Self-Measured Blood Pressure Monitoring in Primary Care: Retrospective Analysis from a Large US Healthcare System

Iridian Guzman,1 Nicole Glowacki,1 Joseph Chase,1 John Brill,2 Alexandras Biskis,1 Rasha Khatib1 1Advocate Aurora Research Institute, Advocate Health, Milwaukee, WI, USA; 2Enterprise Population Health, Advocate Health, Milwaukee, WI, USACorrespondence: Rasha Khatib, Advocate Aurora Research Institute, Advocate Health, 945 N 12th St, Milwaukee, WI, 53233, USA, Tel +1708684-3691, Email [email protected]: Self-measured blood pressure (SMBP) monitoring, or home blood pressure monitoring, is an evidence-based strategy for hypertension management. However, the extent to which SMBP readings are documented in the electronic health record (EHR)—a critical step in integrating SMBP monitoring into routine care—remains unclear. The objective of this study was to evaluate how race/ethnicity, insurance status, and preferred language are associated with documented SMBP monitoring adoption.Patients and Methods: This retrospective study included adults (aged ≥ 18 years) with a diagnosis of hypertension and at least one uncontrolled ambulatory blood pressure reading in 2023. All patients had ≥ 2 primary care visits in 2023. The primary outcome was the presence of at least one SMBP reading documented in the EHR using a structured patient-reported blood pressure readings field. Logistic regression was used to assess associations between patient characteristics and SMBP monitoring documentation.Results: Among 156,444 eligible patients, only 5.0% had at least one SMBP reading documented in the EHR. SMBP readings were mostly recorded during office visits (62.8%). In fully adjusted analyses, Black (OR 0.68; 95% CI, 0.63– 0.72) and Hispanic (OR 0.72; 95% CI, 0.65– 0.80) patients compared to White patients, Medicaid-insured patients (OR 0.88; 95% CI, 0.79– 0.98) compared to Commercial-insured patients, those preferring non-English languages (OR 0.77; 95% CI, 0.67– 0.88) compared to those preferring English, had lower odds of SMBP monitoring documentation.Conclusion: SMBP monitoring documentation in the EHR was rare and significantly lower among populations experiencing inequities in access, language, and outcomes. Although remote monitoring strategies show promise, poor EHR integration and scalability challenges limit their adoption. Targeted efforts are needed to improve SMBP monitoring documentation workflows, enhance EHR integration, and promote equitable access to hypertension self-management tools.Keywords: hypertension, self-management, SMBP monitoring, EHR, primary care