Home Blood Pressure Measurements Will Not Replace 24-Hour Ambulatory Blood Pressure Monitoring

Verdecchia, Paolo; Mazzotta, Giovanni; Gentile, Giorgio; Reboldi, Gianpaolo

doi:10.1161/hypertensionaha.108.122861

Cited by 53 publications

(53 citation statements)

References 85 publications

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“…2,3 We largely agree with O'Brien's 1 observations, although with a slightly different perspective.First, we agree that isolated HBP measurements are of limited clinical value. Indeed, only the average of repeated HBP readings carries diagnostic and prognostic information, which may be partly comparable to that provided by 24-hour ABPM, 4 with most outcome studies being based on structured HBPM schedules including a consistent number of measurements.…”

supporting

confidence: 84%

Response to Home Blood Pressure Measurements Will or Will Not Replace 24-Hour Ambulatory Blood Pressure Measurement

Parati

Bilo

2009

Hypertension

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We have read with interest the letter by O'Brien 1 contributing to the debate on the respective role of home blood pressure (BP; HBP) monitoring (HBPM) and ambulatory BP (ABP) monitoring (ABPM) in the clinical management of hypertensive patients. 2,3 We largely agree with O'Brien's 1 observations, although with a slightly different perspective.First, we agree that isolated HBP measurements are of limited clinical value. Indeed, only the average of repeated HBP readings carries diagnostic and prognostic information, which may be partly comparable to that provided by 24-hour ABPM, 4 with most outcome studies being based on structured HBPM schedules including a consistent number of measurements. The recent European guidelines on HBPM recommend that HBP data from Ն3 (and ideally 7) days of measurements performed twice daily should be used, disregarding the values obtained on the first day. 4 This task does not appear to be particularly demanding for patients, and it could be made even easier by supplying them with a structured logbook, where HBP values collected during the week preceding each physician's visit can be stored, or by using automated BP measuring devices equipped with specific software tools able to follow the HBPM schedule recommended by recent guidelines 4 and providing the average value of the HBPM week after discarding the initial day. It has to be acknowledged that many patients perform HBPM without doctor's guidance, often measuring their HBP much too frequently. The recent European Society of Hypertension and American Heart Association recommendations on HBPM 4,5 strongly advise HBPM to be performed always under a physician's supervision, and the currently recommended schedule indeed represents a simplification of the HBPM habits often self-implemented by patients, rather than a "demanding routine."We also share the view that the availability of ABPM should be increasing with its cost being less prohibitive, a point clearly emphasized at the end of our article. 3 A wider availability of ABPM might allow this diagnostic tool to become a more frequent companion to the HBPM implementation in daily practice, complementing the information that it provides. Indeed, whereas HBPM allows BP to be measured over a relative long time span, ABPM provides unique assessment of the 24-hour ABP profile, including nighttime and morning BP and BP variability. Finally, we acknowledge the possible usefulness of software tools supporting adequate ABPM reporting. Indeed, although international hypertension guidelines recognize the diagnostic and prognostic values of average ABP, only vague reference is made to other potentially relevant information provided by analysis of 24-hour ABP profiles. Clear and evidence-based indications on which clinically relevant features of 24-hour ABP should be included in the final report thus have to be provided by national and international scientific societies, and software tools able to make this information easily available to physicians would be welcome. DisclosuresG.P. has receive...

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supporting

confidence: 84%

Response to Home Blood Pressure Measurements Will or Will Not Replace 24-Hour Ambulatory Blood Pressure Measurement

Parati

Bilo

2009

Hypertension

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“…At present, there is a debate over the exact place for ambulatory and self monitoring. 30,31 However, there is consensus that self monitoring does provide a cheap and patient friendly method of BP monitoring in the management of hypertension. The ESH described a schedule of self-monitoring, 18 which was somewhat pragmatic but until now has lacked any real evidence.…”

Section: Discussionmentioning

confidence: 99%

Self blood pressure monitoring: a worthy substitute for ambulatory blood pressure?

McGowan

Padfield

2010

J Hum Hypertens

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lines for self-monitoring of blood pressure (SBPM). We aimed to demonstrate the equivalence of SBPM with ambulatory blood pressure monitoring (ABPM) in the assessment of hypertension. A total of 87 consecutive subjects referred from primary care for standard ABPM underwent a 1-week period of SBPM, as defined by the ESH guidelines, either before or after ABPM. There was no difference in mean blood pressure (BP): SBPM 142/ 87 mm Hg, daytime average ABPM 141/86 mm Hg. The intra-class correlation coefficient was 0.72 and 0.89 for systolic and diastolic pressure, respectively. SBPM is concordant with ABPM in classifying subjects as hypertensive or normotensive in 87% of cases (j ¼ 0.56). The coefficient of variation of SBPM compared with ABPM was 5%. In answer to a direct question 81% of subjects preferred SBPM to ABPM. The current self-monitoring schedule recommended by the ESH, AHA and ASH is valid. The mean BP obtained from SBPM is equivalent to awake-time BP on ABPM, the accepted reference standard for 'out of office' BP measurement. SBPM is simpler to carry out, preferred by patients and should be considered on a par with ABPM.

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Section: Hypertension Is Not Defined By 140/90 In the "Real World"mentioning

confidence: 99%

“…Patients with borderline AOBP readings should have 24-hour ABPM performed, if available; otherwise, 7 days of home BP readings should be performed to clarify the patient's status. At the present time, 24-hour ABPM has advantages over home BP 6,7 because it provides more readings during usual daily activities including nocturnal BP 37 and can identify patients with masked hypertension, both of which might be particularly helpful in the evaluation of patients with borderline office BP readings.…”

Section: The Future Of Aobpmentioning

confidence: 99%

“…In recognizing this limitation of manual office BP, some guidelines have gone so far as to recommend that home BP and 24-hour ambulatory BP monitoring (ABPM) may need to be performed to obtain an accurate measure of a patient's BP status. The greater reliance on 24-hour ABPM and home BP in the diagnosis and management of hypertension is the result of numerous clinical outcome studies 5,6 that show that these measurement techniques are better predictors of cardiovascular events when compared to manual BP readings, even when manual readings are taken carefully in accordance with guidelines.However, most guidelines do not seem to have fully considered the impact conventional routine office BP might have on both the cut-point and ongoing management of hypertension as experienced by primary care physicians. In most instances, an office BP of 140/90 mm Hg is equated to a mean home BP or mean awake ambulatory BP of 135/ 85 mm Hg.…”

mentioning

confidence: 99%

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Measurement of Blood Pressure in the Office

et al. 2010

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T he widely accepted cut-point for normal blood pressure (BP) in the office setting evolved over several decades, based on data derived from a variety of sources. The Actuarial Society of America was one of the first organizations to publish BP data on thousands of community residents, followed by other classic studies such as Framingham, Western Electric Company, Kaiser Permanente, and the Multiple Risk Factor Intervention Trial. 1,2 In every instance, BP readings were based on measurements taken by specially trained health professionals following guidelines for proper BP measurement. As a result of these and other population studies examining the association between different BP levels and cardiovascular outcomes, the importance of systolic and diastolic hypertension was recognized and an office BP of 140/90 mm Hg became the universally established cut-point for separating normal BP from hypertension. Hypertension Is Not Defined by 140/90 in the "Real World"There are robust scientific data to support the use of 140/90 mm Hg to define hypertension in clinical practice guidelines. However, the guidelines do not take into account widely recognized problems associated with the quality of manual BP measurement in routine clinical practice. 3 More recent recommendations 4 for diagnosing hypertension clearly acknowledge that an increase in BP attributable to the "white coat response" is frequently associated with manual BP recordings performed in community-based practice. In recognizing this limitation of manual office BP, some guidelines have gone so far as to recommend that home BP and 24-hour ambulatory BP monitoring (ABPM) may need to be performed to obtain an accurate measure of a patient's BP status. The greater reliance on 24-hour ABPM and home BP in the diagnosis and management of hypertension is the result of numerous clinical outcome studies 5,6 that show that these measurement techniques are better predictors of cardiovascular events when compared to manual BP readings, even when manual readings are taken carefully in accordance with guidelines.However, most guidelines do not seem to have fully considered the impact conventional routine office BP might have on both the cut-point and ongoing management of hypertension as experienced by primary care physicians. In most instances, an office BP of 140/90 mm Hg is equated to a mean home BP or mean awake ambulatory BP of 135/ 85 mm Hg. However, this relationship has been based on BP readings carefully recorded in accordance with guidelines 4 for proper BP measurement (research-quality office BP readings) and may not reflect the BP obtained by doctors, nurses, and other health professionals in routine office practice. Comparison of Casual and Research-Quality Manual BP MeasurementWhen the primary care physician records BP using a mercury or aneroid device, the resulting value frequently tends to be higher than what it would be if measurement guidelines were strictly adhered to. In a 1995 report from one of our centers, 7 BP data were obtained from 147 hypertensiv...

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Home Blood Pressure Measurements Will Not Replace 24-Hour Ambulatory Blood Pressure Monitoring

Cited by 53 publications

References 85 publications

Response to Home Blood Pressure Measurements Will or Will Not Replace 24-Hour Ambulatory Blood Pressure Measurement

Response to Home Blood Pressure Measurements Will or Will Not Replace 24-Hour Ambulatory Blood Pressure Measurement

Self blood pressure monitoring: a worthy substitute for ambulatory blood pressure?

Measurement of Blood Pressure in the Office

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