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Knowledge, availability, and use of ambulatory and home blood pressure monitoring in primary care in Spain: the MAMPA study

Martín-Rioboó, Enriquea,b; Pérula de Torres, Luis, A.a,c; Banegas, José, R.d; Lobos-Bejarano, José, M.e; Brotons Cuixart, Carlosf; García Criado, Emilio, I.b; Martin-Carrillo, Pilarg; Martín-Rabadán Muro, Maríah; Egocheaga Cabello, M., Isabeli; Maiques Galán, Antonijon behalf of the MAMPA, PAPPS Study Groups

doi: 10.1097/HJH.0000000000001673
ORIGINAL PAPERS: BP measurement

Objective: To examine the degree of knowledge and management of automated devices for office blood pressure measurement (AD), home blood pressure monitoring (HBPM) and ambulatory blood pressure monitoring (ABPM) in primary care in Spain.

Methods: Online self-administered survey sent between May 2016 and February 2017 to 2221 primary-care physicians working across Spain. Clinicians were mostly identified through national primary-care scientific societies (20% overall response rate).

Results: Participants’ mean age was 47.7 years, 55% were women, and 54% reported at least 20 years of primary-care practice. Among them, 47.5% considered ABPM the best diagnostic method for hypertension, 23% chose HBPM, and 7.1% chose office blood pressure. Also, 78.2% had AD available at their centers and 49.0% had ABPM, with slight urban/rural differences. HBPM was recommended in daily practice for hypertension diagnosis by 67% of participants, whereas 30% recommended ABPM. Cost to the patients was the main reason for not using HBPM (42.7%) as was lack of accessibility for not using ABPM (69.8%). Lack of specific training was also reported as an important reason in both cases.

Conclusion: Even in the possibly best primary care scenario presented by highly motivated physicians (respondents to a voluntary anonymous survey), enormous gaps were observed between current guidelines’ recommendations on ABPM and HBPM use for confirming hypertension and the modest degree of knowledge, availability, and use of these technologies.

aInstituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Hospital Reina Sofía/Universidad de Córdoba

bFuensanta Primary Care Health Centre

cCordoba Teaching Unit of Family Medicine, Distrito Sanitario Córdoba y Guadalquivir, Córdoba

dDepartment of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPAZ and CIBER in Epidemiology and Public Health (CIBERESP)

eJazmín Primary Care Health Centre, Área Este, Madrid

fResearch Unit, Sardenya Primary Care Health Centre, Instituto de Investigaciones Biomédicas Sant Pau, Barcelona

gColmenarejo Primary Care Health Centre, Madrid

hCan Misses Primary Healthcare Centre, Ibiza

iIsla de Oza Primary Care Health Centre, Madrid

jManises Primary Care Health Centre, Valencia, Spain

Correspondence to José R. Banegas, MD, Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPAZ – CIBERESP, Avda. Arzobispo Morcillo 2, 28029 Madrid, Spain. Tel: +34 91 4975425; e-mail: joseramon.banegas@uam.es

Abbreviations: ABPM, ambulatory blood pressure monitoring; AD, automated devices; HBPM, home blood pressure monitoring; MAMPA, survey of self-measurement and ambulatory blood pressure monitoring in Spain; PAPPS, Program of Preventive and Health Promotion Activities; SEH-LELHA, Spanish Society of Hypertension; SEMERGEN, Spanish Society of Primary Care Practitioners; semFYC, Spanish Society of Family and Community Medicine; SEMG, Spanish Society of General Medicine

Received 17 August, 2017

Revised 3 December, 2017

Accepted 18 December, 2017

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