Beyond ad hoc home blood pressure monitoring: The need for standardisation and integration into primary care

Hypertension guidelines recommend home blood pressure monitoring (HBPM) using a standardised protocol to ensure accuracy and guide effective management. However, the extent to which HBPM is performed according to standardised protocol is unclear. The study aimed to explore how HBPM is used and understood by both health professionals and community members. A targeted, qualitative content analysis was conducted using a hybrid approach that combined deductive and inductive strategies to identify themes related to HBPM. Data was collected across 17 consultations and 19 co-design workshops with community members (adults 18 years and above, n = 154), and primary health professionals (general practitioners, general practice staff, nurses, health workers, pharmacists, n = 73) for a total of 227 participants. Sessions included unprompted discussions about experiences with HBPM, perceptions of accuracy, and practices in BP measurement and were conducted across three Tasmanian regions. Both community members and health professionals reported HBPM to be valuable and practical for hypertension management. Community members consistently ranked HBPM as a key preference for where they wanted their BP measured. However, there was variability in HBPM technique and limited awareness of evidence-based protocols. Instead, participants described ad hoc, individualised, and often invalid methods for measuring and recording BP at home. HBPM is an acceptable and widely used strategy for monitoring hypertension, but ad hoc, non-standardised use in practice undermines its accuracy and clinical utility. Addressing barriers to standardisation and integration into primary care are essential for optimising the role of HBPM in hypertension management.