Mild sleep restriction increases 24-hour ambulatory blood pressure in premenopausal women with no indication of mediation by psychological effects.

BACKGROUND: Studies assessing the impact of sleep restriction (SR) on blood pressure (BP) are limited by short study length, extreme SR (<4 hours a night), and lack of attention to psychological distress as a possible mediator. METHODS: A community-based cohort was assembled with 237 women (age 34.1 ±â€¯13.5 years; body mass index 25.4 ±â€¯5.4 kg/m2), and a randomized, crossover, intervention study was conducted in 41 women (24 completed: age 30.2 ±â€¯6.5 years; body mass index 24.3 ±â€¯2.8 kg/m2) to determine the causal effect of SR on BP. Sleep was maintained as usual (HS) or reduced by 1.5 hours a night (SR) for 6 weeks. In the cohort, associations between sleep and psychosocial factors were evaluated using multivariable models adjusted for demographic and clinical confounders. In the intervention study, in-office BP was measured weekly; ambulatory BP was measured at end point. Psychological factors were assessed at baseline and end point. Mixed-model analyses with total sleep time (TST, main predictor), week and fraction of time spent in physical activity (covariates), and subject (random effect) were performed. RESULTS: Among the community cohort, higher perceived stress, stressful events and distress, and lower resilience were associated with shorter sleep, worse sleep quality, and greater insomnia symptoms (P < .05). In the intervention, systolic BP increased as TST decreased (TST × week interaction, [coefficient ±â€¯standard error] -0.0097 ±â€¯0.0046, P = .036). Wake ambulatory diastolic blood pressure (-0.059 ±â€¯0.022, P = .021) and mean arterial pressure (-0.067 ±â€¯0.023, P = .018) were higher after SR versus HS. Psychological distress variables were not affected by TST and did not mediate the effects of SR on BP. CONCLUSIONS: These results suggest that SR influences CVD risk in women via mechanisms independent of psychological stressors.

Assessing the routine-practice gap for home blood pressure monitoring among Chinese adults with hypertension.

BACKGROUND: Home blood pressure monitoring (HBPM) is recommended for diagnosis, treatment adjustment and management of most hypertension cases in hypertension guidelines from multiple countries. This study aimed to evaluate HBPM behaviour and explore the routine-practice gap in HBPM among Chinese adults with hypertension. METHODS: Data were collected from 20 communities across three cities and six townships in three provinces (Beijing, Shandong and Jiangsu) in China between October 2014 and November 2014. In total, 2272 patients with hypertension aged ≥35 years that were registered with a primary health station in their local communities were selected by simple random sampling. RESULTS: Among the 2272 participants, 45.3% owned a home blood pressure (BP) monitor. In addition, 27.5% (625/2272) engaged in HBPM weekly or more frequently. Healthcare providers' advice was the strongest factor contributing to home BP monitor ownership and weekly HBPM behaviour, with odds ratios of 13.50 and 8.97, respectively. Approximately 4.4% of participants had achieved optimal HBPM regimens (duplicate measurements in the morning and evening for 7 days). Patients with uncontrolled office-measured BP were more likely to conduct HBPM regularly in the morning and evening, measure their BP two or three times in each session and maintain 7 consecutive days of HBPM than patients with controlled office BP (8.8% vs. 5.8%, P = 0.042; 14.3% vs. 8.1%, P = 0.002; and 19.9% vs. 12.4%, P = 0.005, respectively). Only 16.0% (165/1030) of participants actively reported their HBPM readings to doctors. CONCLUSION: The HBPM strategies specified in hypertension guidelines are seldom achieved in actual practice in China. Only a small proportion of patients actively participate in using HBPM to enhance their hypertension care. HBPM may be improved by healthcare providers offering specific advice and training.

Blood pressure self-monitoring in pregnancy (BuMP) feasibility study; a qualitative analysis of women's experiences of self-monitoring.

BACKGROUND: Hypertensive disorders in pregnancy are a leading cause of maternal and fetal morbidity worldwide. Raised blood pressure (BP) affects 10% of pregnancies worldwide, of which almost half develop pre-eclampsia. The proportion of pregnant women who have risk factors for pre-eclampsia (such as pre-existing hypertension, obesity and advanced maternal age) is increasing. Pre-eclampsia can manifest itself before women experience symptoms and can develop between antenatal visits. Incentives to improve early detection of gestational hypertensive disorders are therefore strong and self-monitoring of blood pressure (SMBP) in pregnancy might be one means to achieve this, whilst improving women's involvement in antenatal care. The Blood Pressure Self-Monitoring in Pregnancy (BuMP) study aimed to evaluate the feasibility and acceptability of SMBP in pregnancy. METHODS: To understand women's experiences of SMBP during pregnancy, we undertook a qualitative study embedded within the BuMP observational feasibility study. Women who were at higher risk of developing hypertension and/or pre-eclampsia were invited to take part in a study using SMBP and also invited to take part in an interview. Semi-structured interviews were conducted at the women's homes in Oxfordshire and Birmingham with women who were self-monitoring their BP as part of the BuMP feasibility study in 2014. Interviews were conducted by a qualitative researcher and transcribed verbatim. A framework approach was used for analysis. RESULTS: Fifteen women agreed to be interviewed. Respondents reported general willingness to engage with monitoring their own BP, feeling that it could reduce anxiety around their health during pregnancy, particularly if they had previous experience of raised BP or pre-eclampsia. They felt able to incorporate self-monitoring into their weekly routines, although this was harder post-partum. Self-monitoring of BP made them more aware of the risks of hypertension and pre-eclampsia in pregnancy. Feelings of reassurance and empowerment were commonly reported by the women in our sample. CONCLUSIONS: SMBP in pregnancy was both acceptable and feasible to women in this small pilot study.

Mother-induced hypertension in familial dysautonomia.

Here we report the case of a patient with familial dysautonomia (a genetic form of afferent baroreflex failure), who had severe hypertension (230/149 mmHg) induced by the stress of his mother taking his blood pressure. His hypertension subsided when he learnt to measure his blood pressure without his mother's involvement. The case highlights how the reaction to maternal stress becomes amplified when catecholamine release is no longer under baroreflex control.

Integrating Out-of-Office Blood Pressure in the Diagnosis and Management of Hypertension.

Guidelines for the diagnosis and monitoring of hypertension were historically based on in-office blood pressure measurements. However, the US Preventive Services Task Force recently expanded their recommendations on screening for hypertension to include out-of-office blood pressure measurements to confirm the diagnosis of hypertension. Out-of-office blood pressure monitoring modalities, including ambulatory blood pressure monitoring and home blood pressure monitoring, are important tools in distinguishing between normotension, masked hypertension, white-coat hypertension, and sustained (including uncontrolled or drug-resistant) hypertension. Compared to in-office readings, out-of-office blood pressures are a greater predictor of renal and cardiac morbidity and mortality. There are multiple barriers to the implementation of out-of-office blood pressure monitoring which need to be overcome in order to promote more widespread use of these modalities.

The effectiveness of a life style modification and peer support home blood pressure monitoring in control of hypertension: protocol for a cluster randomized controlled trial.

BACKGROUND: Death rates due to hypertension in low and middle income countries are higher compared to high income countries. The present study is designed to combine life style modification and home blood pressure monitoring for control of hypertension in the context of low and middle income countries. METHODS: The study is a two armed, parallel group, un-blinded, cluster randomized controlled trial undertaken within lower income areas in Kuala Lumpur. Two housing complexes will be assigned to the intervention group and the other two housing complexes will be allocated in the control group. Based on power analysis, 320 participants will be recruited. The participants in the intervention group (n = 160) will undergo three main components in the intervention which are the peer support for home blood pressure monitoring, face to face health coaching on healthy diet and demonstration and training for indoor home based exercise activities while the control group will receive a pamphlet containing information on hypertension. The primary outcomes are systolic and diastolic blood pressure. Secondary outcome measures include practice of self-blood pressure monitoring, dietary intake, level of physical activity and physical fitness. DISCUSSION: The present study will evaluate the effect of lifestyle modification and peer support home blood pressure monitoring on blood pressure control, during a 6 month intervention period. Moreover, the study aims to assess whether these effects can be sustainable more than six months after the intervention has ended.

The association of heart rate variability examined in supine and standing position with ambulatory blood pressure monitoring in anorexia nervosa.

OBJECTIVE: To evaluate the association of heart rate variability (HRV) examined in supine and standing position with ambulatory blood pressure monitoring (ABPM) in patients with anorexia nervosa (AN). METHODS: HRV in supine and standing position and ABPM were examined in 30 AN patients and 30 control subjects. The correlations between HRV and ABPM were evaluated. RESULTS: The average age was 25±5 in AN patients and 25±4 years in controls (NS). LF (low frequency) power in AN patients and controls was comparable in supine position. LF power significantly increased during standing in controls, but no increment was detected in AN patients. The HF (high frequency) power was significantly increased in AN patients in supine position, but after standing was comparable with controls. The ratio LF/HF was lower both in supine and standing position in AN patients but the differences did not reach statistical significance. Blood pressure values in AN patients were comparable with controls in supine position but were significantly lower in standing position. Ambulatory blood pressure values were significantly lower in AN patients during active but not sleeping period. In standing position HF and LF powers positively and LF/HF negatively correlated with ABPM blood pressure values during active period in controls while in AN patients only LF power correlated with diastolic and mean blood pressures. CONCLUSION: The lower ABPM values in AN patients during active period in comparison with control subjects may be explained by HRV changes, mainly by its impaired relations with blood pressure in standing position.

Approach to antihypertensive adherence: a feasibility study on the use of student health coaches for uninsured hypertensive adults.

Despite pharmacologic advances, medication non-adherence continues to challenge primary care providers in blood pressure (BP) management. Medical, nursing and pharmacy students (n=11) were recruited and trained as health coaches for uninsured, hypertensive patients (n=25) of a free clinic in an uncontrolled open trial. Pre-post analysis was conducted on BP, medication adherence, frequency of home BP monitoring, and health behavior (eg, diet, exercise). Patient satisfaction and feasibility of a student coach model was qualitatively evaluated. In the 12 patients who completed the intervention, an increase in medication adherence as measured by the Brief Medication Questionnaire was observed (P<.01), with a 11 mmHg reduction in systolic BP (P=.03). Qualitative data showed patient satisfaction with the intervention and other health behavior change. This feasibility study shows use of student health coaches to combat medication non-adherence in uninsured, hypertensive adults is promising.

The Contributions of Hypertension Diagnosis and Blood Pressure Control to Subjective Life Expectancy in a Representative Sample of Older U.S. Adults.

OBJECTIVES: High blood pressure (BP) or hypertension, a major risk factor for death and disease, is pervasive among older adults. While reducing BP to targeted levels can prevent adverse outcomes, rates of successful BP control remain suboptimal, and it is unclear whether older adults recognize its proven benefits. The current study sheds light on older adults' beliefs about the consequences of hypertension and benefits of BP control by examining how their self-reports of hypertension diagnosis and BP control, as well as measured BP, contribute to subjective life expectancy (SLE), their perceived probability of surviving to a target age. METHODS: In a representative sample of U.S. adults aged 50-89 from the 2006-2014 Health and Retirement Study (n = 18,979 respondents), we analyze SLE using generalized linear regression. RESULTS: Diagnosed hypertension is associated with lower SLE, regardless of measured BP. Among diagnosed hypertensives, those who self-report controlled BP expect to live longer than those who do not. Finally, about 1 in 10 older adults have high measured BP but have never been diagnosed with hypertension, and most diagnosed hypertensives with uncontrolled measured BP self-report their BP as controlled. DISCUSSION: Older adults appear to recognize the harmful effects of hypertension and the benefits of BP control, but often lack knowledge of their own hypertension and BP control statuses. Health communications should continue to stress the value of BP control, although improvements may require increased hypertension awareness and BP monitoring.

Tolerability of the Oscar 2 ambulatory blood pressure monitor among research participants: a cross-sectional repeated measures study.

BACKGROUND: Ambulatory blood pressure monitoring (ABPM) is increasingly used to measure blood pressure (BP) in research studies. We examined ease of use, comfort, degree of disturbance, reported adverse effects, factors associated with poor tolerability, and association of poor tolerability with data acquisition of 24-hour ABPM using the Oscar 2 monitor in the research setting. METHODS: Sixty adults participating in a research study of people with a history of borderline clinic BP reported on their experience with ABPM on two occasions one week apart. Poor tolerability was operationalized as an overall score at or above the 75th percentile using responses to questions adapted from a previously developed questionnaire. In addition to descriptive statistics (means for responses to Likert-scaled "0 to 10" questions and proportions for Yes/No questions), we examined reproducibility of poor tolerability as well as associations with poor tolerability and whether poor tolerability was associated with removal of the monitor or inadequate number of BP measurements. RESULTS: The mean ambulatory BP of participants by an initial ABPM session was 148/87 mm Hg. After wearing the monitor the first time, the degree to which the monitor was felt to be cumbersome ranged from a mean of 3.0 to 3.8, depending on whether at work, home, driving, or other times. The most bother was interference with normal sleeping pattern (mean 4.2). Wearers found the monitor straightforward to use (mean 7.5). Nearly 67% reported that the monitor woke them after falling asleep, and 8.6% removed it at some point during the night. Reported adverse effects included pain (32%), skin irritation (37%), and bruising (7%). Those categorized as having poor tolerability (kappa = 0.5 between sessions, p = 0.0003) were more likely to report being in fair/poor health (75% vs 22%, p = 0.01) and have elevated 24-hour BP average (systolic: 28% vs 17%, p = 0.56; diastolic: 30% vs 17%, p = 0.37). They were also more likely to remove the monitor and have inadequate numbers of measurements. CONCLUSIONS: The Oscar 2 ABPM device is straightforward to use but can interfere with sleep. Commonly reported adverse effects include pain, skin irritation, and bruising. Those who tolerate the monitor poorly are more likely to report being in fair or poor health and to remove it, particularly at night.

Understanding the connection between spiritual well-being and physical health: an examination of ambulatory blood pressure, inflammation, blood lipids and fasting glucose.

Growing research has demonstrated a link between spiritual well-being and better health; however, little is known about possible physiological mechanisms. In a sample of highly religious healthy male and female adults (n = 100) ages 19-59 (m = 28.28) we examined the influence of spiritual well-being, as measured by the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp-Ex), on physiological risk factors for heart disease. Specifically we examined 24-h ambulatory blood pressure (BP), inflammation (hs-C-reactive protein), fasting glucose, and blood lipids. Regression analyses reveal that higher levels of spiritual-wellness (total FACIT-Sp-Ex score) was significantly related to lower systolic ambulatory BP (ß = -.345; P < .001), diastolic ambulatory BP (ß = -.24; P = .02), hs-C-reactive protein (ß = -.23; P = .04), fasting glucose (ß = -.28; P = .006), and marginally lower triglycerides (ß = -.21; P = .09) and VLDL (ß = -.21; P = .10) controlling for age, gender, and church attendance. Results remained generally consistent across the Meaning, Peace, Faith and Additional Spiritual Concerns subscales of the FACIT-Sp-Ex. Spiritual well-being may be cardio protective.

Patient perceptions of ambulatory blood pressure monitoring testing, tolerability, accessibility, and expense.

Use of 24-hour ambulatory blood pressure monitoring is strongly endorsed by contemporary hypertension guidelines. The objective of this study was to assess patient perceptions of ambulatory blood pressure testing, tolerability, accessibility, and expense. A convenience sample of 50, consenting patients undergoing ambulatory blood pressure monitoring at the University of Alberta Hypertension Clinic in Edmonton, Canada was studied. A 16-item structured questionnaire was administered in person or electronically. Questions regarding the tolerability of ambulatory monitoring were evaluated using a 5-point Likert scale and wait times, expenditures, and willingness to pay were evaluated by direct questioning. Mean age was 53.1 ± 15.4 years, 32 (64%) were female, and 23 (46%) were employed. Mean 24-hour ambulatory BP was 134 ± 12/79 ± 8 mmHg. Ambulatory monitoring caused discomfort in 40 (80%) patients and disturbed sleep in 39 (78%). Forty-one (82%) patients perceived that the home (vs pharmacy, primary care clinic, and speciality care clinic) would be the easiest venue to access future testing. On average, patients waited 27.3 ± 23.7 days for testing; they felt that a wait time of 21.3 ± 12.3 days was appropriate. Mean time taken off work was 8.6 ± 10.8 hours. Twelve (24%) patients indicated that they would be willing to pay out-of-pocket to undergo testing sooner, at a mean expenditure of $120 ± 69. Nineteen (62%) patients were willing to buy a monitor and felt that a mean purchase cost of $125 ± 89 was appropriate. These findings extend current knowledge of patient perceptions of ambulatory monitoring and may help to refine and optimize future delivery of this essential test.

Improving hypertension control in diabetes mellitus: the effects of collaborative and proactive health communication.

BACKGROUND: Communication between patients and clinicians using collaborative goals and treatment plans may overcome barriers to achieving hypertension control in routine diabetes mellitus care. We assessed the interrelation of patient-clinician communication factors to determine their independent associations with hypertension control in diabetes care. METHODS AND RESULTS: We identified 566 older adults with diabetes mellitus and hypertension at the DeBakey VA Medical Center in Houston, Tex. Clinical and pharmacy data were collected, and a patient questionnaire was sent to all participants. A total of 212 individuals returned surveys. Logistic regression analyses were performed to assess the effect of patient characteristics, self-management behaviors, and communication factors on hypertension control. Three communication factors had significant associations with hypertension control. Two factors, patients' endorsement of a shared decision-making style (odds ratio 1.61, 95% confidence interval 1.01 to 2.57) and proactive communication with one's clinician about abnormal results of blood pressure self-monitoring (odds ratio 1.89, 95% confidence interval 1.10 to 3.26), had direct, independent associations in multivariate regression. Path analysis was used to investigate the direct and indirect effects of communication factors and hypertension control. Decision-making style (beta=0.20, P<0.01) and proactive communication (beta=0.50, P<0.0001) again demonstrated direct effects on hypertension control. A third factor, clinicians' use of collaborative communication when setting treatment goals, had a total effect on hypertension control of 0.16 (P<0.05) through its direct effects on decision-making style (beta=0.28, P<0.001) and proactive communication (beta=0.22, P<0.01). CONCLUSIONS: Three communication factors were found to have significant associations with hypertension control. Patient-clinician communication that facilitates collaborative blood pressure goals and patients' input related to the progress of treatment may improve rates of hypertension control in diabetes care independent of medication adherence.

Unfair treatment and trait anger in relation to nighttime ambulatory blood pressure in African American and white adolescents.

OBJECTIVE: To determine if ambulatory blood pressure (ABP) at night relative to day ABP among adolescents is influenced by unfair treatment and trait anger, and whether these associations are stronger in African Americans and adolescents from lower socioeconomic status (SES) families and neighborhoods. METHODS: A total of 189 healthy white and African American adolescents (ages = 14-16 years, standard deviation = 0.62, 50% female) completed 2 days and 1 night of ABP monitoring and unfair treatment and trait anger questionnaires. SES was measured using 1) parental education and 2) a composite neighborhood SES score based on U.S. Census tract data for neighborhood poverty and education. The night/day ABP ratio was calculated by dividing the night ABP mean (readings from the self-reported bedtime of each participant through 5 AM) by the day ABP mean (8:30 AM until self-reported bedtime). RESULTS: Higher trait anger was associated with a higher night/day diastolic blood pressure (DBP) ratio in the full sample, B = 0.003, SE = 0.001, t = 2.20, p = .03. A significant interaction effect for Race x Unfair Treatment on the night/day DBP ratio, B = 0.01, SE = 0.003, t = 3.17, p = .002, followed by post hoc tests indicated that greater unfair treatment was associated with a higher night/day DBP ratio among African Americans, B = 0.006, SE = 0.002, t = 2.56, p = .01. Further, among African American adolescents living in lower SES neighborhoods, greater unfair treatment predicted a higher night/day DBP ratio, B = 0.008, SE = 0.003, t = 3.15, p = .002, and higher trait anger scores predicted a higher night/day DBP ratio, B = 0.008, SE = 0.002, t = 3.19, p = .002. CONCLUSIONS: Trait anger may be a factor leading to elevated nighttime DBP in both African Americans and whites. Unfair treatment and trait anger are important predictors of elevated night/day ABP ratios among African American adolescents living in lower SES neighborhoods. These factors may contribute to the onset of hypertension in African Americans at a younger age.

'Adaptive' psychosocial factors in relation to home blood pressure: a study in the general population of southern Netherlands.

BACKGROUND: Evidence is accumulating for an association between psychosocial stress and elevated blood pressure. However, studies focusing on adaptive psychosocial factors are scarce. PURPOSE: We examined the association between putatively adaptive psychosocial factors and home blood pressure in a population study in the Netherlands. METHOD: Resting blood pressure was measured of 985 female and 777 male participants between 20 and 55 years of age in their home setting. Questionnaires assessing problem-focused coping (active coping), adaptive emotion-focused coping (positive reinterpretation) and social support were completed. RESULTS: When controlled for age, marital and socio-economic status, body mass index, parental history of hypertension, physical exercise, smoking, alcohol, coffee, and--in women--oral contraceptives, positive reinterpretation was associated with a lower prevalence of elevated home blood pressure (>or=140/90 mmHg): OR = 0.60, 95% CI = 0.40-0.88 (P = 0.009). Although all three psychosocial variables were associated with both systolic and diastolic blood pressure level, in multivariable analyses, only the associations between systolic blood pressure and positive reinterpretation (beta = -0.09, t = 3.25, P = 0.001) and active coping (beta = 0.07, t = 2.65, P = 0.008) remained significant. CONCLUSION: Independent of other factors, only positive reinterpretation of the situation appeared to be related to more favorable blood pressure levels.

White coat effect and its clinical implications in the elderly.

The aim of this study was to investigate the frequency and correlated factors of white coat effect (WCE) in the elderly. Geriatric patients who were known as normotensive and office BP exceeding 140/90 mmHg underwent 24-hour ambulatory blood pressure monitoring (ABPM). Correlation of WCE with clinical parameters, geriatric assessment scales, co-existing diseases, and laboratory results were analyzed. Within 61 patients 72.1% were diagnosed as white coat hypertension (WCH). Independent correlates of systolic WCE were activities of daily living, instrumental activities of daily living scores, creatinine; independent correlate of diastolic WCE was Geriatric Depression Scale score. White coat hypertension constitutes a major part of office-detected hypertension in geriatric patients. Ambulatory blood pressure monitoring should be performed on geriatric patients with office-measured hypertension in order to avoid overtreatment.

[Home blood pressure measurement: source of anxiety? Prospective observational study]. / L'automesure tensionnelle, source d'anxiété? Etude prospective observationnelle.

BACKGROUND: Home blood pressure measurement has been widely used for the diagnosis and the follow-up of hypertension. However there are few data concerning its impact on patient's quality of life. OBJECTIVE: To assess whether home blood pressure measurement provokes anxiety and to check for predictive factors of this side effect. METHOD: A prospective study was performed by six general practitioners in Finistère (Brittany). Over four months, fifty patients were included. Twelve patients underwent home blood pressure measurement for the diagnosis and thirty-eight for the follow-up of hypertension. Three home blood pressure measurements were performed every morning and every evening for five days. Within a week, quality of life was evaluated by a phone questionnaire, and again after three months. RESULTS: The incidence of anxiety was 20% in this series. Urban patients (p = 0.21) and those with high education levels (p = 0.07) tended to be more anxious. Home blood pressure measurements were significantly ower (p < 0.0001) than office blood pressure and 8% of the patients with office high blood pressure had normal home blood pressure. However, anxious patients had significantly higher diastolic home blood pressure than non anxious patients (p = 0.04). In the patients that underwent a second cycle of home blood pressure measurement three months later, anxiety was reduced by 40%. CONCLUSION: These preliminary results suggest that home blood pressure measurement causes anxiety in some patients but that this side effect might decrease with time. To confirm these observations, additional studies over longer periods are needed.

Acceptability and psychological impact of out-of-office monitoring to diagnose hypertension: an evaluation of survey data from primary care patients.

BACKGROUND: Out-of-office blood pressure (BP) is recommended for diagnosing hypertension in primary care due to its increased accuracy compared to office BP. Moreover, being diagnosed as hypertensive has previously been linked to lower wellbeing. There is limited evidence regarding the acceptability of out-of-office BP and its impact on wellbeing. AIM: To assess the acceptability and psychological impact of out-of-office monitoring in people with suspected hypertension. DESIGN AND SETTING: A pre- and post-evaluation of participants with elevated (≥130 mmHg) systolic BP, assessing the psychological impact of 28 days of self-monitoring followed by ambulatory BP monitoring for 24 hours. METHOD: Participants completed standardised psychological measures pre- and post-monitoring, and a validated acceptability scale post-monitoring. Descriptive data were compared using χ2 tests and binary logistic regression. Pre- and post-monitoring comparisons were made using the paired t-test and Wilcoxon signed rank test. RESULTS: Out-of-office BP monitoring had no impact on depression and anxiety status in 93% and 85% of participants, respectively. Self-monitoring was more acceptable than ambulatory monitoring (n = 183, median 2.4, interquartile range [IQR] 1.9-3.1 versus median 3.2, IQR 2.7-3.7, P<0.01). When asked directly, 48/183 participants (26%, 95% confidence interval [CI] = 20 to 33%) reported that self-monitoring made them anxious, and 55/183 (30%, 95% CI = 24 to 37%) reported that ambulatory monitoring made them anxious. CONCLUSION: Out-of-office monitoring for hypertension diagnosis does not appear to be harmful. However, health professionals should be aware that in some patients it induces feelings of anxiety, and self-monitoring may be preferable to ambulatory monitoring.

SMS-facilitated home blood pressure monitoring: A qualitative analysis of resultant health behavior change.

OBJECTIVE: Hypertension is largely asymptomatic and, as a result, patients often fail to sufficiently engage in medication adherence and other health behaviors to control their blood pressure (BP). This study explores the mechanisms by which MyBP, an automated SMS-facilitated home blood pressure monitoring (HBPM) program, helps facilitate healthy behavior changes. METHODS: A thematic analysis of transcribed audio-recordings from semi-structured post-intervention interviews (n = 40) was conducted. RESULTS: Three primary themes were identified as contributing most to patients' decision to initiate a behavior change: 1) increased hypertension literacy attributed to educational videos presented at enrollment, 2) increased day-to-day salience of blood pressure levels as a result of consistent HBPM, and 3) use of BP readings as feedback, with high readings triggering motivations to make behavior changes. These themes and most accompanying sub-themes correspond to constructs in the Health Belief Model and Social Cognitive Theory. CONCLUSION: Patient-centered HBPM interventions such asMyBP appear to promote improvements in hypertension self-management via several mechanisms consistent with recognized models of behavior change. PRACTICE IMPLICATIONS: SMS-supported HBPM, paired with video-based education, may provide a simple and scalable way of encouraging health behavior adherence in hypertensive patients.