2011 update: A report from the American Heart Association. Circulation. 2011; 123(4). doi: 10.1161/CIR.0b013e3182009701.
  8. Aronow WS, Ahmed MI, Ekundayo OJ, et al. A propensity-matched study of the association of peripheral arterial disease with cardiovascular outcomes in community-dwelling older adults. Am J Cardiol. 2009; 103(1):130-135. doi: 10.1016/j.amjcard.2008.08.037.
  9. Fletcher BR, Hartmann-Boyce J, Hinton L, et al. The effect of self-monitoring of blood pressure on medication adherence and lifestyle factors: A systematic review and meta-analysis. Am J Hypertens. 2015; 28(10):1209-1221. doi: 10.1093/ajh/hpv008.
  10. Fischer M, Stedman M, Lii J, et al. Primary medication non-adherence: Analysis of 195,930 electronic prescriptions. J Gen Intern Med. 2010; 25:284-290. doi: 10.1007/s11606-010-1253-1259.
  11. Gwadry-Sridhar FH, Manias E, Lal L, et al. Impact of interventions on medication adherence and blood pressure control in patients with essential hypertension: A systematic review by the ISPOR medication adherence and persistence special interest group. Value Health. 2013; 16:863-871. doi: 10.1016/j.jval.2013.03.1631.
  12. Bejan-Angoulvant T, Saadatian-Elahi M, Wright JM, et al. Treatment of hypertension in patients 80 years and older: The lower the better? A meta-analysis of randomized controlled trials. J Hypertens. 2010; 28(7):1366-1372.

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