The Japanese Society of Hypertension Guidelines for Self-monitoring of Blood Pressure at Home (Second Edition)

Abstract

INTRODUCTIONSince Riva-Rocci invented indirect brachial cuff sphygmomanometry in 1896 1 and Korotkoff proposed the auscultatory method in 1905, 2 the method for blood pressure (BP) measurements has remained essentially unchanged for the past 100 years.In 1969, Posey et al. 3 identified mean BP on the basis of the cuff-oscillometric method. With subsequent theoretical and technical improvements, the method to determine systolic and diastolic BP (S and D, respectively) was introduced to the cuff-oscillometric method. As a result, many of the automatic electronic sphygmomanometers available today have adopted this method, and those different from the auscultatory method have begun to be used in general clinical practice. Since the advent of indirect methods for sphygmomanometry, the past century has developed the practical and clinical sciences of hypertension. However, BP information necessary for the diagnosis and treatment of hypertension is still obtained essentially on the basis of casual measurements at the outpatient clinic (clinic BP). However, the reliability of clinic BP was called into question 40 years after the advent of indirect sphygmomanometry. In 1940, Ayman and Goldshine 4 widely adopted the concept of self-BP measurements in the field of clinic BP measurements and demonstrated discrepancies between clinic BP and self-BP measurements. Bevan, 5 in the United Kingdom, first reported the results of ambulatory BP (ABP) monitoring (ABPM) using a direct arterial BP measurement method in 1969, and showed that human BP changes markedly with time. The quantity and quality of BP information vary greatly according to different methods, and the problem of interpreting clinic BP, which is obtained specifically in a medical environment, has been an issue in the clinical practice of hypertension during the past 50 years.However, the practice and epidemiology of hypertension still depend entirely on BP information obtained in a medical environment (clinic BP/BP at a health examination), resulting in the

Pragmatic Method Using Blood Pressure Diaries to Assess Blood Pressure Control

“…[18][19][20][21][22][23][24] Averaging all HBP values to assess blood pressure control is impractical in busy clinical practice, however. We therefore sought to determine if it was possible to reliably determine blood pressure control and likely underlying target organ disease by quick assessment of patient HBP diaries.…”

“…[12][13][14][15][16][17] Accordingly, use of HBP as a tool to help guide management of high blood pressure is advocated in many countries. [18][19][20][21][22][23][24][25] A disadvantage of HBP is the requirement for manual calculation of the average of multiple values from patient diaries (eg, up to 28 recordings over 7 days) when using blood pressure devices that do not have storage memory, which currently predominate the market. If the patient has not calculated the average (which has its own reliability issue), the physician is…”

“…Also, we did not standardize the timing of antihypertensive medication relative to HBP (other than asking patients to measure morning blood pressure before taking medication), nor attempt to control other daily life activity that may affect consistency of HBP (ie, exercise habits, food and drink intake). Nonetheless, better reproducibility and confidence in underly- 19,21 Overall, the best clinical approach would be using a validated blood pressure monitor with a memory function and automated averaging, and a standard method taking into account timing of antihypertensive medications. The demonstrated association of inadequate blood pressure control with markers of target organ disease supports the validity of our approach and might suggest that the problem with a suboptimal hypotensive effect may not be limited to a recent period, but possibly is a more general phenomenon covering longer time spans.…”

“…29 We used only the morning and evening readings for our analyses. 19,21,23,24 To record 24-hour ABP, we used a validated device with correct cuff size (TM-2430, A&D Mercury), 31 with measures acquired every 30 minutes during the day (between 6 am and 10 pm) and every 60 minutes overnight (between 10 pm and 6 am). …”

Suitability of Fast Healthcare Interoperability Resources (FHIR) for Wellness Data

“…As suggested by Imai et al [29] blood pressure should be measured at least once in the morning and once in the evening for self-monitoring at home. Pickering [30] made the same suggestions.…”