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Home blood pressure monitoring: primary role in hypertension management
George S Stergiou1, Anastasios Kollias, Marilena Zeniodi
1Hypertension Center, STRIDE Hellas-7, Third University Department of Medicine, Sotiria Hospital, 152 Mesogion Avenue, Athens, 11527, Greece, gstergi@med.uoa.gr.
Insights
Home blood pressure monitoring accurately predicts cardiovascular events and aids in hypertension management. Current guidelines recommend its widespread clinical use for diagnosis, treatment adjustment, and follow-up.
Area of Science:
- Cardiology
- Hypertension Management
- Preventive Medicine
Background:
- Home blood pressure monitoring (HBPM) has gained significant traction over the last two decades.
- Current clinical guidelines advocate for the broad implementation of HBPM in practice.
Purpose of the Study:
- To evaluate the predictive value of HBPM for preclinical target organ damage and cardiovascular events.
- To assess the agreement between HBPM and 24-hour ambulatory monitoring in identifying hypertension phenomena.
- To determine the impact of HBPM on blood pressure control and treatment adherence.
Main Methods:
- Review of outcome studies comparing HBPM with office blood pressure measurements and 24-hour ambulatory monitoring.
- Analysis of cross-sectional studies examining the detection of white-coat and masked hypertension using HBPM.
- Evaluation of studies investigating blood pressure changes and treatment adherence with HBPM-guided adjustments.
Main Results:
- HBPM demonstrates superior prediction of cardiovascular events compared to office measurements and is comparable to ambulatory monitoring.
- HBPM effectively identifies white-coat and masked hypertension, aligning well with ambulatory monitoring.
- HBPM facilitates greater blood pressure reduction and improved long-term adherence to antihypertensive medications.
Conclusions:
- HBPM is a reliable tool for diagnosing and managing hypertension, not merely a screening method.
- HBPM should play a primary role in the diagnosis, treatment adjustment, and long-term follow-up of most hypertensive patients.
- Unbiased HBPM, following current recommendations, is crucial for effective hypertension care.
Abstract:
In the last two decades, considerable evidence on home blood pressure monitoring has accumulated and current guidelines recommend its wide application in clinical practice. First, several outcome studies have shown that the ability of home blood pressure measurements in predicting preclinical target organ damage and cardiovascular events is superior to that of the conventional office blood pressure measurements and similar to that of 24-hour ambulatory monitoring. Second, cross-sectional studies showed considerable agreement of home blood pressure measurements with ambulatory monitoring in detecting the white-coat and masked hypertension phenomena, in both untreated and treated subjects. Third, studies have shown larger blood pressure decline by using home blood pressure monitoring instead of office measurements for treatment adjustment. Fourth, in treated hypertensives, home blood pressure monitoring has been shown to improve long-term adherence to antihypertensive drug treatment and thus, has improved hypertension control rates. These data suggest that home blood pressure should no longer be regarded as only a screening tool that requires confirmation by ambulatory monitoring. Provided that an unbiased assessment is obtained according to current recommendations, home blood pressure monitoring should have primary role in diagnosis, treatment adjustment, and long-term follow-up of most cases with hypertension.
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