Blood Pressure

Blood pressure, the force exerted by the blood against a vessel wall, depends on the volume of blood
contained within the vessel and the compliance, or distensibility, of the vessel walls (how easily they can
be stretched). If the volume of blood entering the arteries were equal to the volume of blood leaving the
arteries during the same period, arterial blood pressure would remain constant. This is not the case,
however. During ventricular systole, a stroke volume of blood enters the arteries from the ventricle,
while only about one third as much blood leaves the arteries to enter the arterioles. During diastole, no
blood enters the arteries, while blood continues to leave, driven by elastic recoil. The maximum pressure
exerted in the arteries when blood is ejected into them during systole, the systolic pressure, averages
120 mm Hg. The minimum pressure within the arteries when blood is draining off into the rest of the
vessels during diastole, the diastolic pressure, averages 80 mm Hg. Although ventricular pressure falls to
0 mm Hg during diastole, arterial pressure does not fall to 0 mm Hg because the next cardiac contraction
refills the arteries before all the blood drains off.
Clinically, arterial blood pressure is expressed as systolic pressure over diastolic pressure, with desirable
blood pressure being 120/80 (read “120 over 80”) mm Hg or slightly less.
The changes in arterial pressure throughout the cardiac cycle can be measured directly by connecting a
pressure-measuring device to a needle inserted in an artery. However, it is more convenient and
reasonably accurate to measure the pressure indirectly with a sphygmomanometer, an externally
applied inflatable cuff attached to a pressure gauge. When the cuff is wrapped around the upper arm
and then inflated with air, the pressure of the cuff is transmitted through the tissues to the underlying
brachial artery, the main vessel carrying blood to the forearm. The technique involves balancing the
pressure in the cuff against the pressure in the artery. When cuff pressure is greater than the pressure in
the vessel, the vessel is pinched closed so that no blood flows through it. When blood pressure is greater
than cuff pressure, the vessel is open and blood flows through. During the determination of blood
pressure, a stethoscope is placed over the brachial artery at the inside bend of the elbow just below the
cuff. No sound can be detected either when blood is not flowing through the vessel or when blood is
flowing in the normal, smooth laminar flow. Turbulent blood flow, in contrast, creates vibrations that can
be heard. The sounds heard when determining blood pressure are known as Korotkoff sounds.
At the onset of a blood pressure determination, the cuff is inflated to a pressure greater than systolic
blood pressure so
e and Hypertension
Blood Pressure
Blood pressure, the force exerted by the blood against a vessel wall, depends on the volume of blood
contained within the vessel and the compliance, or distensibility, of the vessel walls (how easily they can
be stretched). If the volume of blood entering the arteries were equal to the volume of blood leaving the
arteries during the same period, arterial blood pressure would remain constant. This is not the case,
however. During ventricular systole, a stroke volume of blood enters the arteries from the ventricle,
while only about one third as much blood leaves the arteries to enter the arterioles. During diastole, no
blood enters the arteries, while blood continues to leave, driven by elastic recoil. The maximum pressure
exerted in the arteries when blood is ejected into them during systole, the systolic pressure, averages
120 mm Hg. The minimum pressure within the arteries when blood is draining off into the rest of the
vessels during diastole, the diastolic pressure, averages 80 mm Hg.
Clinically, arterial blood pressure is expressed as systolic pressure over diastolic pressure, with desirable
blood pressure being 120/80 (read “120 over 80”) mm Hg or slightly less.
The changes in arterial pressure throughout the cardiac cycle can be measured with a
sphygmomanometer, an externally applied inflatable cuff attached to a pressure gauge. When the cuff is
wrapped around the upper arm and then inflated with air, the pressure of the cuff is transmitted through
the tissues to the underlying brachial artery, the main vessel carrying blood to the forearm. The
technique involves balancing the pressure in the cuff against the pressure in the artery. When cuff
pressure is greater than the pressure in the vessel, the vessel is pinched closed so that no blood flows
through it. When blood pressure is greater than cuff pressure, the vessel is open and blood flows
through. During the determination of blood pressure, a stethoscope is placed over the brachial artery at
the inside bend of the elbow just below the cuff. No sound can be detected either when blood is not
flowing through the vessel or when blood is flowing in the normal, smooth laminar flow. Turbulent blood
flow, in contrast, creates vibrations that can be heard. The sounds heard when determining blood
pressure are known as Korotkoff sounds.
At the onset of a blood pressure determination, the cuff is inflated to a pressure greater than systolic
blood pressure so that the brachial artery collapses. Because the externally applied pressure is greater
than the peak internal pressure, the artery remains completely pinched closed throughout the entire
cardiac cycle; no sound can be heard because no blood is passing through. As air in the cuff is slowly
released, the pressure in the cuff is gradually reduced. When the cuff pressure falls to just below the
peak systolic pressure, the artery transiently opens a bit when the blood pressure reaches this peak.
Blood escapes through the partially occluded artery for a brief interval before the arterial pressure falls
below the cuff pressure and the artery collapses again. This spurt of blood is turbulent, so it can be
heard. Thus, the highest cuff pressure at which the first sound can be heard indicates the systolic
pressure. As the cuff pressure continues to fall, blood intermittently spurts through the artery and
produces a sound with each subsequent cardiac cycle whenever the arterial pressure exceeds the cuff
pressure. When the cuff pressure finally falls below diastolic pressure, the brachial artery is no longer
pinched closed during any part of the cardiac cycle, and blood can flow uninterrupted through the
vessel. With the return of nonturbulent blood flow, no further sounds can be heard. Therefore, the
lowest cuff pressure at which the last sound can be detected indicates the diastolic pressure.
The process of checking the Blood Pressure requires Clinical expertise, however with the advent of
medical technology advancement, the process has been automated with Blood Pressure monitors
making it possible to assess an individual blood pressure without the aid of a Clinician. Hence Blood
Pressure can be checked outside if the hospital or clinic setting such as Home Checks.
Hypertension
Hypertension is defined as abnormally high blood pressure levels.
it is one of the most common worldwide diseases afflicting humans. It is a major risk factor for stroke,
myocardial infarction, vascular disease, and chronic kidney disease. Despite extensive research, the
etiology of most cases of adult hypertension is still unknown, and control of blood pressure (BP) is
suboptimal in the general population. Due to the associated morbidity and mortality and cost to society,
preventing and treating hypertension is an important public health challenge. Fortunately, relatively
recent advances and trials in hypertension research are leading to an increased understanding of the
pathophysiology of hypertension and inteventions reducing the level mortality.
Blood Pressure Level Awareness amongst populations
Several studies have investigated the awareness of blood pressure levels among different populations
and have highlighted various factors influencing this awareness. In Japan, a study found that individuals
with greater health-related knowledge were more likely to be aware of their blood pressure levels, even
after adjusting for potential confounders (Tanihara et al., 1999). Similarly, a study in South Korea found
that awareness of blood pressure levels was associated with knowledge of cardio-cerebrovascular
diseases' warning signs (KCVDs) (Jeong, 2021). Moreover, a study in Austria revealed that despite a high
understanding of the risks of hypertension among the population, there was a widespread
misconception regarding blood pressure symptoms and infrequent personal checks (Steiner et al., 2011).
The importance of hypertension awareness among specific demographic groups was also highlighted.
For instance, a study in the United States found that foreign-born participants were significantly less
likely than US-born participants to report awareness of having high blood pressure, indicating potential
disparities in awareness by nativity (Cole et al., 2018). Additionally, a study in Bangladesh revealed
gender differences in high blood pressure awareness and antihypertensive use, with women being more
likely to have their blood pressure measured and to be aware of their own high blood pressure, but this
did not necessarily translate into better antihypertensive medication practice (Rahman et al., 2017).
Furthermore, the practice of self-monitoring of blood pressure was found to be influenced by various
sociodemographic factors. A study in Ghana identified factors such as awareness of self-monitoring, level
of education, valid health insurance, occupation, income levels, and marital status as significantly related
to self-monitoring of blood pressure among individuals with hypertension (Konlan et al., 2020).
Overall, these studies emphasize the importance of increasing awareness of blood pressure levels and
the associated cardiovascular risks, as well as the need to address disparities in awareness among
different demographic groups. They also underscore the significance of education and targeted
interventions to improve blood pressure awareness and control.
1. Article Title: Clinical Practice Guideline for Screening and Management of High Blood Pressure in
Children and Adolescents.
Authors: Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, de Ferranti SD, Dionne
JM, Falkner B, Flinn SK, Gidding SS, Goodwin C, Leu MG, Powers ME, Rea C, Samuels J, Simasek M, Thaker
VV, Urbina EM,
Journal: Pediatrics 140 3
Date: Sep
Link: https://www.ncbi.nlm.nih.gov/pubmed/28827377
2. Article Title: Correlates of Blood Pressure Awareness, Treatment, and Control Among Adults 50
Years or Older by HIV Status in Northwestern Tanzania.
Authors: Muiruri C, Wajanga B, Kim C, Knettel BA, Mhina CJ, Bartlett JA, Msangi JJ, Msabah MA, Vilme H,
Kalluvya S,
Journal: Current hypertension reports 24 8
Date: Aug
3. Article Title: Blood Pressure Awareness and Knowledge of Cardio-Cerebrovascular Diseases in

South Korean Women with Hypertension.
Authors: Jeong YW,
Journal: Healthcare (Basel, Switzerland) 9 3
Date: Mar 23 2021
4. Article Title: BASIS: The blood pressure awareness and insight scale.
Authors: Gerretsen P, Kim J, Shah P, Quilty L, Balakumar T, Caravaggio F, Plitman E, Chung JK, Iwata Y,
Pollock BG, Dash S, Sockalingam S, Graff-Guerrero A,
Journal: Journal of clinical hypertension (Greenwich, Conn.) 20 4
Date: Apr
5. Article Title: Believing impossible things: achieving universal blood pressure awareness on a
global basis.
Authors: Feldman RD, Campbell NRC,

Journal: European heart journal 40 25
Date: Jul 01 2019
6. Article Title: Awareness of High Blood Pressure by Nativity Among Black Men: Implications for
Interpreting the Immigrant Health Paradox.
Authors: Cole HVS, Reed HE, Tannis C, Trinh-Shevrin C, Ravenell JE,
Journal: Preventing chronic disease 15
Date: Oct 04 2018
7. Article Title: Blood pressure awareness in Austria. A 20-year evaluation, 1978-1998.
Authors: Schmeiser-Rieder A, Kunze U,
Date: Mar
8. Article Title: Gender differences in hypertension awareness, antihypertensive use and blood
pressure control in Bangladeshi adults: findings from a national cross-sectional survey.
Authors: Rahman M, Williams G, Al Mamun A,
Journal: Journal of health, population, and nutrition 36 1
Date: May 25 2017
9. Article Title: Awareness of blood pressure: interoception or contextual judgement?
Authors: Fahrenberg J, Franck M, Baas U, Jost E,
Journal: Journal of psychosomatic research 39 1
Date: Jan
10. Article Title: Blood pressure awareness in Austria: lessons from a 30 years horizon.
Authors: Steiner S, Dorner TE, Fodor JG, Kunze M, Rieder A,
Journal: American journal of hypertension 24 4

Date: Apr
11. Article Title: Hypertension and blood pressure awareness among American Indians of the
northern plains.
Authors: Sharlin KS, Heath GW, Ford ES, Welty TK,
Journal: Ethnicity & disease 3 4
12. Article Title: [Blood pressure awareness in Austria: indicators of an increasing information
deficit].
Journal: Wiener klinische Wochenschrift 107 16
13. Article Title: Practice and Sociodemographic Factors Influencing Self-Monitoring of Blood
Pressure in Ghanaians with Hypertension.
Authors: Konlan KD, Afam-Adjei CJ, Afam-Adjei C, Oware J, Appiah TA, Konlan KD, Bella-Fiamawle J,
Journal: International journal of chronic diseases 2020
14. Article Title: Association between health-related knowledge and the awareness of blood
pressure readings. Japan Lifestyle Monitoring Study Group.
Authors: Tanihara S, Ojima T, Nakamura Y, Yanagawa H, Yoshiike N, Nakayama T, Tanaka H,
Journal: Journal of epidemiology 9 4
Date: Aug
15. Article Title: No surprises in blood pressure awareness study findings: we can do a better job.
Authors: Moser M,
Journal: Archives of internal medicine 163 6
Date: Mar 24 2003
Blood pressure self monitoring practice
Self-monitoring of blood pressure (SMBP) has gained attention as a potential tool for improving the
diagnosis and management of hypertension. Several studies have investigated the effectiveness of SMBP
in various populations, including pregnant individuals and those with chronic hypertension.
A systematic review and meta-analysis of smartphone app-based self-monitoring interventions found

that these interventions had a small but significant effect in reducing systolic blood pressure (SBP) and
improving changes in medication adherence behavior compared to usual care or minimal intervention
(Kassavou et al., 2022). Additionally, self-monitoring of blood pressure appears to reduce blood pressure
in hypertensive patients, particularly when combined with co-interventions such as systematic
medication titration, education, or lifestyle counseling (Tucker et al., 2017).
However, the effectiveness of SMBP in pregnancy is less clear. A randomized clinical trial in higher-risk
pregnancies found that self-monitoring of blood pressure did not lead to earlier detection of pregnancy
hypertension (Prabhu et al., 2022). Similarly, another trial in pregnant individuals with chronic or
gestational hypertension did not find a significant improvement in clinic-based blood pressure control
with self-monitoring compared to usual care (Prabhu et al., 2022).
Overall, the evidence suggests that self-monitoring of blood pressure, particularly when combined with
additional interventions, may be effective in reducing blood pressure and supporting changes in health
behaviors. However, further research is needed to better understand the impact of SMBP in specific
populations, and to optimize the implementation of SMBP in clinical practice.
1. Article Title: Self-monitoring of blood pressure in hypertension: A systematic review and

individual patient data meta-analysis.
Authors: Tucker KL, Sheppard JP, Stevens R, Bosworth HB, Bove A, Bray EP, Earle K, George J, Godwin M,
Green BB, Hebert P, Hobbs FDR, Kantola I, Kerry SM, Leiva A, Magid DJ, Mant J, Margolis KL, McKinstry B,
McLaughlin MA, Omboni S, Ogedegbe O, Parati G, Qamar N, Tabaei BP, Varis J, Verberk WJ, Wakefield BJ,
McManus RJ,
Journal: PLoS medicine 14 9
Date: Sep
2. Article Title: The Association Between Smartphone App-Based Self-monitoring of Hypertension-

Related Behaviors and Reductions in High Blood Pressure: Systematic Review and Meta-analysis.
Authors: Kassavou A, Wang M, Mirzaei V, Shpendi S, Hasan R,
Journal: JMIR mHealth and uHealth 10 7
Date: Jul 12 2022
3. Article Title: Effect of Self-monitoring of Blood Pressure on Blood Pressure Control in Pregnant
Individuals With Chronic or Gestational Hypertension: The BUMP 2 Randomized Clinical Trial.
Authors: Chappell LC, Tucker KL, Galal U, Yu LM, Campbell H, Rivero-Arias O, Allen J, Band R, Chisholm A,
Crawford C, Dougall G, Engonidou L, Franssen M, Green M, Greenfield S, Hinton L, Hodgkinson J, Lavallee
L, Leeson P, McCourt C, Mackillop L, Sandall J, Santos M, Tarassenko L, Velardo C, Wilson H, Yardley L,
McManus RJ,
Journal: JAMA 327 17
Date: May 03 2022
4. Article Title: Effect of Self-monitoring of Blood Pressure on Diagnosis of Hypertension During

Higher-Risk Pregnancy: The BUMP 1 Randomized Clinical Trial.
Authors: Tucker KL, Mort S, Yu LM, Campbell H, Rivero-Arias O, Wilson HM, Allen J, Band R, Chisholm A,
Crawford C, Dougall G, Engonidou L, Franssen M, Green M, Greenfield S, Hinton L, Hodgkinson J, Lavallee
L, Leeson P, McCourt C, Mackillop L, Sandall J, Santos M, Tarassenko L, Velardo C, Yardley L, Chappell LC,
McManus RJ,
Date: May 03 2022
5. Article Title: Self-monitoring of Blood Pressure During Pregnancy.

Authors: Prabhu M, Malha L, Riley LE,
Date: May 03 2022
6. Article Title: Self-monitoring and self-management: new interventions to improve blood

pressure control.
Authors: McCartney DE, McManus RJ,
Journal: Current opinion in nephrology and hypertension 25 6
Date: Nov
7. Article Title: Effect of self-monitoring blood pressure in pregnancy.
Journal: Drug and therapeutics bulletin 60 9
Date: Sep
8. Article Title: Self-monitoring of blood pressure for preeclampsia patients: Knowledge and
attitudes.
Authors: Munyungula J, Shakwane S,
Journal: Curationis 44 1
Date: Sep 21 2021
9. Article Title: Self-monitoring for improving control of blood pressure in patients with
hypertension: a Cochrane intervention review.
Authors: Doogue R, Hayes P, Tucker K, Fahey T, Sheikhi A, Koshiaris C, Glynn L,
Journal: Rural and remote health 23 1
Date: Jan
10. Article Title: Self-monitoring blood pressure in hypertension, patient and provider perspectives:
A systematic review and thematic synthesis.
Authors: Fletcher BR, Hinton L, Hartmann-Boyce J, Roberts NW, Bobrovitz N, McManus RJ,
Journal: Patient education and counseling 99 2
Date: Feb
11. Article Title: Self-monitoring of blood pressure among women with hypertensive disorders of
pregnancy: a systematic review.
Authors: Yeh PT, Rhee DK, Kennedy CE, Zera CA, Lucido B, Tunçalp Ö, Gomez Ponce de Leon R,
Narasimhan M,
Journal: BMC pregnancy and childbirth 22 1
Date: May 31 2022
12. Article Title: Schedules for Self-monitoring Blood Pressure: A Systematic Review.
Authors: Hodgkinson JA, Stevens R, Grant S, Mant J, Bray EP, Hobbs FDR, Martin U, Schwartz C,
McCartney D, O'Mahony R, Perera-Salazar R, Roberts N, Stevens S, Williams B, McManus RJ,
Date: Mar 16 2019
13. Article Title: Feasibility of a Self-Measured Blood Pressure Monitoring Program to Reduce
Uncontrolled Hypertension.
Authors: Haskell J, Cooper EL, Jenkins B, Campanile C, Capizzo LF, Gardner RL,
Journal: Rhode Island medical journal (2013) 105 8
Date: Oct 03 2022
14. Article Title: Setting and techniques for monitoring blood pressure during pregnancy.
Authors: Ashworth DC, Maule SP, Stewart F, Nathan HL, Shennan AH, Chappell LC,
Journal: The Cochrane database of systematic reviews 8 8
Date: Jul 23 2020
15. Article Title: Self-monitoring of blood pressure in pregnancy: A mixed methods evaluation of a
national roll-out in the context of a pandemic.
Authors: Wilson H, Tucker KL, Chisholm A, Hodgkinson J, Lavallee L, Mackillop L, Cairns AE, Hinton L,
Podschies C, Chappell LC, McManus RJ,
Journal: Pregnancy hypertension 30
Date: Dec
Blood Pressure Level Awareness amongst populations
Several studies have investigated the awareness of blood pressure levels among different populations
and have highlighted various factors influencing this awareness. In Japan, a study found that individuals
with greater health-related knowledge were more likely to be aware of their blood pressure levels, even
after adjusting for potential confounders (Journal of Epidemiology). Similarly, a study in South Korea
found that awareness of blood pressure levels was associated with knowledge of cardio-cerebrovascular
diseases' warning signs (KCVDs) (Healthcare). Moreover, a study in Austria revealed that despite a high
understanding of the risks of hypertension among the population, there was a widespread
misconception regarding blood pressure symptoms and infrequent personal checks (American Journal of
Hypertension).
The importance of hypertension awareness among specific demographic groups was also highlighted.
For instance, a study in the United States found that foreign-born participants were significantly less
likely than US-born participants to report awareness of having high blood pressure, indicating potential
disparities in awareness by nativity (Preventing Chronic Disease). Additionally, a study in Bangladesh
revealed gender differences in high blood pressure awareness and antihypertensive use, with women
being more likely to have their blood pressure measured and to be aware of their own high blood
pressure, but this did not necessarily translate into better antihypertensive medication practice (Journal
of Health, Population, and Nutrition).
Furthermore, the practice of self-monitoring of blood pressure was found to be influenced by various
sociodemographic factors. A study in Ghana identified factors such as awareness of self-monitoring, level
of education, valid health insurance, occupation, income levels, and marital status as significantly related
to self-monitoring of blood pressure among individuals with hypertension (International Journal of
Chronic Diseases).
Overall, these studies emphasize the importance of increasing awareness of blood pressure levels and
the associated cardiovascular risks, as well as the need to address disparities in awareness among
different demographic groups. They also underscore the significance of education and targeted
interventions to improve blood pressure awareness and control.
16. Article Title: Clinical Practice Guideline for Screening and Management of High Blood Pressure in
Children and Adolescents.
Authors: Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, de Ferranti SD, Dionne
JM, Falkner B, Flinn SK, Gidding SS, Goodwin C, Leu MG, Powers ME, Rea C, Samuels J, Simasek M, Thaker
VV, Urbina EM,
Journal: Pediatrics 140 3
Date: Sep
17. Article Title: Correlates of Blood Pressure Awareness, Treatment, and Control Among Adults 50
Years or Older by HIV Status in Northwestern Tanzania.
Authors: Muiruri C, Wajanga B, Kim C, Knettel BA, Mhina CJ, Bartlett JA, Msangi JJ, Msabah MA, Vilme H,
Kalluvya S,
Date: Aug
18. Article Title: Blood Pressure Awareness and Knowledge of Cardio-Cerebrovascular Diseases in
South Korean Women with Hypertension.
Authors: Jeong YW,
Journal: Healthcare (Basel, Switzerland) 9 3
Date: Mar 23 2021
19. Article Title: BASIS: The blood pressure awareness and insight scale.
Authors: Gerretsen P, Kim J, Shah P, Quilty L, Balakumar T, Caravaggio F, Plitman E, Chung JK, Iwata Y,
Pollock BG, Dash S, Sockalingam S, Graff-Guerrero A,
Date: Apr
20. Article Title: Believing impossible things: achieving universal blood pressure awareness on a
global basis.
Authors: Feldman RD, Campbell NRC,
Date: Jul 01 2019
21. Article Title: Awareness of High Blood Pressure by Nativity Among Black Men: Implications for
Interpreting the Immigrant Health Paradox.
Authors: Cole HVS, Reed HE, Tannis C, Trinh-Shevrin C, Ravenell JE,
Journal: Preventing chronic disease 15
Date: Oct 04 2018
22. Article Title: Blood pressure awareness in Austria. A 20-year evaluation, 1978-1998.
Date: Mar
23. Article Title: Gender differences in hypertension awareness, antihypertensive use and blood
pressure control in Bangladeshi adults: findings from a national cross-sectional survey.
Authors: Rahman M, Williams G, Al Mamun A,
Journal: Journal of health, population, and nutrition 36 1
Date: May 25 2017
24. Article Title: Awareness of blood pressure: interoception or contextual judgement?
Authors: Fahrenberg J, Franck M, Baas U, Jost E,
Journal: Journal of psychosomatic research 39 1
Date: Jan
25. Article Title: Blood pressure awareness in Austria: lessons from a 30 years horizon.
Authors: Steiner S, Dorner TE, Fodor JG, Kunze M, Rieder A,
Date: Apr
26. Article Title: Hypertension and blood pressure awareness among American Indians of the
northern plains.
Authors: Sharlin KS, Heath GW, Ford ES, Welty TK,
Journal: Ethnicity & disease 3 4
27. Article Title: [Blood pressure awareness in Austria: indicators of an increasing information
deficit].
Journal: Wiener klinische Wochenschrift 107 16
28. Article Title: Practice and Sociodemographic Factors Influencing Self-Monitoring of Blood
Pressure in Ghanaians with Hypertension.
Authors: Konlan KD, Afam-Adjei CJ, Afam-Adjei C, Oware J, Appiah TA, Konlan KD, Bella-Fiamawle J,
Journal: International journal of chronic diseases 2020
29. Article Title: Association between health-related knowledge and the awareness of blood
pressure readings. Japan Lifestyle Monitoring Study Group.
Authors: Tanihara S, Ojima T, Nakamura Y, Yanagawa H, Yoshiike N, Nakayama T, Tanaka H,
Journal: Journal of epidemiology 9 4
Date: Aug
30. Article Title: No surprises in blood pressure awareness study findings: we can do a better job.
Authors: Moser M,
Journal: Archives of internal medicine 163 6
Date: Mar 24 2003
Blood pressure self monitoring practice
Self-monitoring of blood pressure (SMBP) has gained attention as a potential tool for improving the
diagnosis and management of hypertension. Several studies have investigated the effectiveness of SMBP
in various populations, including pregnant individuals and those with chronic hypertension.
A systematic review and meta-analysis of smartphone app-based self-monitoring interventions found

that these interventions had a small but significant effect in reducing systolic blood pressure (SBP) and
improving changes in medication adherence behavior compared to usual care or minimal intervention
(JMIR mHealth and uHealth). Additionally, self-monitoring of blood pressure appears to reduce blood
pressure in hypertensive patients, particularly when combined with co-interventions such as systematic
medication titration, education, or lifestyle counseling (PLoS Medicine).
However, the effectiveness of SMBP in pregnancy is less clear. A randomized clinical trial in higher-risk
pregnancies found that self-monitoring of blood pressure did not lead to earlier detection of pregnancy
hypertension (JAMA). Similarly, another trial in pregnant individuals with chronic or gestational
hypertension did not find a significant improvement in clinic-based blood pressure control with self-
monitoring compared to usual care (JAMA).
The implementation of SMBP in pregnancy has been explored in the context of the COVID-19 pandemic.
A mixed methods evaluation of a national roll-out of SMBP in pregnancy during the pandemic found that
while SMBP was generally viewed positively in terms of reducing the need for additional face-to-face
contacts and giving women more control and insight into their own blood pressure, there were
challenges in setting up SMBP services rapidly and embedding them within existing care pathways
(Pregnancy Hypertension).
Overall, the evidence suggests that self-monitoring of blood pressure, particularly when combined with
additional interventions, may be effective in reducing blood pressure and supporting changes in health
behaviors. However, further research is needed to better understand the impact of SMBP in specific
populations, such as pregnant individuals, and to optimize the implementation of SMBP in clinical
practice.
Hypertension, a major public health concern in Africa, has been the subject of extensive research across
the continent. The burden of hypertension in Africa is multifaceted, affecting both adults and children.
Studies have highlighted the prevalence of hypertension in various African regions, with significant
underdiagnosis and suboptimal control. The lack of awareness, treatment, and control of hypertension
has been identified as a major challenge, contributing to the increasing burden of cardiovascular
diseases in the region. In adults, the prevalence of hypertension in older people living in Africa was
estimated to be 55.2%, with higher prevalence in urban compared with rural settings. The review
emphasized the need for timely and aggressive strategies for prevention, detection, and control of
hypertension among older people in Africa (Journal of Hypertension, PubMed). Furthermore, the
underdiagnosis of hypertension and diabetes mellitus in South Africa was highlighted, with
approximately 49% of hypertension cases and 61% of diabetes mellitus cases likely to be undiagnosed.
This underdiagnosis has significant population health implications, contributing to the high burden of
these treatable conditions (South African Medical Journal, PubMed). The impact of hypertension extends
beyond its prevalence, with studies emphasizing the need for improved awareness, treatment, and
control. A call to action from the World Hypertension League outlined specific goals to be achieved in
Africa by 2030, including the diagnosis, treatment, and control of hypertension in 80% of adults with
high blood pressure (Hypertension, PubMed). In addition to the clinical aspects, population-level
interventions targeting risk factors for diabetes and hypertension have been identified as crucial for
curbing the rising burden of non-communicable diseases in South Africa. While there has been progress
in policy formulation, there are gaps in the implementation of these policies and programs, highlighting
the need for comprehensive strategies (BMC Public Health, PubMed). The burden of hypertension in
Africa is further complicated by the presence of pulmonary hypertension, particularly in low- and
middle-income countries. The prevalence of pulmonary hypertension in Africa was found to be relatively
high, driven mainly by left heart diseases, emphasizing the need for context-specific interventions (BMC
Pulmonary Medicine, PubMed). Overall, the research on hypertension in Africa underscores the urgent
need for collaborative efforts, resources, and policies to address the growing public health concern. The
findings highlight the importance of improving awareness, diagnosis, treatment, and control of
hypertension to mitigate its impact on cardiovascular health in the region.
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6. Article Title: How to Improve Awareness, Treatment, and Control of Hypertension in Africa, and
How to Reduce Its Consequences: A Call to Action From the World Hypertension League.
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7. Article Title: Underdiagnosis of hypertension and diabetes mellitus in South Africa.
Authors: Kamerman P,
Journal: South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 112 1
Date: Feb 02 2022
8. Article Title: Prevalence of white coat and masked hypertension in Africa: A systematic review
and meta-analysis.
Authors: Noubiap JJ, Nansseu JR, Nkeck JR, Nyaga UF, Bigna JJ,
Date: Jul 09 2018
9. Article Title: Hypertension Diagnosis and Management in Africa Using Mobile Phones: A Scoping
Review.
Authors: Oronti IB, Iadanza E, Pecchia L,
Journal: IEEE reviews in biomedical engineering 17
10. Article Title: Hypertension awareness, treatment and control in Africa: a systematic review.
Authors: Kayima J, Wanyenze RK, Katamba A, Leontsini E, Nuwaha F,
Journal: BMC cardiovascular disorders 13
Date: Aug 02 2013
11. Article Title: Cardiovascular disease and hypertension in sub-Saharan Africa: burden, risk and
interventions.
Authors: Cappuccio FP, Miller MA,
Journal: Internal and emergency medicine 11 3
Date: Apr
12. Article Title: Prevalence of hypertension in older people in Africa: a systematic review and meta-
analysis.
Authors: Kaze AD, Schutte AE, Erqou S, Kengne AP, Echouffo-Tcheugui JB,
Journal: Journal of hypertension 35 7
Date: Jul
13. Article Title: Population-level interventions targeting risk factors of diabetes and hypertension in
South Africa: a document review.
Authors: Uwimana-Nicol J, Hendricks L, Young T,
Journal: BMC public health 21 1
Date: Dec 14 2021
14. Article Title: Factors influencing treatment adherence in hypertension and HIV management in
South Africa: A comparative literature review.
Authors: Enslin D, Mallya P,
Journal: South African family practice : official journal of the South African Academy of Family
Practice/Primary Care 64 1
Date: Jun 29 2022
15. Article Title: Prevalence of Chronic Kidney Disease as a Marker of Hypertension Target Organ
Damage in Africa: A Systematic Review and Meta-Analysis.
Authors: Ajayi SO, Ekrikpo UE, Ekanem AM, Raji YR, Ogah OS, Ojji DB, Okpechi-Samuel US, Ndlovu KCZ,
Bello AK, Okpechi IG,
Journal: International journal of hypertension 2021
Blood pressure self-monitoring has been the subject of several studies, each providing valuable insights
into its effectiveness and impact on treatment outcomes. A randomized controlled trial (RCT) conducted
in the UK, known as OPTIMUM-BP, assessed the feasibility of a blood pressure self-monitoring (SMBP)
intervention for managing pregnancy hypertension. The trial indicated that a large RCT would be feasible
and demonstrated that participants persisted with the intervention for 80% or more of their time from
enrollment until delivery. Additionally, recorded clinic and study blood pressures were similar for both
groups (PUBMED).
Adherence to treatment in hypertension is a critical factor affecting approximately 30% of patients.

Various intervention strategies have been recommended, including blood pressure self-monitoring,
which has shown effectiveness in improving treatment compliance. The combination of different
interventions is recommended against isolated interventions (PUBMED).
A qualitative study embedded within a RCT of healthcare professionals participating in the TASMINH2
trial of patient self-monitoring with self-titration of antihypertensives from 24 West Midlands general
practices revealed that primary care professionals were positive about self-monitoring. However,
procedures for ensuring patients measured blood pressure correctly were haphazard. There was
evidence of a need for training of both patients and professionals for successful integration of self-
management (PUBMED).
Another RCT in primary health care found that self-monitoring of blood pressure led to better blood
pressure control compared to ordinary treatment. The study concluded that self-monitoring decreased
systolic and pulse pressure significantly more than ordinary treatment and promoted achievement of
target blood pressure (PUBMED).
The TASMINH4 trial aims to evaluate whether GP-led antihypertensive titration using self-monitoring
results in lower systolic blood pressure compared to usual care and whether telemonitoring adds
anything to self-monitoring alone. The trial will provide insights into the effectiveness of self-monitoring
and telemonitoring in the management of hypertension (PUBMED).
A systematic review of RCTs found that self-monitoring was associated with net reductions in systolic and
diastolic blood pressure. The review also highlighted the importance of a vigorous stepped care
approach when patients do not reach target blood pressure levels and suggested that self-monitoring is
a useful adjunct to care (PUBMED).
A randomized controlled trial conducted in China found that a combined pedometer and home blood
pressure monitoring (HBPM) program significantly decreased blood pressure levels in elderly adults with
hypertension and diabetes. The study demonstrated the potential of combination interventions in
improving blood pressure control (PUBMED).
A study pooling individual participant data from four RCTs of SMBP in the United Kingdom found that
one year of SMBP plus telemonitoring or self-management increased the likelihood of antihypertensive
intensification and could improve blood pressure control rates at 5 years (PUBMED).
In contrast, a randomized controlled trial conducted in Iran could not confirm that self-monitoring
improved blood pressure control in patients with frequent medical visits (PUBMED).
A Markov model-based economic evaluation found that self-management of blood pressure in high-risk
people with poorly controlled hypertension was cost-effective and represented a cost-effective use of
healthcare resources (PUBMED).
The TASMIN-SR trial aims to assess the added value of self-management in high-risk groups over and
above usual care. The trial will provide insights into the effectiveness of self-management in high-risk
groups and its potential impact on hypertension care processes and longer-term blood pressure
outcomes (PUBMED).
A study involving computerized self-monitoring and technology-assisted feedback found that a program
using computerized self-monitoring, technology-assisted feedback, and monthly measurement visits
produced significant weight loss after 12 weeks. However, the addition of an enhanced behavioral
component did not improve the effectiveness of the program (PUBMED).
Guided imagery as a non-pharmacological treatment of hypertension in pregnancy remains unclear due

to sparse evidence. Large and well-designed RCTs are needed to identify the effects of guided imagery on
hypertension during pregnancy and on other relevant outcomes associated with short-term and long-
term maternal and neonatal health (PUBMED).
A randomized trial comparing standard follow-up with self-monitoring home blood pressure (SMHBP)-
based follow-up in type 2 diabetics found that SMHBP-based follow-up was equivalent to standard clinic-
based follow-up in blood pressure and albuminuria control (PUBMED).
In summary, blood pressure self-monitoring has shown promise in improving treatment outcomes,
particularly in pregnancy hypertension and in high-risk groups. However, the effectiveness of self-
monitoring may vary based on the specific patient population and the implementation of additional
interventions. Further research is needed to fully understand the impact of self-monitoring on long-term
treatment outcomes and its cost-effectiveness
Article Title: Telemonitoring and/or self-monitoring of blood pressure in hypertension (TASMINH4):

protocol for a randomised controlled trial.
Authors: Franssen M, Farmer A, Grant S, Greenfield S, Heneghan C, Hobbs R, Hodgkinson J, Jowett S,

Mant J, Martin U, Milner S, Monahan M, Ogburn E, Perera-Salazar R, Schwartz C, Yu LM, McManus RJ,
Journal: BMC cardiovascular disorders 17 1
Date: Feb 13 2017
Article Title: Self-monitoring and other non-pharmacological interventions to improve the management
of hypertension in primary care: a systematic review.
Authors: Glynn LG, Murphy AW, Smith SM, Schroeder K, Fahey T,
Journal: The British journal of general practice : the journal of the Royal College of General Practitioners
60 581
Date: Dec
Article Title: A randomised controlled trial of blood pressure self-monitoring in the management of
hypertensive pregnancy. OPTIMUM-BP: A feasibility trial.
Authors: Pealing LM, Tucker KL, Mackillop LH, Crawford C, Wilson H, Nickless A, Temple E, Chappell LC,
McManus RJ,
Journal: Pregnancy hypertension 18
Date: Oct
Article Title: Effects of self-monitoring devices on blood pressure in older adults with hypertension and
diabetes: a randomised controlled trial.
Authors: Gu Y, Bao X, Wang Y, Meng G, Wu H, Zhang Q, Liu L, Song K, Wang Y, Niu K,
Journal: Journal of epidemiology and community health 74 2
Date: Feb
Article Title: Adherence to Treatment in Hypertension.

Authors: Villalva CM, Alvarez-Muiño XLL, Mondelo TG, Fachado AA, Fernández JC,
Journal: Advances in experimental medicine and biology 956
Article Title: Impact of Self-Monitoring of Blood Pressure on Processes of Hypertension Care and Long-
Term Blood Pressure Control.
Authors: Bryant KB, Sheppard JP, Ruiz-Negrón N, Kronish IM, Fontil V, King JB, Pletcher MJ, Bibbins-
Domingo K, Moran AE, McManus RJ, Bellows BK,
Journal: Journal of the American Heart Association 9 15
Date: Aug 04 2020
Article Title: Patient self-monitoring of blood pressure and self-titration of medication in primary care:
the TASMINH2 trial qualitative study of health professionals' experiences.
Authors: Jones MI, Greenfield SM, Bray EP, Hobbs FR, Holder R, Little P, Mant J, Williams B, McManus RJ,
Journal: The British journal of general practice : the journal of the Royal College of General Practitioners
63 611
Date: Jun
Article Title: Self-Monitoring of Blood Glucose in Youth-Onset Type 2 Diabetes: Results From the TODAY
Study.
Authors: Weinstock RS, Braffett BH, McGuigan P, Larkin ME, Grover NB, Walders-Abramson N, Laffel LM,
Chan CL, Chang N, Schwartzman BE, Barajas RA, Celona-Jacobs N, Haymond MW,
Journal: Diabetes care 42 5
Date: May
Article Title: Self-monitoring of blood pressure promotes achievement of blood pressure target in
primary health care.
Authors: Halme L, Vesalainen R, Kaaja M, Kantola I,
Date: Nov
Article Title: Self-monitoring of blood pressure for improving adherence to antihypertensive medicines
and blood pressure control: a randomized controlled trial.
Authors: Hosseininasab M, Jahangard-Rafsanjani Z, Mohagheghi A, Sarayani A, Rashidian A, Javadi M,

Ahmadvand A, Hadjibabaie M, Gholami K,
Date: Nov
Article Title: Targets and self-management for the control of blood pressure in stroke and at risk groups
(TASMIN-SR): protocol for a randomised controlled trial.
Authors: O'Brien C, Bray EP, Bryan S, Greenfield SM, Haque MS, Hobbs FD, Jones MI, Jowett S, Kaambwa
B, Little P, Mant J, Penaloza C, Schwartz C, Shackleford H, Varghese J, Williams B, McManus RJ,
Journal: BMC cardiovascular disorders 13
Date: Mar 23 2013
Article Title: Cost-effectiveness of self-management of blood pressure in hypertensive patients over 70

years with suboptimal control and established cardiovascular disease or additional cardiovascular risk
diseases (TASMIN-SR).
Authors: Penaloza-Ramos MC, Jowett S, Mant J, Schwartz C, Bray EP, Sayeed Haque M, Richard Hobbs FD,
Little P, Bryan S, Williams B, McManus RJ,
Journal: European journal of preventive cardiology 23 9
Date: Jun
Article Title: Computerized self-monitoring and technology-assisted feedback for weight loss with and
without an enhanced behavioral component.
Authors: Chambliss HO, Huber RC, Finley CE, McDoniel SO, Kitzman-Ulrich H, Wilkinson WJ,
Journal: Patient education and counseling 85 3
Date: Dec
Article Title: Home blood pressure vs. clinic blood pressure measurement-based follow up in type ii
diabetics: Effect on 24-h ambulatory BP and albuminuria. Randomised trial.
Authors: Martínez MA, Garcia-Puig J, Loeches MP, Mateo MC, Utiel I, Torres R,
Journal: Medicina clinica 150 11

Date: Jun 08 2018
Article Title: Guided imagery for treating hypertension in pregnancy.
Authors: Haruna M, Matsuzaki M, Ota E, Shiraishi M, Hanada N, Mori R,
Journal: The Cochrane database of systematic reviews 4 4
Date: Apr 27 2019
METHODOLOGY
3.1 Study Design
The study will be conducted using a cross-sectional study design. This study design will be
used to determine the prevalence of mental health issues among children and adolescents as
outlined in the study objectives. Structured questionnaires will be used to administer research
questions to participants.
3.2 Study Site
The study will be conducted in two health facilities namely, Ho Teaching Hospital and Volta
Regional Hospital both in the Volta Region of Ghana. The HTH, located in Ho, the capital of
Volta Region is the main referral health facility in the Volta Region and has been in operation
for over 20 years (Ho Teaching Hospital, 2021). It has a Sickle Cell Clinic attendance of
about 250 for patients aged 17 and below. VRH formerly known as Hohoe Municipal
Hospital is situated in the Hohoe Municipality (Hohoe To Get Regional Hospital -
DailyGuide Network, n.d.). VRH has a SCD OPD of about 250 regular patients. Its location
makes it a referral point for other facilities especially in the Oti Region.
3.3 Subject/Study Population
This study will comprise children with sickle cell disease aged 4 to 17 years, irrespective of
their haemoglobin genotypes and sex, who are attending the sickle cell clinic of HTH and
VRH.
3.4 Inclusion Criteria

i. All patients aged 4 to 17 whose caregivers have given informed consent (assent for
participants 8 years and above) to participate in this study.
3.5 Exclusion Criteria
i. Patients aged 4-17 years who are not accompanied or whose caregivers are unable to
give reliable information on the child’s condition.
ii. Patients who are acutely ill and need urgent care.
Sample Size Determination
The sample size will be calculated using the Cochran’s formula for cross-sectional studies:
Where; n = sample size,
z = Statistics for a level of confidence
d = degree of precision (in proportion of one; it is 5%, d=0.05)
p= expected prevalence or proportion.
q = 1-p
d = margin of error
The confidence level for this study is 95% with a Z statistics of 1.96 and margin of error at 5%
Therefore, n = (1.96)2 (0.333) (0.667)/ (0.05)2 = 341.32 ≈ 341
Data Collection methods and instruments
After ethical clearance data will be gathered by interviews using the study questionnaire (See
Appendix 3).
Data handling
Questionnaires will be coded with 3-digit codes and the information shall be kept under tight
security. The only other persons who may have access will be my supervisor.
Statistical Analysis
The data will be analysed using the Statistical Package for Social Science (SPSS) software
version. Continuous variables will be summarised using means and standard deviations or
medians and interquartile ranges. Categorical variables will be presented using frequency tables,
graphs, and pie charts
Dissemination of Results
The results obtained from this research will be presented to the School of Medicine in partial
fulfilment of the conditions for the award of Bachelor of Medicine and Bachelor of Surgery
degree. It will also be disseminated among the University staff and the management of the
various hospitals if needed. The results will also be published in journals and other scientific
publications to add to the knowledge on the subject.
ETHICAL ISSUES
Ethical clearance
Ethical Clearance will be sought from the Reasearch and Ethical Committee
Possible benefits or risks
This study will not carry direct benefit to the individual participants. However, their participation
in this study will help influence the early detection and psychological intervention of mental
health issues among children and adolescents aged 10 to 17 with SCD. There is no risk to the
participants involved in the study.
Confidentiality
Participants will be assured of absolute confidentiality of all information privy to the researcher,
or research supervisor. The initials of their names will be used. No name will be recorded. Data
collected cannot be linked to them in anyway. No name or identifier will be used in any
publication or reports from this study.
Consenting process
Participants will be made aware of the goals of the study. Consent will be sought from each
participant to indicate their willingness to participate in the study.
Voluntary consent or Withdrawal
Participants will be made aware that, participation in the study is voluntary and as such, they
have the freedom to withdraw from the study at any point in time at any stage.
Conflict of interest
There is no conflict of interest in the study.

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Blood Pressure

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Blood pressure, the force exerted by the blood against a vessel wall, depends on the volume of blood

Hypertension is defined as abnormally high blood pressure levels.

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