Home blood pressure self-measurement: ''Current situation and new perspectives'' (original) (raw)

Usefulness of Home Blood Pressure in the Diagnosis and Control of Hypertension in Primary Care

Current Hypertension Reviews, 2006

Self-measurement of blood pressure (BP) at home has gained increasing importance for the diagnostic and therapeutic evaluation of hypertensive patients. In comparison with clinic BP, self-measurement of BP with automated devices has several advantages: (1) higher reproducibility; (2) elimination of the "white coat effect" and observer bias; and (3) improvement of both compliance and BP control. Furthermore, there is evidence that home BP better correlates with target-organ damage and prognosis and provides a more accurate evaluation of treatment effect. On the other hand, it has great potential advantages of lower equipment and staff cost compared with ambulatory BP. These features of home BP have led various medical organizations to recognize its clinical usefulness in the diagnosis of white coat hypertension and in evaluating response to antihypertensive medication, particularly in the primary care setting. We aim here to present a critical review of the uses, strengths and weaknesses of the technique of home BP monitoring for the assessment of hypertension in the clinical practice.

Home Readings of Blood Pressure in Assessment of Hypertensive Subjects

Acta Medica Scandinavica, 2009

Outpatient clinic blood pressure (OPC-BP) was compared to home blood pressure (Home-BP) measured three times daily during a two week period in 122 consecutively referred hypertensive subjects. A semi-automatic device (TM-101) including a microphone for detection of Korotkoff-sounds, selfdeflation of cuff pressure and digital display of blood pressure was used. Mean difference between OPC-BP and Home-BP was systolic + 13 mm Hg (range-21-+ loo mg Hg) and diastolic + 5 mm Hg (Irange-2 7-+ 36 mm Hg). Although a significant correlation could be demonstrated between Home-BP and OPC-BP, the inter-individual scatter was pronounced and unpredictable from the hypertensive organ damages. It is argued, that home readings should be used to greater extent in the evaluation of patients with hypertension.

Home Blood Pressure Measurement - Epidemiology and Clinical Application

2008

Hypertension, the leading global risk factor for early mortality, can not be detected or treated without accurate and practical methods of BP measurement. Although home blood pressure (BP) measurement enjoys considerable popularity among patients, the lack of evidence needed to assure its place in modern clinical practice has hindered its widespread acceptance among physicians. The objective of this study was to show that home BP measurement is more accurate than conventional clinic BP measurement and can be used effectively in clinical practice. We assessed the use of home BP for diagnosing hypertension and guiding antihypertensive treatment. The association between home BP and hypertensive end-organ damage was also examined. The first study population consisted of a representative sample of the Finnish adult population (2 120 individuals aged 45-74 years). These subjects underwent a clinical interview, electrocardiography and measurement of clinic and home BP. Carotid intima-media thickness (an indicator of atherosclerosis) and arterial pulse wave velocity (an indicator of arterial stiffness) were also measured in two subsets of 758 and 237 subjects, respectively. In a second study cohort, consisting of 98 hypertensive patients, adjustment of antihypertensive treatment was randomized to either daytime ambulatory BP or home diastolic BP. Clinic BP was significantly higher than home BP (mean systolic/diastolic difference was 8/3 mmHg), and the overall agreement between the two methods in diagnosing hypertension was moderate at best (75%). Of 593 subjects with elevated clinic BP, 38% had normal BP at home; so called white-coat hypertension. Hypertension could therefore be overdiagnosed in every third patient in a clinical screening situation. White-coat hypertension was associated with mildly elevated clinic BP, lower body mass index and non-smoking status, but not with psychiatric disease. However, the cardiovascular risk profile of white-coat hypertensives was between that of the normotensives and sustained hypertensives, indicating that white-coat hypertension is not a completely benign phenomenon, and may be a precursor of true hypertension. Home BP was more closely associated with hypertensive end-organ damage (intima-media thickness, pulse wave velocity, and electrocardiographic evidence of left ventricular hypertrophy) than was clinic BP. The adjustment of antihypertensive treatment based on home BP measurement is effective as it led to equally good BP control as did ambulatory BP monitoring, which has been considered by many as the gold standard. On the basis of these results and data from previous studies, it can be concluded that home BP measurement is an improvement over conventional clinic BP measurement. Home monitoring of BP is as a convenient, accurate, and widely available option and may become the method of choice when diagnosing and treating hypertension. A paradigm shift is needed in BP measurement as evidencebased medicine suggests that clinic BP measurement should only be used for screening purposes.

Home Blood Pressure Measurement

Journal of The American College of Cardiology, 2005

The purpose of this research was to review the literature on home blood pressure measurement (HBPM) and to provide recommendations regarding HBPM assessment. Observational studies on HBPM, published after 1992, as identified by PubMed, EMBASE, and Cochrane literature searches were reviewed. Studies were selected if they met the following criteria: 1) self-measurements had been performed with validated devices; 2) measurement procedures were described in sufficient detail; and 3) papers clearly explained how final HBPM results were calculated upon which conclusions and/or treatment decisions were based. Office blood pressure measurement (OBPM) yields higher blood pressure values than HBPM. For systolic blood pressure, differences between OBPM and HBPM increase with age and the height of office pressure. Differences also tend to be greater in men than in women and greater in patients without than in those with antihypertensive treatment. Furthermore, HBPM can diagnose normotension with almost absolute certainty; it correlates better with target organ damage and cardiovascular mortality than OBPM, it enables prediction of sustained hypertension in patients with borderline hypertension, and it proves to be an appropriate tool for assessing drug efficacy. Despite some limitations and although more data are needed, HBPM is suitable for routine clinical practice. (J Am Coll Cardiol 2005;46:743-51)

Jananese Society of Hypertension (JSH) Guidelines for Self-Monitoring of Blood Pressure at Home

Hypertension Research, 2003

on Behalf of the Japanese Society of Hypertension Home blood pressure (BP) measurements are indispensable for the improvement of hypertension management in medical practice as well as for the recognition of hypertension in the population. The Working Group for Establishment of Guidelines for Measurement Procedures of Self-Monitoring of Blood Pressure at Home of the Japanese Society of Hypertension has established standards for all techniques and procedures of home BP measurements. The recommendations are as follows. Recommendation: 1) Arm-cuff devices based on the cuff-oscillometric method that have been validated officially, and the accuracy of which has been confirmed in each individual, should be used for home BP measurement. 2) The BP should be measured at the upper arm. Finger-cuff devices and wrist-cuff devices should not be used for home BP measurements. 3) Devices for home BP measurement should be adapted to the American Association for Medical Instrumentation (AAMI) standards and the British Hypertension Society (BHS) guidelines. In addition, the difference between the BP measured by the auscultatory method and that measured using the device should be within 5 mmHg in each individual. The home measurement device should be validated before use, and at regular intervals during use. 4) Home BP should be monitored under the following conditions. The morning measurement should be made within 1 h after waking, after micturition, sitting after 1 to 2 min of rest, before drug ingestion, and before breakfast. The evening measurement should be made just before going to bed, sitting after 1 to 2 min of rest. 5) Home BP should be measured at least once in the morning and once in the evening. 6) All home BP measurements should be documented without selection, together with the date, time, and pulse rate. Use of devices with a printer or an integrated circuit memory is useful to avoid selection bias. 7) The home BP in the morning and that in the evening should be averaged separately for a certain period. The first measurement on each occasion should be used for totaling. 8) Home BP values averaged for a certain period indicate hypertension when 135/80 mmHg and over and definite hypertension when 135/85 mmHg and over. Normotension is defined as less than 125/80 mmHg and definite normotension as less than 125/75 mmHg. Home BP measurements based on these guidelines can be considered an appropriate tool for clinical decision-making, and it is hoped that these guidelines will serve to reduce confusion and confirm the place of home BP measurement in clinical practice. (Hypertens Res 2003; 26: 771-782)

Self-measured home blood pressure in predicting ambulatory hypertension

American journal of hypertension, 2004

Physicians are commonly uncertain whether a person with office blood pressure (BP) around 140/90 mm Hg actually has hypertension. This is primarily because of BP variability. One approach is to perform self-measured home BP and determine if home BP is elevated. There is a general agreement that if home BP is >/=135/85 mm Hg, then antihypertensive therapy may be commenced. However, some persons with home BP below this cut-off will have ambulatory hypertension. We therefore prospectively study the role of home BP in predicting ambulatory hypertension in persons with stage 1 and borderline hypertension. We studied in a cross-sectional way home and ambulatory BP in a group of 48 patients with at least two elevated office BP readings. The group was free of antihypertensive drug therapy for at least 4 weeks and performed 7 days of standardized self-BP measurements at home. We examined the relationships of the three BP methods and also defined a threshold (using receiver operating curve...