7-step SMBP quick guide: 7 steps - American Medical Association

Helping patients achieve and maintain blood pressure goals

There are over 115 million adults in the United States with hypertension, with many cases being uncontrolled hypertension.¹ These patients are at higher risk for heart attacks, strokes, heart failure, kidney disease and peripheral vascular disease so they would benefit from continued monitoring and treatment of their hypertension, regardless of whether the care is provided virtually or in-person.²

This guide highlights seven key steps physicians and care teams can take to use SMBP with high blood pressure patients who are 18 years and older and includes links to useful supporting resources.

1. Identify patients for SMBP

Patients with an existing diagnosis of hypertension
Patients with high blood pressure without a diagnosis of hypertension
Patients suspected of having hypertension (labile or masked hypertension)

2. Confirm device validation and cuff size

Make sure patients have automated, validated devices with appropriately sized upper arm cuffs

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3. Train patients

Educate patients on how to perform SMBP using an evidence-based measurement protocol and education should include proper preparation, proper positioning before taking measurements and resting one minute between measurements
Verify patients' understanding and share educational resources

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4. Have patients perform SMBP and relay results

Conduct SMBP monitoring whenever BP assessment is desired (e.g., to confirm a diagnosis, to assess every 2-4 weeks if BP is uncontrolled or at physician discretion)
Provide instructions on the duration of monitoring and the number of measurements to take each day
- 7 days of monitoring recommended; 3 days minimum (i.e., 12 readings)
- Measurements should be taken twice daily (morning and evening) with at least two measurements taken each time
Determine when and how patients will share results back to care team
- Examples include phone, portal or secure messaging

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5. Average results

Average all SMBP measurements received from patients for monitoring period
Document average systolic and average diastolic blood pressure in medical record
- Use the average systolic and average diastolic blood pressure for clinical decision making
- Three days of measurements (i.e., 12 readings) are recommended as a minimum for clinical decision-making

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6. Interpret results

Make diagnosis and/or assess control
Initiate, intensify or continue treatment as needed

To view the SMBP interpretation tables, go to the "Interpret results" tab of this page.

7. Document plans and communicate to patients

Document treatment and follow-up plans and communicate to patients
Confirm patients' agreement and understanding

Download the 7-step SMBP quick guide

The guide (PDF) highlights seven key steps physicians and care teams can take to use SMBP with patients 18 years and older with high blood pressure, and includes links to useful supporting resources.

References

¹ Virani SS. Alonso A. Benjamin EJ. et al, on behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2020 update: a report from the American Heart Association. Circulation. 2020:141:e139-e596. doi: 10.1161/CIR.0000000000000757.

² Whelton PK, Carey RM, Aronow WS. Casey DE Jr. Collins KJ, Dennison Himmelfarb C. et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ ASPC/NMNPCNA guideline for the prevention, detection. evaluation. and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018:71(19).

Disclaimer: These steps are for informational purposes only. These steps are not intended as a substitute for the medical advice of a physician; they offer no diagnoses or prescription. Furthermore, this information should not be interpreted as setting a standard of care or be deemed inclusive of all proper methods of care, nor exclusive of other methods of care reasonably directed to obtaining the same results. This protocol reflects the best available evidence at the time that it was prepared. The results of future studies may require revisions to the recommendations in this protocol to reflect new evidence, and it is the clinician's responsibility to be aware of such changes.

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