"The More Data, The Better": Patient Experiences With Blood Pressure Measurement For Hypertension Diagnosis

Background: Out-of-office blood pressure (BP) measurement is recommended when making new hypertension diagnoses. However, in current practice, hypertension is primarily diagnosed using clinic BP measurements. Objective: To understand patient attitudes about the accuracy and patient-centeredness of different BP measurement and hypertension diagnostic methods. Design: Qualitative study within a randomized controlled diagnostic study comparing the accuracy and acceptability of clinic BP, home BP monitoring (HBPM), and kiosk BP (in a waiting room or pharmacy) for diagnosing hypertension among patients in an integrated delivery system. All participants also completed 24-hour ambulatory blood pressure monitoring regimen (ABPM). Participants: Qualitative interview participants (aged 31-76 years) were recruited from the main study with a goal of balancing by study arms, measurement result (high vs normal ABPM), hypertension diagnosis status at 6 months, gender, and age. Approach: We conducted semi-structured interviews at two time points—shortly after completion of diagnostic testing and 6 months later—to explore attitudes and behaviors related to the different BP measurement diagnostic methods. Key results: Interview participants (n=35) found HBPM to be comfortable, convenient, and low burden, and believed it produced accurate results. Participants reported higher confidence in high BP measurements from HBPM or ABPM compared to measurement in clinics. Clinic measurements were reported as less convenient than HBPM. Participants overall did not favor kiosks due to concerns about accuracy and privacy. ABPM was described by participants as the most accurate method, partly due to repeated measurements over the 24-hour period in real-world contexts, but many found it uncomfortable and disruptive. Participants also noted that methods that involved repeated measures such as HBPM and ABPM were especially influential in making their own personal decision as to whether or not they had hypertension. Conclusions: Our findings suggest that strategies to enhance HBPM implementation for hypertension diagnosis in primary care may improve diagnosis and patient understanding of hypertension.