Assessing the routine-practice gap for home blood pressure monitoring among Chinese adults with hypertension

Background: Home blood pressure monitoring (HBPM) is recommended and specified for diagnosis, treatment adjustment and management of most hypertension cases by hypertension guidelines. This study aimed to evaluate the HBPM behaviour and to explore the routine-practice gap among Chinese adults with hypertension. Methods: Between October 2014 and November 2014, data were collected from 20 communities across three cities and six townships in three provinces located in Beijing, Shandong and Jiangsu Provinces in China. A total of 2,272 patients with hypertension aged ≥35 years were registered with a primary health station in local communities were selected by simple random sampling. Results: Among 2,272 subjects, 45.3% owned a home sphygmomanometer. In addition, 27.5% (625/2,272) engaged in HBPM weekly or more frequently. Healthcare providers’ advice was the strongest factor contributing to home sphygmomanometer ownership and weekly HBPM behaviour, with an odds ratio of 13.50 and 8.97. Patients with uncontrolled hypertension were more likely to conduct HBPM regularly (morning and evening), measure their BP two or three times in each measuring session and report 7 consecutive days of HBPM than patients with controlled hypertension (8.8% vs. 5.8%, P=0.042; 14.3% vs. 8.1%, P=0.002; and 19.9% vs. 12.4%, P=0.005, respectively). Only 16.0% (165/1,030) of patients actively reported their HBPM readings to doctors. Conclusion: The strategies of HBPM specified by ESH/ESC hypertension guidelines (2013) and those from China (2018) are seldom achieved in current practice in China. Only a small proportion of patients actively participate in utilizing home BP measurements to enhance their care. HBPM may be improved by healthcare providers’ specific advice and training.