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Review
Home blood pressure monitoring: what does the evidence say?
  1. Teck K Khong1,
  2. Henry Fok12
  1. 1 Clinical Pharmacology, St George's, University of London, London, UK
  2. 2 Clinical Pharmacology, King's College British Heart Foundation Centre, London, UK
  1. Correspondence to Dr Teck K Khong, Clinical Pharmacology, St George's University of London, London SW17 0RE, UK; tkhong{at}sgul.ac.uk

https://doi.org/10.1136/dtb.2021.000025

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    Key learning points

    • Home blood pressure monitoring (HBPM) is superior to clinic blood pressure measurements in predicting future cardiovascular events.

    • HBPM is relatively inexpensive and acceptable to patients, but its uptake in the UK has been slower than in other countries.

    • Current evidence, professional bodies and clinical guidelines support the use of HBPM for confirmation of hypertension and also for identification and management of white coat and masked hypertension.

    • Evidence on the role of HBPM in long-term management of hypertension is evolving, with education, ongoing support and engagement with patients appearing to be important to its success.

    • Relatively short-term studies suggest that combining HBPM with additional interventions such as telemonitoring may be helpful in improving blood pressure levels and adherence to treatment.

    • Blood pressure measured at home is lower than when measured in clinics, with greater differences at higher levels of blood pressure, so it is important that an adjustment of +5/+5 mm Hg is added to readings acquired from HBPM for equivalence with clinic values at blood pressure levels around the threshold for diagnosis of hypertension.

    Introduction

    Hypertension affects 25% of the global population and is a major preventable cause of premature disability and mortality.1 Importantly, symptoms are usually absent and as a result patients are often undiagnosed and undertreated—this, despite the unequivocal evidence confirming the health and economic benefits of blood pressure (BP) lowering in hypertension. Non-invasive brachial artery BP measurement has been central to the screening, assessment and treatment monitoring of hypertension in clinical practice and has traditionally been undertaken in the clinic. This practice has shifted in the past decade, with major international hypertension societies endorsing the use of home blood pressure monitoring (HBPM) as a standard of care for hypertension management.2–7 This is supported by accumulating evidence that HBPM is reproducible and accurate provided that patients are taught …

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    Footnotes

    • Competing interests None declared. Refer to the online supplementary files to view the ICMJE form(s).

    • Provenance and peer review Commissioned; externally peer reviewed.