Home blood pressure measurements: Advantages and disadvantages compared to office and ambulatory monitoring

Figures & data

Table I. Aspects that require attention when measuring blood pressure, and especially home blood pressure.

Preliminary procedures	Measurement procedures
Patient training (short for automated devices)	Quiet and temperate environment
Use of validated devices, preferably an oscillometric automatic device	Avoid physical activity (at least 5 min rest), smoking, coffee and alcohol intake before measurement
Periodically check for accuracy	Avoid talking, reading, watching television and eating during measurement
Adequate cuff and bladder size (covering 80–100% of the arm circumference)	Sitting position suggested, with back and arm supported
Upper arm cuff suggested (use wrist cuff only if brachial BP measurement is impossible, e.g. in severe obesity)	Upper arm at the level of the heart
	Immediate reporting of all readings

Table II. Indications for home blood pressure monitoring.

All patients receiving antihypertensive drugs, especially those who need closer control (e.g. resistant hypertension, hypertension in pregnancy)

To evaluate resistant hypertension

To evaluate white-coat effect and white-coat hypertension

To evaluate masked hypertension

To improve treatment compliance and persistence

Table III. Adherence-enhancing strategies.

Patient	Information and motivational strategies
	Self-monitoring of blood pressure
	Group sessions
Drug treatment	Simplification of drug regimen
	Reminders
Health system	Intensified care, including telemonitoring of home blood pressure
	Involvement of pharmacists

Table IV. Criteria for the definition of hypertension by office (OBPM), ambulatory (ABPM) and home blood pressure monitoring (HBPM).

Category	Systolic		Diastolic
OBPM
Optimal	< 120	and	< 80
Normal	120–129	and/or	80–84
High normal	130–139	and/or	85–89
Grade 1 hypertension	140–159	and/or	90–99
Grade 2 hypertension	160–179	and/or	100–109
Grade 3 hypertension	≥ 180	and	≥ 110
Isolated systolic hypertension	≥ 140	and	< 90
ABPM
Hypertension: day-time or awake	≥ 135	and/or	≥ 85
Hypertension: night-time or asleep	≥ 120	and/or	≥ 70
Hypertension: 24 -h	≥ 130	and/or	≥ 85
HBPM
Hypertension	≥ 135	and/or	≥ 85

Table V. Advantages and disadvantages of using home blood pressure monitoring (HBPM) compared to office blood pressure (OBPM) and ambulatory blood pressure monitoring (ABPM).

Advantages and disadvantages of HBPM vs ABPM
HBPM	ABPM
More time to adequately instruct the patient	Less time to instruct the patient
More controlled by the patient	More controlled by the doctor
Once purchased, can be repeated indefinitely without added costs	Relatively expensive
Possible reporting bias	Possible technical errors
Probably more useful to evaluate the effect of therapy measuring BP over a longer period	Gives information about the effect of BP medication only on the day of ABPM
Can give information about day-to-day variability (the clinical significance of which is still under evaluation)	Can give information about short-term BP variability, including nocturnal dipping (for which there is more evidence of clinical significance)
Can give more information about specific situations, e.g. drug-induced hypotension or post-prandial hypotension	Can give more information about specific situations, if present on the day of registration
Gives information only when patient is awake at home	Gives information about BP during daily activity and during sleep, including possible clues about secondary forms of hypertension, e.g. obstructive sleep apnoea
Detection of white-coat effect and masked hypertension, but few studies on prognostic significance	Detection of white-coat effect and masked hypertension, and more studies on prognostic significance
Detection of true resistant hypertension	Detection of true resistant hypertension
Can favour adherence to treatment by giving the patient a more active role	Probably not useful to enhance adherence
Advantages and disadvantages of HBPM vs OBPM
HBPM	OBPM
Minimizes white-coat hypertension and white-coat effects	Prone to white-coat hypertension and white-coat effects
Potentially more practical to evaluate the effect of therapy, measuring BP more often and over a longer period	Less practical to evaluate the effect of therapy
More controlled by the patient	More controlled by the doctor
Gives information about day-to-day BP variability (the clinical significance of which is still under evaluation)	Gives information about visit-to-visit BP variability (for which there is more evidence of clinical significance)
Can give information about specific situations, e.g. drug-induced hypotension or post-prandial hypotension	More studies on prognostic significance
Detection of true resistant hypertension	Less useful to detect true resistant hypertension
Less standardized diagnostic criteria	Standardized diagnostic criteria
Can favour adherence to treatment by giving the patient a more active role	Reduced risk of self-medication
Gives information about BP at home and after home activities	More difficult to implement in underdeveloped countries

BP, blood pressure.