Home Blood Pressure Monitoring: Current Status and New Developments

Abstract

Home blood pressure monitoring (HBPM) is a reliable, convenient and less costly alternative to ambulatory blood pressure monitoring (ABPM) for the diagnosis and management of hypertension. Recognition and use of HBPM has dramatically increased over the last 20 years and current guidelines make strong recommendations for the use of both HBPM and ABPM in patients with hypertension. The accuracy and reliability of home BP measurements requires use of a validated device and standardized procedures, and good patient information and training. Key HBPM parameters include morning BP, evening BP and the morning-evening difference. In addition, newer semi-automatic HBPM devices can also measure nighttime BP at fixed intervals during sleep. Advances in technology mean that HBPM devices could provide additional relevant data (e.g. environmental conditions) or determine BP in response to a specific trigger (e.g. hypoxia, increased heart rate). The value of HBPM is highlighted by a growing body of evidence showing that home BP is an important predictor of target organ damage, and cardiovascular disease- and stroke-related morbidity and mortality, and provides better prognostic information than office BP. In addition, use of HBPM to monitor antihypertensive therapy can help to optimize reductions in BP, improve BP control, and reduce target organ damage and cardiovascular risk. Overall, HBPM should play a central role in the management of patients with hypertension, with the goal of identifying increased risk and predicting the onset of cardiovascular disease events, allowing proactive interventions to reduce risk and eliminate adverse outcomes.

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“…7 Compared with office BP, home BP is more closely associated with cardiovascular event risk. 36, 37 In addition, in Asian countries, the benefit of BP lowering is greater than that of Westerners, especially for stroke. 38 The comparison of cost-effectiveness studies using different DTx apps in different contigs is also needed in the future.…”

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“…Current guidelines recommend that the average of all these values should be used with the exception of the first day, which should be discarded for clinical decision-making. If there is a discrepancy between office BP and home BP readings, a home BPbased diagnosis should take precedence (46). HBPM reference values are as follows:…”

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“…2,4,5,11 These devices have been deemed reliable and accurate, but similar to ABPM, require use of validated devices, standardized procedures, and appropriate patient information and training. 12 The Centers for Disease Control and Prevention found strong evidence that self-measured BP, with additional support, was more effective than usual care in lowering BP. 13 In addition, the Million Hearts initiative 13 supports out-of-office BP monitoring and associated strategies, according to the best evidence.…”