Study suggests without feedback loops, home blood pressure monitoring may increase unnecessary ER visits

By Jonah Comstock
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New data out of Ontario, Canada suggests that blood pressure home monitoring without any kind of feedback loop about the readings, can lead to an unnecessary strain on the healthcare system. In the study, published last week in the Annals of Emergency Medicine, an analysis of more than 200,000 emergency room visits across 180 sites showed a 64 percent increase in emergency room visits for hypertension from 2002 to 2012 -- despite a 28 percent decrease in hospitalizations for hypertension over that same time frame.

Although this data might seem at first glance like a cautionary tale for home monitoring, it could also be seen as demonstrative of the value of digital remote patient monitoring. Many of the digital health interventions around blood pressure monitoring today -- for instance, Ochsner Health in New Orlean's program -- involve patients automatically and wirelessly sending their data to a dashboard, where a doctor or care manager can review it. With constant digital access to their doctor, those patients are probably not flooding the emergency room.


The Canadian study didn't purport to know for certain what the explanation was for the increase in largely unnecessary ED visits for hypertension, but researchers did employ process of elimination to come up with a strong theory: Canadians had been encouraged to monitor their blood pressure at home and educated about what readings were considered normal, but not given much guidance about what to do in the case of too-high blood pressure.

"Hypertension awareness may have increased substantially in the last decade because of guideline recommendations around blood pressure self-measurement," researchers wrote, after noting that data didn't support lack of access to care or increased prevalance of hypertension as compelling explanations. "In 2005, the Canadian Hypertension Education Program began recommending home blood pressure monitoring as a self-management tool for the majority of all patients with hypertension; US and European guidelines have done the same. Our recent work at two sites found that the majority of ED visits for hypertension occurred after an elevated home or pharmacy blood pressure measurement. Therefore, it is plausible that these guideline recommendations have inadvertently contributed to the increased presentations of hypertension to the ED in Ontario."

"If so, increased patient and professional education efforts are needed around when to seek emergency care," the paper continues. "Currently, in the Canadian Hypertension Education Program guidelines there is only a single mention of this education: patients 'should be given adequate information about interpreting these readings.'"

Mortality in this group was extremely low: less than 1 percent died within 90 days of ER admittance, and less than 5 percent died within two years. And while Canada's state-sponsored healthcare system -- which means these patients didn't pay out of pocket for these ER visits -- may exacerbate the numbers, similar studies in the US have also shown that emergency department admissions for hypertension are on the rise, researchers wrote. 

"Stroke remains a huge killer and we do appreciate patients with hypertension being so conscientious about monitoring their readings," Dr. Clare Atzema, the lead researcher in the Ontario study, told ScienceDaily. "Patients should be aware that unless their high blood pressure coincides with symptoms of a medical emergency, such as chest pain, severe headache, nausea or shortness of breath, they probably do not need to visit the ER. We of course encourage them to follow up as soon as possible with their regular physician. If there is any doubt, come to the emergency department: we would rather have you come without an emergency than stay home with one."