Response to Additional Benefits of Home Blood Pressure Monitors
The suggestion that the use of home blood pressure (BP) monitoring (HBPM) may be of particular value in patients who are indigent and therefore get less satisfactory medical care than those of us who are insured in the United States is of interest.1 A large and well-conducted study in the Group Health organization, an integrated group practice in Seattle, Washington, found that HBPM on its own did not significantly improve BP control in 1 group of patients, but there was a marked improvement in another group in whom HBPM was coupled with added communication with health care providers.2 The improvement of BP control using HBPM could, thus, have ≥2 mechanisms. The first is improved compliance with prescribed medication, which, before the home monitoring is started, is likely to be lower in the indigent patients than in those getting more regular medical care, such as the Seattle Group Health organization. The second mechanism might be the alteration of prescribed medications in patients who are already compliant, which did occur in the Group Health patients who had the health care provider intervention, as well as the HBPM, in whom there was a marked improvement in BP control. Given the huge importance of improving BP control in patients who currently get inadequate health care, the described studies are of great interest and relevance.