Influence of the recommendations on the implementation of home blood pressure measurement by French general practitioners: a 2004-2009 longitudinal survey

Objectives To assess the implementation of home blood pressure measurement (HBPM) by French general practitioners (GPs) in current practice in 2009 and to assess the evolution of practices between 2004 and 2009; the perceived benefits and limitations of the method; and the adherence to methodological European [European Society of Hypertension (ESH) 2007] or French [La Haute Autorite de Sante (HAS) 2005] recommendations. Method Two phone surveys on a representative random sample of French GPs in 2004 and then in 2009. Results Five hundred and forty and 801 GPs were contacted in 2004 and 2009, respectively, in which 511 and 500 participated, including the same 214 in both surveys. The proportion of HBPM users increased between 2004 (70%) and 2009 (92%) (P < 0.0001). The majority still remained occasional users (71%), whereas a minority (21%) used this method nearly systematically in 2009. In 2009, both users and nonusers highlighted the lack of reliability of devices (19 and 47%) and lack of patient reliability (27 and 24%) and patient anxiety (47 and 29%). The expected benefit was primarily the detection of white-coat effect (70%), therapeutic adaptation (36%), diagnostic aid (25%), and better compliance with treatment (14%). Masked hypertension detection (2%) and prognostic interest (0.7%) were marginal. The GPs declared rarely adopting ESH methodology (3% of users), but more often HAS methodology (33%). Adherence to the complete methodology was rare (absolute adherence < 1%), but more often 'minimal' (three morning and evening measurements, at least 3 days with an upper arm cuff: 17%). Contraindications of HBPM use were not known. Conclusion Despite greater use of HBPM after enactment of the recommendations, the methodology is not strictly implemented, making its diagnostic and prognostic value uncertain. J Hypertens 29: 2105-2115 (C) 2011 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.