Home BP Monitoring

• Home Is Where the Heart Is: Call for Greater Use of Home Blood-Pressure Monitoring

  Michael O'Riordan

• Monitors that use oscillometry to measure the blood pressure at the brachial artery are preferred as are those with electric inflation of cuffs and memory.
• Wrist monitors are not recommended.
• Patients should follow similar procedures for HBPM as followed in the clinical measurement of blood pressure. For example, HBPM should be performed after resting for at least 5 minutes, with the upper arm supported at the level of the heart and both feet on the floor.
• At least 2 to 3 readings should be taken at 1 sitting, during intervals as little as 1 minute. Readings first thing in the morning and at night are preferred.
• HBPM by the oscillometric method may be unreliable among patients with atrial fibrillation or frequent ectopic beats.
• Readings may be continued for at least 1 week. Medical decisions should be based on 12 or more readings.
• Up to 10% of patients will have higher home blood pressure levels vs levels measured in the medical office (masked hypertension). This form of hypertension is associated with the same cardiovascular risk as sustained hypertension and mandates treatment.
• HBPM has been demonstrated to be useful in the prediction of target organ damage, cardiovascular events, and cardiovascular mortality. It has been demonstrated to be superior to office blood pressure monitoring in the prediction of microvascular and macrovascular complications of diabetes. 4 of 5 studies comparing home vs office blood pressure monitoring found that HBPM was the stronger predictor of cardiovascular events and mortality.
• The target home blood pressure for most patients with hypertension is less than 135/85 mm Hg. HBPM is useful in patients with a blood pressure goal of less than 130/80, such as those with diabetes, coronary heart disease, and chronic kidney disease.
• HBPM may improve medication adherence and blood pressure control. Blood pressure has been demonstrated to be 2.2/1.9 mm Hg lower among patients who use HBPM.
• HBPM may be particularly useful among older adults because this group is more likely to have white-coat hypertension, and patients may also be assessed for changes in orthostatic blood pressure.
• Blood pressure during pregnancy decreases and then increases. HBPM may detect abnormalities to this pattern, suggesting preeclampsia, sooner than office visits alone.
• The usual out-of-pocket cost for a home monitoring device is $80 to $100. HBPM is generally most cost effective when used to diagnose white-coat hypertension and therefore avoid treatment with antihypertensive medication. The authors of the scientific statement call for reimbursement for these devices.
• Overall, the current statement recommends that HBPM become a routine part of the management of hypertension, especially for patients with diabetes, coronary heart disease, chronic kidney disease, suspected medication nonadherence, or substantial white-coat hypertension.