Measuring blood pressure (BP) at home rather than in the clinic is more reliable and better at predicting risk for heart attack or stroke. However, in a brief report published in JAMA Cardiology, almost half of patients with home-monitoring devices took too few readings to be useful, and one third took no readings at all.

“We know that measuring blood pressures at home is a crucial part of managing hypertension well,” said Naomi Fisher, MD, endocrinologist and hypertension specialist at Mass General Brigham in Boston.

Fisher and her colleagues enrolled more than 3000 patients in a remote management program for hypertension. They asked them to perform home BP monitoring according to the American Heart Association (AHA) guidelines. All patients received a free home BP-monitoring device that was able to automatically transmit data as well as education and support from healthcare navigators.

Monitoring involved taking two readings 1 minute apart in both the morning and evening for 1 week at the beginning of the program and again after each medication change. When performed correctly, a patient should have four readings a day, totaling 28 readings a week.

But as the program went on, the researchers noticed many patients were struggling to adhere to the schedule. A third of them (32.7%) took no readings at all, whereas another 14.2% took between 1 and 11 readings — too few to be clinically useful. Slightly more than one third (34.8%) were highly engaged with the program, taking 24-28 readings a week, whereas 18.2% took 12-23 measurements.

Problems With Compliance

Fisher said she was not surprised by the results.

“I’ve seen firsthand that while some people can accomplish home blood pressure monitoring as recommended, many cannot,” she said. However, the low levels of engagement were more dramatic than she expected, given the amount of support these patients had.

“These patients had the cards stacked in their favor: they all received free blood pressure cuffs to use, as well as instruction and regular contact with navigators to help guide them and answer any questions,” said Fisher.

Daniel W. Jones, MD, dean of the School of Medicine at the University of Mississippi Medical Center in Jackson, Mississippi, and chair of the 2025 AHA/American College of Cardiology high BP guideline committee, said that because high BP is asymptomatic in most patients, the lack of compliance with at-home monitoring is a major concern.

“We usually only think of compliance with therapy. But home blood pressure monitoring with reporting and interaction with a healthcare provider improves blood pressure control,” he said. “Lack of compliance to home blood pressure monitoring reduces blood pressure control rates.”

The study did not record the reasons for poor adherence, but Fisher said she often hears the same list of complaints in her clinical practice.

“For many people, the process of sitting down twice a day for a week, fitting a cuff over their arm, and sitting still for several minutes proves too much of a hassle. Some people hate the clutter of a bulky electronic apparatus on their desk. Parents may not have even a few minutes to spare in the morning,” she said. “And perhaps most important, many people don’t fully understand the importance of measuring their blood pressure at home.”

A ‘Need for Alternative Approaches’

Michihiro Satoh, PhD, who studies hypertension at the Tohoku Medical and Pharmaceutical University in Sendai, Japan, said further research is needed to identify which patient subgroups struggle the most with adherence and examine the psychological factors behind it.

Counterintuitively, he suggested some of the support given to patients might actually reduce engagement. “Free device distribution may have contributed to low engagement through resentment of ‘forced measurement’ or the perception of ‘no loss if unused,’” he said.

Jones said healthcare providers need to take more responsibility for ensuring their patients are engaging with their BP monitoring.

“We are in the early phase of clinicians being held accountable for the control of blood pressure in their patients,” she said. “Clinicians must engage with their patients to make this tool useful.”

But Fisher said the low engagement rates highlight the need for alternative approaches to measure BP that are much more convenient for patients.

“It is clearly time for innovative technologies that will capture blood pressure measurements accurately and easily, without requiring placement of an inflatable arm cuff, and without annoying and potentially alarming people,” she said.

New cuffless devices that can measure BP continually without the patient even being aware of it could be a game changer.

“Once validated, these cuffless devices hold the promise of providing extremely valuable data which can help lower blood pressure for millions of people with hypertension,” Fisher said.

Fisher reported receiving grants from Aktiia Healthcare and Recor Medical. Satoh reported receiving academic support from Kowa Life Science Foundation (funded by Kowa Co., Ltd and Bayer Yakuhin Co., Ltd) and lecture fees from Fuji Yakuhin Co., Ltd and AstraZeneca. Jones reported having no relevant financial relationships.

Brian Owens is a freelance journalist based in New Brunswick, Canada.