Can a blood pressure cuff be prescribed as Durable Medical Equipment (DME) for a patient with hypertension, a history of smoking, and likely hyperlipidemia?

Can a Blood Pressure Cuff Be Prescribed as DME?

Yes, home blood pressure monitors should be prescribed as Durable Medical Equipment (DME) and reimbursed, as they are recommended as a routine component of blood pressure measurement for the majority of patients with known or suspected hypertension. 1

Clinical Rationale for DME Coverage

Home blood pressure monitoring (HBPM) has the potential to improve the quality of care while reducing costs, and should be reimbursed. 1 The evidence supporting this recommendation is compelling:

• Home BP measurements are more reproducible than office readings and show better correlations with measures of target organ damage 1
• Home BP predicts cardiovascular risk better than office BP (Class IIa; Level of Evidence A) 1
• HBPM overcomes many limitations of traditional office BP measurement and is both cheaper and easier to perform than ambulatory BP monitoring 1

Specific Indications for This Patient

For a patient with hypertension, smoking history, and likely hyperlipidemia, HBPM is particularly indicated:

• Newly diagnosed or suspected hypertension: HBPM distinguishes between white coat and sustained hypertension 1
• Evaluating treatment response: HBPM is recommended for evaluating the response to any type of antihypertensive treatment and may improve adherence 1
• High-risk patients: HBPM is of value in patients with diabetes and other conditions where tight BP control is paramount 1

Device Specifications for Prescription

When prescribing a BP monitor as DME, specify the following requirements:

• Validated oscillometric monitors that measure BP on the upper arm with appropriate cuff size 1
• Devices must be validated according to standard international protocols (BHS, AAMI, or International Protocol) 1
• Monitors with memory that store readings are preferred 1
• Upper arm devices only—avoid wrist or finger cuffs 1

Target BP Goals for Home Monitoring

The prescription should include target goals:

• Target HBPM goal: <135/85 mmHg for most patients 1
• <130/80 mmHg for high-risk patients with diabetes, coronary heart disease, or chronic kidney disease (Class IIa; Level of Evidence B) 1
• Note that home BP thresholds differ from office BP (office hypertension is ≥140/90 mmHg) 1

Measurement Protocol to Include in Prescription

The prescription should reference proper measurement technique:

• 2-3 readings while resting in the seated position, both morning and evening, over a period of 1 week 1
• Minimum of 12 readings recommended for making clinical decisions 1
• Measurements taken after 5 minutes rest, with arm at heart level, back supported, and feet flat on the ground 1
• No tobacco or caffeine for 30 minutes preceding measurement 1

Patient Training Requirements

The prescription should note that patient training is required:

• Patients should be trained by their healthcare provider, and monitor readings checked against office measurements 1
• The patient should bring the monitor to the office to verify technique and accuracy of the device 1
• Re-evaluate patient technique and device accuracy annually 1

Contraindications to Note

Document any contraindications in the prescription:

• HBPM may not work well in patients with atrial fibrillation or frequent ectopic beats, as oscillometric methods may be unreliable 1
• Some patients may become obsessional about taking readings—the inherent variability of BP means there will inevitably be some high readings 1

Reimbursement Justification

The prescription should include clinical justification:

• HBPM is indicated for confirming hypertension diagnosis, distinguishing white coat from sustained hypertension 1
• Essential for monitoring treatment response and improving medication adherence 1
• More cost-effective than repeated office visits or ambulatory BP monitoring 1
• Better predictor of cardiovascular outcomes than office BP measurements 1

Common Pitfalls to Avoid

• Do not prescribe "one size fits all" automated cuffs at pharmacies—these are unreliable 1
• Ensure proper cuff size is specified based on patient's arm circumference 1
• Avoid devices that have not been validated according to standard protocols 1
• Do not rely on auscultatory devices for home monitoring, as patients rarely master the required technique 1