[Epidemiological study and participant-level meta-analysis on ambulatory monitoring and self-measured home blood pressure]

Self-measured blood pressure at home is a more accurate prognosticator than the conventionally measured blood pressure, because of the greater number of readings and the avoidance of the white-coat effect and measurement error. Ambulatory blood pressure recordings also have higher reproducibility and provide a better estimate of usual blood pressure and cardiovascular prognosis in individual. Participant-level meta-analysis showed that these out-of-office blood pressure substantially refines risk stratification at conventional blood pressure levels assumed to carry no or only mildly increased risk, in particular in the presence of masked hypertension. Properly designed randomized clinical trials are required to demonstrate whether identification and treatment of high out-of-office blood pressure versus the current standard of care, i.e., not to perform home blood pressure measurement and not to treat people with normotension on conventional measurement, leads to a reduction of cardiovascular complications and is cost-effective.