Home blood pressure measurement: a means for improving blood pressure control?

Abstract

The best way to measure blood pressure (BP) remains a matter of debate. Office BP recorded by the physician has long been the clinical standard in decision making of therapeutic strategies. However, the clinical value of a single or a few office BP measurements in predicting BP values outside the medical office, and more importantly organ damage and cardiovascular events is rather limited. 1 This is related to two main problems: (1) the poor reproducibility of clinic BP values due to the marked BP variation over time; (2) the alarm reaction to BP measurement by the physician; this phenomenon induces transient increments in BP that may be particularly pronounced in some patients. 2 Over the past three decades, an impressive increase in self BP measurement at home or at the work place and in ambulatory BP measurement by innovative automated devices has taken place. The clinical usefulness of BP measurement at home by semiautomated devices has been investigated over the past 30 years. Several studies have shown that home BP (HBP) measurement, by providing multiple BP recordings under relatively stable conditions and avoiding the so-called 'white-coat effect', is superior to office or clinic BP measurement in terms of reliability, 3 correlation with organ damage 4,5 and predictive value of cardiovascular events. [6][7][8][9] In addition, HBP has been shown to be free of the placebo effect, to improve patients' compliance and to be useful in detecting white-coat and masked hypertension phenomena. 10,11 As a consequence, HBP is now considered a useful procedure not only in complementing clinic BP readings for the management of hypertensive patients in daily practice but also in providing substantial information in clinical research.In this issue of the Journal of Human Hypertension Obara et al. 12 describe the results of a study about the association between HBP measurement and hypertension control among a Japanese population of essential hypertensives in a primary care setting. Factors associated with patients' preference for HBP measurement were also addressed. The conclusion of the study is that home BP measurement that was performed on 77% of the patients was associated with a better control of either home or office BP. Despite some limitations, this paper extends and refines previous evidence on the prevalence of HBP and the impact of this procedure on BP control in a representative population of patients routinely seen in clinical practice. Before addressing the study in detail, some general considerations on HBP measurement might be useful. HBP monitoring in clinical practiceSeveral studies investigated the prevalence of HBP measurement among hypertensive patients in different clinical settings and reported an impressive increase in the use of this procedure over time; this is also testified by the huge growth in the market of automated devices for home BP measurement in affluent societies. In their pioneering survey, Krecke et al. 13 reviewed the prevalence of HBP measurement in eight German investigations ove...