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We Can’t Address Hypertension Without Widespread Patient Self-Monitoring

There is a major disconnect between the need for people with hypertension to monitor their blood pressure at home, and the extent to which people do this. The gap is enormous: the prevalence of hypertension in the U.S. and around the world keeps rising.

High blood pressure (BP) is a principal cause of cardiac events, strokes, and chronic kidney disease, is common and costly in the U.S. and around the globe. One out of two adults in the U.S. have hypertension (47% or 116 million), and according to the World Health Organization, almost half are not aware their BP is high.

Hypertension is highly treatable yet the number of people with this condition keeps climbing and those “under control” is falling. While those with hypertension and controlled BP rose from 32% to 54% between 2000 and 2014, it then declined to 44% in 2018. Currently, only about 4 of 10 adults with hypertension have their BP under control. Among those on medication, BP control increased from 53% to 72 from 2000 to 2014, only to fall to 65% more recently.

With such somber statistics showing more people undertreated, it will be impossible to move the needle on hypertension diagnosis and BP control without one key behavior: Self-Measured Blood Pressure Monitoring.

Why Self-Measured Blood Pressure Monitoring (SMBP) is critical

In-Clinic BP Readings Are Insufficient. A study just published examined visit-to-visit variability in BP values. Among >7 million measurements, BP readings varied significantly across visits. This large variability in clinic-based measurement significantly challenges clinicians to assess BP and indications for treatment. The authors view home BP monitoring as a critical need for accuracy to establish the diagnosis of hypertension and to tailor treatment to adequately control BP.

BP Self-Monitoring is Effective. Evidence shows self-monitoring helps people with high BP gain better control. SMBP offers the best opportunity with clinical support. Benefits go beyond measuring BP. A qualitative study of patient self-monitoring found that self-monitoring can rule out ‘white coat’ hypertension, improve medication adherence and enhance lifestyle behavior. Some patients expressed a need to better understand hypertension and high BP readings.

Remote Patient Monitoring (RPM) Is Not for Everyone. Bluetooth-enabled BP measurement with professional monitoring is effective. Challenges arise from issues with device usability and the digital divide. Patients have a more passive role as readings are sent for professional review. Finally, RPM is resource-intensive and requires professionals to manage readings and communicate with practitioners. Combined, these limit dissemination across populations.

Why Florence Drives Self-Monitoring Impact.

Texting Reaches Those Who Need it the Most. Since Flo uses SMS texts for BP self-monitoring, there is no need to download an app and have internet access. Texting is used by over 95% of the population, making Flo is an easy-to-use tool that maximizes the reach of SMBP across settings and demographics.

Automated Messages Drive Patient Activation. Patients take an active role in home self-monitoring as they are encouraged, supported, and immediately informed about how they are doing managing their BP. Messages are conversational and can automatically be increased or reduced in frequency according to an individual’s BP trend over time.

Care Teams Spend Less Time Managing. Flo has been shown to support SMBP and lead to behaviour change. As patients improve self-care and medication adherence and are more active in lifestyle changes, clinical teams can lower their work conducting outreach across all patients with hypertension – and can focus on individuals who may need a higher level of care. Flo’s evidence can be found here.

CTA control hypertension

Source: The Surgeon General’s Call to Action to Control Hypertension

Integrating SMBP Into Care Everywhere.

Improving hypertension control continues as a national priority, and SMBP is identified as a critical component to achieve this aim. The U.S. Surgeon General (see figure above) and The Million Hearts program, a national initiative led by the Centers for Disease Control and the Centers for Medicare & Medicaid Services, are promoting and disseminating SMBP across the country. This task has been made more challenging with the pandemic, as access to care and routine care delivery has declined. Increasing the widespread use of simple tools – such as automated texting – can help us get back on track to ensure people with hypertension are diagnosed, treated and monitored. Using Flo for SMBP can help make the task easier.


Centers for Disease Control and Prevention. Hypertension Cascade: Hypertension Prevalence, Treatment and Control Estimates Among U.S. Adults Aged 18 Years and Older Applying the Criteria from the American College of Cardiology and American Heart Association’s 2017 Hypertension Guideline—NHANES 2015–2018. Atlanta, GA: U.S. Department of Health and Human Services; 2021. Accessed April 9, 2023.

Muntner P, Hardy ST, Fine LJ, et al. Trends in Blood Pressure Control Among US Adults with Hypertension, 1999-2000 to 2017-2018. JAMA. 2020;324(12):1190–1200. doi:10.1001/jama.2020.14545 

Lu Y, Linderman GC, Mahajan S, Liu Y et. al. Quantifying Blood Pressure Visit-to-Visit Variability in the Real-World Setting: A Retrospective Cohort Study. Circ Cardiovasc Qual Outcomes. 2023; e009258. doi:10.1161/CIRCOUTCOMES.122.009258

Curfman G, Bauchner H, Greenland P. Treatment and Control of Hypertension in 2020: The Need for Substantial Improvement. JAMA. 2020 Sep 22;324(12):1166-1167. doi:10.1001/jama.2020.13322.

Fix G. Behavioral Change for Hypertension. Generated Health Insights. Accessed April 10, 2023.

Shimbo D, Artinian NT, Basile JN, et. al. Self-Measured Blood Pressure Monitoring at Home: A Joint Policy Statement from the American Heart Association and American Medical Association. Circulation. 2020;142:e42–e63. doi: 10.1161/CIR.0000000000000803

Natale P, Yi Ni J, Martinez-Martin D et. al. Perspectives and Experiences of Self-monitoring of Blood Pressure Among Patients With Hypertension: A Systematic Review of Qualitative Studies. Amer J of Hypertension 2023.

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