Self-monitoring blood pressure in hypertension – internet based survey of UK general practitioners
McManus R., Hobbs FDR., Hinton L., Fletcher BR., Bray EP., Hayen A., Mant J., Potter JF.
Background<br/> Previous research suggests most UK General Practitioners (GPs) use self-monitoring of blood pressure (SMBP) to monitor control of hypertension rather than for diagnosis. This study sought to assess current practice in the use of self-monitoring and any changes in practice following more recent guideline recommendations. <br/><br/>Aim<br/> To survey views and practice with regard to SMBP of UK GPs in 2015 and to compare to a previous survey in 2011. <br/><br/>Design and setting<br/> Web-based survey of a regionally representative sample of 300 UK GPs. <br/><br/>Method<br/> GPs completed an on-line questionnaire concerning the use of SMBP in the management of hypertension. Analyses comprised descriptive statistics, tests for between group differences (z test, Wilcoxon, chi square), and multivariate logistic regression. <br/><br/>Results<br/> Results were available from 300 GPs (94% of those who started the survey). GPs reported using self-monitoring for diagnosing hypertension (169/291 (58% (95%CI 52-64))) and to monitor control (245/291 (84% (80-88))), the former significantly increased since 2011 (from 37% (33-41), p<0.001) with no change in monitoring for control. More than half of the GPs used higher systolic thresholds for diagnosis and treatment than recommended in guidelines and under half (120/169 GPs (42% (95%CI 36-47))) adjusted SMBP results for use in guiding treatment decisions. <br/><br/>Conclusion<br/> Since new UK national guidance in 2011, GPs are more likely to use SMBP in the diagnosis of hypertension but significant proportions continue to use non-standard diagnostic and monitoring thresholds. The use of out of office methods to improve the accuracy of diagnosis is unlikely to be beneficial if sub optimal thresholds are used.