Patient practices, perceptions, and barriers to self-measurement of blood pressure in a rural health system.

BACKGROUND: Self-measurement of blood pressure (SMBP) is endorsed by current guidelines for diagnosing and managing hypertension (HTN). We surveyed individuals in a rural healthcare system on practices and attitudes related to SMBP that could guide future practice. METHODS: : Survey questions were sent via an online patient portal to a random sample of 56,275 patients with either BP >140/90 mmHg or cardiovascular care in the system. Questions addressed home blood pressure (BP) monitor ownership, use, willingness to purchase, desire to share data with providers, perceptions of patient education, and patient-centeredness of care. Multivariable logistic regression was used to examine patient characteristics associated with SMBP behaviors. RESULTS: The overall response rate was 12%, and 8.4% completed all questions. Most respondents, 60.9%, owned a BP monitor, while 51.5% reported checking their BP at home the month prior. Among device owners, 45.1% reported receiving instructions on SMBP technique, frequency, and readings interpretation. Only 29.2% reported sharing readings with providers in the last six months, whereas 57.9% said they would be willing to do so regularly. Older age, female sex, and higher income were associated with a higher likelihood of device ownership. Younger age, lower income, and Medicaid insurance were associated with a greater willingness to share SMBP results with providers regularly. CONCLUSIONS: While a significant proportion of respondents performed SMBP regularly, many reported insufficient education on SMBP, and few shared their home BP readings with providers. Patient-centered interventions and telemedicine-based care are opportunities that emerged in our survey that could enhance future HTN care.

Inspiratory muscle responses to airway occlusion during learned breathing movements.

Respiratory muscle responses to sudden obstruction of learned breathing movements were studied in seven normal adults. Subjects were trained to inspire at a constant rate (0.4 liters/s), or maintain a static inspiratory effort(-10 cmH2O). On each trial these efforts were loaded unpredictably by occluding the airway or applying an opposing negative pressure at the mouth. Surface EMGs were recorded from the neck, parasternal intercostal, pectoral, diaphragmatic, and abdominal muscles. The latency and pattern of the responses to occlusion or to negative pressure were obtained from 10-trial computer-averaged records. When subjects were trained to relax in response to loading, inhibitory responses (mean latency: 32 ms) were recorded from the neck (16 out of 21 10-trial averages), diaphragm (9 out of 21), and parasternal (3 out of 21) locations. Excitatory responses (mean latency: 69 ms) were also recorded from the neck (11 out of 21 10-trial averages), diaphragm (8 out of 21), and parasternal (1 out of 21) sites. These responses were also observed in many single trial records. When subjects were trained to make an additional inspiratory effort as quickly as possible after loading, the reaction was a high-amplitude EMG burst, sometimes preceded by a brief inhibitory response. The mean reaction times for the large bursts were: 70 ms for the neck, 86 ms for the diaphragm, and 91 ms for the parasternal intercostals. Latencies in the 60- to 70-ms range were found on many 10-trial averages. Because the latencies of the excitatory responses evoked when subjects were trained to relax in response to loading were similar to those of the EMG bursts recorded when subjects were trained to react quickly in response to loading, it is not possible to distinguish long-latency reflex and learned response components on the basis of latency alone. Previous work, which has assumed that responses in the 50- to 70-ms latency range must be reflexive rather than learned, may need to be reexamined.