Is routine home blood pressure monitoring really such a good idea? OR How much healthcare should be delegated to the patient?

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ROCKY BILHARTZ, MD | CONDITIONS | NOVEMBER 5, 2015

occurred to me that this is a terrible idea.

In fact, it’s possibly the least beneficial thing for the general health of a population to have gained momentum in recent years. I’m not discussing cigarettes or e-cigarettes or low-yield cancer screening procedures. I’m not talking about diet drinks or sugary drinks.

I’m talking about home blood pressure monitoring.

It’s a terrible idea.

OK, I get it. The idea sounds benign. Buy your own cuff. Monitor your blood pressure at home. Why? Well, it might be high. And, we need data. Lots of it. So, monitor away.

Of course, it’s never really about an idea or its intention. It’s about results. And, how this concept currently gets implemented is the number one cause of preventable panic attacks in my area.

You think breast cancer screening is inflicting unnecessary angst on the general public? It’s nowhere even close to blood pressure monitoring. I’ve even found this practice to occasionally worsen the disease state of hypertension. Yes, it literally makes some people’s blood pressure get worse!

Very soon, I may give up recommending the idea to anyone. In fact, I currently tell more and more of my patients to check it less and less at home.

I’m really not trying to offend anyone involved with the patient empowerment movement. These are the people laser-focused on proving medicine’s paternalism has long been the problem with health care. They claim the “asymmetry of information” between the doctor and the patient must be eradicated. We must democratize medicine. Patient’s should own their medical data, be informed of all potential outcomes, and be equal participants in deciding upon medical therapies they know far less about.

And, let me tell you, I’m all for the dispersion of power. I’m fine with you believing this will improve your health. But, I just see so many people supporting this kind of thing who really have no clue what they are supporting.

Good intentions begone, what matters are results. And, the results of this ongoing home blood pressure project are a disaster.

I’m “on call” an average of 1 out of every 4 days all year long. People who aren’t in medicine really have no clue what it’s like to be on call. And, that’s okay. I have no clue what it’s like to be an astronaut. I just know that on many call nights, I’d rather be on the moon. Somewhere far away from call.

When I’m on call, I do my job. I manage emergencies that arise in my specialty at the hospitals nearby. I also take personal calls from patients who think they are having “emergencies” at home. These calls get patched into my phone from our office answering service.

If you are one of my patients, please don’t think that I don’t want you to call me when you need me. That’s why I’m on call, to help you in a time of need. Call me! But, just know that the human race is all over the place, and this is never more apparent than call nights.

I tell you more about my lifestyle in Finding Truth in Transparency, so I’m not going to repeat all of that here. But, I will tell you this. I drive a truck. Maybe, it’s outdated, but it has one light that comes on when it needs to be “serviced.” It doesn’t tell me what to do. It doesn’t tell me the radiator coolant needs flushing.

“Just bring her in,” it says.

And, for me, this seems to work fairly well.

You may presume monitoring blood pressure is an easy thing. Just give people a simple algorithm to follow that works. I haven’t found one. Doesn’t matter what I say in the office, the situation explodes out of control whenever people get home. Suspect the same thing would happen to me if I left the dealership with an air compressor.

I get calls frequently at 2 a.m. because, for whatever reason, the electronic home blood pressure monitor won’t turn on. People are literally stricken with panic, not sure what they should do.

I get calls in the middle of the night because someone without symptoms found his diastolic blood pressure (the bottom number) to be 45 mmHg. A neighbor told him that this number wasn’t compatible with life. Of note, this guy lived.

Patients frequently call after midnight with blood pressure readings to ask if they should go the emergency department. Who checks it then, you ask? On many nights, it seems like almost everyone. One person told me the insurance company instructed her to do it.

The first blood pressure may be 152/82 mmHg, which, not surprisingly, increases to 160/90 mmHg when checked five minutes later, and then increases again to 168/95 mmHg when checked a few minutes after that.

“What should I do?” people ask.

“Go to sleep,” I commonly say.

This movement has gotten out of control. I’m sure someone sitting behind medicine’s curtain of Oz will study this practice and find it to be helpful. I’m studying it now, and it’s not.

This post isn’t intended to provide medical advice. But, I’m just not certain there is much utility for an asymptomatic patient, feeling normal, to take a routine blood pressure before going to the bathroom in the middle of the night.

Yet, plenty of people think we need more of this patient participation and not less. Almost to the point that patients feel they are doing something wrong if they choose to be managed entirely by the discretion and expertise of a doctor, someone who (at this point) is still a human being capable of using judgement (despite a myriad of government mandates that appear less focused on incentivizing it).

Yes, we have apps on our phone that measure heart rate. The rhythm of our body is viewable on a watch. Consumers can now request any blood test they want to be drawn from a lab on the street corner.

And, I’m not against it. Just be ready for the consequences. They are coming. You think it will save doctor visits or drive more of them?

I’m not here to predict the future. The future of healt hcare will take care of itself.

I just think you’ll find that many things are better left for servicing at the dealership.

Rocky Bilhartz is a cardiologist and the author of Finding Truth in Transparency: Our Broken Healthcare System and How We Can Heal It. He can be reached at BilhartzMD.com.

Comment: While we in India are not there yet, but very soon these problems are going to surface in our country as well. Too much decision making in the hands of people is not necessarily going to reduce the cost/ burden of healthcare