People who involve themselves in the management of their hypertension have been shown to have better blood pressure control (3
). HBPM is a major component of the self-management of hypertension. In randomized controlled trials, hypertensive people who measure their blood pressure at home have lower blood pressures and are more likely to achieve blood pressure control, likely because they also have better adherence to therapy (5
). Like any therapy or therapeutic adjunct, to be effective, HBPM must be used. The present study demonstrates that nearly one-half of Canadians who report having hypertension as diagnosed by a health professional reported engaging in HBPM. Another one-quarter of Canadians with hypertension have their blood pressure measured outside of a clinical or medical setting, most often a pharmacy. Taken together, approximately 70% of Canadians with hypertension assess their own blood pressure between visits to health professionals. Conversely, almost 30% of Canadians with hypertension report relying exclusively on blood pressure measurements taken during a health care visit to monitor and manage their hypertension.
The regular monitoring of blood pressure at home may allow people with hypertension to assess the effectiveness of lifestyle and pharmacological interventions in its management. Given the evidence of the benefit of HBPM in increasing the ability to predict cardiovascular risk, promoting adherence to antihypertensive drug therapy and controlling blood pressure, hypertension management in Canada likely could be improved, and cardiovascular, cerebrovascular and renal disease risks mitigated, by an increase in the use of HBPM (5
). In the present study, only slightly more than one-third of respondents reported measuring their blood pressure at home on a monthly or more frequent basis.
In the present study, instruction in HBPM by a health care professional was the strongest factor associated with regular HBPM. Reporting having a plan to control blood pressure was also associated with regular HBPM. Interdisciplinary teams have been shown to be effective in facilitating improved self-management of hypertension (3
). Such teams may have a role in instructing people on HBPM, and in assisting them to develop a management plan to support blood pressure control. Availability of instruction may encourage HBPM in the majority of hypertensive Canadians who do not measure their blood pressure at home.
In the present study, only approximately one-third of Canadian adults with hypertension practiced HBPM and communicated results to a health professional. One way around the issue of patients not bringing records with them to the clinic is to have records telemonitored or communicated using the Internet. This appears to be an effective and patient-acceptable method to improve blood pressure control (24
Special consideration may need to be given to younger Canadian adults with hypertension. It is noteworthy, but perhaps anticipated, that in the present study, younger adults with hypertension were less likely to regularly monitor their blood pressure at home. They were also less likely to have been shown how to measure their own blood pressure by a health professional, or to share their home readings with their health professional. A previous study found that younger hypertensive Canadians were often not pharmacologically treated for diagnosed hypertension, even if they had multiple risk factors (26
). Increased instruction by health professionals, as well as programs promoting self-management of hypertension that are integrated into the community and workplace may encourage younger hypertensive Canadians to become more engaged in their hypertension management.
Over the past several years, groups including Blood Pressure Canada, the Canadian Hypertension Society, the Quebec Hypertension Society, and the Canadian Hypertension Education Program have developed resources aimed at encouraging Canadians with hypertension to measure their blood pressure at home (available at www.hypertension.ca/tools
). While the SLCDC was being conducted, new educational interventions were developed to facilitate HBPM. These include a video that provides careful instruction on how to assess blood pressure (available for download at www.hypertension.ca/video
) as well as printed instructions (available for download at www.htnupdate.ca
). In addition, just before the introduction of the SLCDC, the Heart and Stroke Foundation of Canada developed a Web site that allows Canadians to monitor and track their home blood pressure measurements (www.heartandstroke.ca/bp
). A new Web site (www.MyBPsite.ca
) has been launched to provide Canadians with hypertension information and resources to improve their self-management. Broad dissemination of this information and these resources may increase the number of hypertensive Canadians measuring their blood pressure at home, improve the quality of their measurements, and increase sharing of home readings with health professionals. This may be reflected in a greater number of Canadians with hypertension reporting good control of blood pressure. Because the SLCDC is the first detailed examination of HBPM practices in Canada, the impact of past and current education programs on home measurement of blood pressure cannot be ascertained. However, the present results will form a basis for determining the impact of future interventions in HBPM in Canada, and suggest areas for improvement.
The SLCDC was designed to provide data that are representative of the Canadian household population that has been diagnosed with hypertension by a health professional. Even though the response rate was 78%, certain segments of the Canadian population may be under-represented. Moreover, certain groups, including those living in institutions, were not captured in the sample. Furthermore, the self-report measures assessed in the present survey cannot ascertain whether appropriate HBPM methods were used by respondents, or whether their self-reported hypertension control would be valid relative to more objective physical measures. It is noteworthy, however, that the levels of hypertension control reported in the SLCDC are comparable with those reported for Canadians who were aware of their hypertension in the recent Canadian Health Measures Survey (27
In the present study, HBPM practices had no clear association with self-reported blood pressure control. This was an unanticipated finding given the evidence that people who involve themselves in the management of their hypertension generally have been shown to have better blood pressure control (3
). Given that fewer than one-half of all Canadians reporting hypertension engaged in HBPM, it is possible that patients and their health professionals may choose to practice HBPM when there are concerns about blood pressure control.
The 2009 SLCDC hypertension component shows that most Canadians with hypertension monitor their blood pressure at home or at some other place outside of visits to their health professional. These data provide the baseline to evaluate the effectiveness of future interventions to improve HBPM, and suggest that increasing instruction in HBPM by health professionals is an important intervention target. The use of surveys such as the SLCDC allow the identification of care and knowledge gaps and, with repeated surveys, will allow assessment of interventions to improve hypertension management and the health of Canadians.