PT  - JOURNAL ARTICLE
AU  - Alice C Tompson
AU  - Alison M Ward
AU  - Richard J McManus
AU  - Rafael Perera
AU  - Matthew J Thompson
AU  - Carl J Heneghan
AU  - David Nunan
TI  - Acceptability and psychological impact of out-of-office monitoring to diagnose hypertension: an evaluation of survey data from primary care patients
AID  - 10.3399/bjgp19X702221
DP  - 2019 Jun 01
TA  - British Journal of General Practice
PG  - e389--e397
VI  - 69
IP  - 683
4099  - http://bjgp.org/content/69/683/e389.short
4100  - http://bjgp.org/content/69/683/e389.full
SO  - Br J Gen Pract2019 Jun 01; 69
AB  - 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.