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Home Blood Pressure Monitoring: Primary Role in Hypertension Management

  • Blood Pressure Monitoring and Management (G Ogedegbe and JA Staessen, Section Editors)
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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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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31:1281–357.

    CAS  PubMed  Google Scholar 

  2. Parati G, Stergiou GS, Asmar R, Bilo G, de Leeuw P, Imai Y, et al. European Society of Hypertension guidelines for blood pressure monitoring at home: a summary report of the Second International Consensus Conference on Home Blood Pressure Monitoring. J Hypertens. 2008;26:1505–26.

    CAS  PubMed  Google Scholar 

  3. O’Brien E, Parati G, Stergiou G, Asmar R, Beilin L, Bilo G, et al. European Society of Hypertension position paper on ambulatory blood pressure monitoring. J Hypertens. 2013;31:1731–68. Recent European guidelines on ambulatory blood pressure monitoring with complete review of the evidence.

    PubMed  Google Scholar 

  4. Stergiou GS, Asayama K, Thijs L, Kollias A, Niiranen TJ, Hozawa A, et al. International Database on HOme blood pressure in relation to Cardiovascular Outcome (IDHOCO) Investigators. Prognosis of white-coat and masked hypertension: international database of home blood pressure in relation to cardiovascular outcome. Hypertension. 2014;63:675–82. Individual data analysis of five populations (n = 6458, follow-up 8.3 years) showing increased cardiovascular risk in untreated and treated masked hypertensives detected by home measurements, whereas the white-coat hypertension phenomenon was a risk factor only in untreated subjects.

    CAS  PubMed  Google Scholar 

  5. Bliziotis IA, Destounis A, Stergiou GS. Home versus ambulatory and office blood pressure in predicting target organ damage in hypertension: a systematic review and meta-analysis. J Hypertens. 2012;30:1289–99.

    CAS  PubMed  Google Scholar 

  6. Stergiou GS, Bliziotis IA. Home blood pressure monitoring in the diagnosis and treatment of hypertension: a systematic review. Am J Hypertens. 2011;24:123–34.

    PubMed  Google Scholar 

  7. Stergiou GS, Siontis KC, Ioannidis JP. Home blood pressure as a cardiovascular outcome predictor: it’s time to take this method seriously. Hypertension. 2010;55:1301–3.

    CAS  PubMed  Google Scholar 

  8. Ward AM, Takahashi O, Stevens R, Heneghan C. Home measurement of blood pressure and cardiovascular disease: systematic review and meta-analysis of prospective studies. J Hypertens. 2012;30:449–56.

    CAS  PubMed  Google Scholar 

  9. Karpettas N, Destounis A, Kollias A, Nasothimiou E, Moyssakis I, Stergiou GS. Prediction of treatment-induced changes in target-organ damage using changes in clinic, home and ambulatory blood pressure. Hypertens Res. 2014.

  10. Mancia G, Facchetti R, Bombelli M, Grassi G, Sega R. Long-term risk of mortality associated with selective and combined elevation in office, home, and ambulatory blood pressure. Hypertension. 2006;47:846–53.

    CAS  PubMed  Google Scholar 

  11. Hansen TW, Kikuya M, Thijs L, Björklund-Bodegård K, Kuznetsova T, Ohkubo T, et al. IDACO Investigators. Prognostic superiority of daytime ambulatory over conventional blood pressure in four populations: a meta-analysis of 7,030 individuals. J Hypertens. 2007;25:1554–64.

    CAS  PubMed  Google Scholar 

  12. Nesbitt SD, Amerena JV, Grant E, Jamerson KA, Lu H, Weder A, et al. Home blood pressure as a predictor of future blood pressure stability in borderline hypertension. The Tecumseh Study. Am J Hypertens. 1997;10:1270–80.

    CAS  PubMed  Google Scholar 

  13. Stergiou GS, Zourbaki AS, Skeva II, Mountokalakis TD. White coat effect detected using self-monitoring of blood pressure at home: comparison with ambulatory blood pressure. Am J Hypertens. 1998;11:820–7.

    CAS  PubMed  Google Scholar 

  14. Stergiou GS, Skeva II, Baibas NM, Kalkana CB, Roussias LG, Mountokalakis TD. Diagnosis of hypertension using home or ambulatory blood pressure monitoring: comparison with the conventional strategy based on repeated clinic blood pressure measurements. J Hypertens. 2000;18:1745–51.

    CAS  PubMed  Google Scholar 

  15. Masding MG, Jones JR, Bartley E, Sandeman DD. Assessment of blood pressure in patients with type 2 diabetes: comparison between home blood pressure monitoring, clinic blood pressure measurement and 24-h ambulatory blood pressure monitoring. Diabet Med. 2001;18:431–7.

    CAS  PubMed  Google Scholar 

  16. Hond ED, Celis H, Fagard R, Keary L, Leeman M, O’Brien E, et al. THOP investigators. Self-measured versus ambulatory blood pressure in the diagnosis of hypertension. J Hypertens. 2003;21:717–22.

    PubMed  Google Scholar 

  17. Stergiou GS, Efstathiou SP, Argyraki CK, Roussias LG, Mountokalakis TD. White coat effect in treated versus untreated hypertensive individuals: a case-control study using ambulatory and home blood pressure monitoring. Am J Hypertens. 2004;17:124–8.

    PubMed  Google Scholar 

  18. Bayó J, Cos FX, Roca C, Dalfó A, Martín-Baranera MM, Albert B. Home blood pressure self-monitoring: diagnostic performance in white-coat hypertension. Blood Press Monit. 2006;11:47–52.

    PubMed  Google Scholar 

  19. Shimbo D, Kuruvilla S, Haas D, Pickering TG, Schwartz JE, Gerin W. Preventing misdiagnosis of ambulatory hypertension: algorithm using office and home blood pressures. J Hypertens. 2009;27:1775–83.

    CAS  PubMed  PubMed Central  Google Scholar 

  20. McGowan N, Padfield PL. Self blood pressure monitoring: a worthy substitute for ambulatory blood pressure? J Hum Hypertens. 2010;24:801–6.

    CAS  PubMed  Google Scholar 

  21. Nasothimiou EG, Tzamouranis D, Rarra V, Roussias LG, Stergiou GS. Diagnostic accuracy of home vs. ambulatory blood pressure monitoring in untreated and treated hypertension. Hypertens Res. 2012;35:750–5. The largest cross-sectional study (n = 613) on the diagnostic accuracy of home compared to ambulatory blood pressure with separate analyses in untreated and treated subjects.

    PubMed  Google Scholar 

  22. Almeida AE, Stein R, Gus M, Nascimento JA, Arévalo JR, Fuchs FD, et al. Improved diagnostic accuracy of a 3-day protocol of home blood pressure monitoring for the diagnosis of arterial hypertension. Blood Press Monit. 2013;18:119–26.

    PubMed  Google Scholar 

  23. Stergiou GS, Baibas NM, Gantzarou AP, Skeva II, Kalkana CB, Roussias LG, et al. Reproducibility of home, ambulatory, and clinic blood pressure: implications for the design of trials for the assessment of antihypertensive drug efficacy. Am J Hypertens. 2002;15:101–4.

    PubMed  Google Scholar 

  24. Stergiou GS, Salgami EV, Tzamouranis DG, Roussias LG. Masked hypertension assessed by ambulatory blood pressure versus home blood pressure monitoring: is it the same phenomenon? Am J Hypertens. 2005;18:772–8.

    PubMed  Google Scholar 

  25. Stergiou GS, Nasothimiou EG, Destounis A, Poulidakis E, Evagelou I, Tzamouranis D. Assessment of the diurnal blood pressure profile and detection of non-dippers based on home or ambulatory monitoring. Am J Hypertens. 2012;25:974–8.

    PubMed  Google Scholar 

  26. Nasothimiou EG, Tzamouranis D, Roussias LG, Stergiou GS. Home versus ambulatory blood pressure monitoring in the diagnosis of clinic resistant and true resistant hypertension. J Hum Hypertens. 2012;26:696–700.

    CAS  PubMed  Google Scholar 

  27. Comas A, González-Nuevo JP, Plaza F, Barreda MJ, Madiedo R, Pajón P, et al. Home self-monitoring of arterial pressure: identification of the white coat reaction. Aten Primaria. 1999;24:5–11.

    CAS  PubMed  Google Scholar 

  28. Llisterri JL, Gil VF, Rodríguez G, Orozco D, García A, Merino J. Interest of home blood pressure measurements to establish degree of hypertensive control. Blood Press. 2003;12:220–4.

    PubMed  Google Scholar 

  29. Martínez MA, Sancho T, García P, Moreno P, Rubio JM, Palau FJ, et al. Home blood pressure in poorly controlled hypertension: relationship with ambulatory blood pressure and organ damage. Blood Press Monit. 2006;11:207–13.

    PubMed  Google Scholar 

  30. Mancia G, Zanchetti A, Agabiti-Rosei E, Benemio G, De Cesaris R, Fogari R, et al. Ambulatory blood pressure is superior to clinic blood pressure in predicting treatment-induced regression of left ventricular hypertrophy. SAMPLE Study Group. Study on Ambulatory Monitoring of Blood Pressure and Lisinopril Evaluation. Circulation. 1997;95:1464–70.

    CAS  PubMed  Google Scholar 

  31. Zarnke KB, Feagan BG, Mahon JL, Feldman RD. A randomized study comparing a patient-directed hypertension management strategy with usual office-based care. Am J Hypertens. 1997;10:58–67.

    CAS  PubMed  Google Scholar 

  32. Broege PA, James GD, Pickering TG. Management of hypertension in the elderly using home blood pressures. Blood Press Monit. 2001;6:139–44.

    CAS  PubMed  Google Scholar 

  33. Staessen JA, Den Hond E, Celis H, Fagard R, Keary L, Vandenhoven G, et al. Treatment of Hypertension Based on Home or Office Blood Pressure (THOP) Trial Investigators. Antihypertensive treatment based on blood pressure measurement at home or in the physician’s office: a randomized controlled trial. JAMA. 2004;291:955–64.

    CAS  PubMed  Google Scholar 

  34. Halme L, Vesalainen R, Kaaja M, Kantola I. HOme MEasuRement of blood pressure study group. Self-monitoring of blood pressure promotes achievement of blood pressure target in primary health care. Am J Hypertens. 2005;18:1415–20.

    PubMed  Google Scholar 

  35. Verberk WJ, Kroon AA, Lenders JW, Kessels AG, van Montfrans GA, Smit AJ, et al. Home versus office measurement, reduction of unnecessary treatment study investigators. Self-measurement of blood pressure at home reduces the need for antihypertensive drugs: a randomized, controlled trial. Hypertension. 2007;50:1019–25.

    CAS  PubMed  Google Scholar 

  36. Tobe SW, Hunter K, Geerts R, Raymond N, Pylypchuk G. Canadian Hypertension Society. IMPPACT: Investigation of Medical Professionals and Patients Achieving Control Together. Can J Cardiol. 2008;24:205–8.

    PubMed  PubMed Central  Google Scholar 

  37. McManus RJ, Mant J, Bray EP, Holder R, Jones MI, Greenfield S, et al. Telemonitoring and self‑management in the control of hypertension (TASMINH2): a randomized controlled trial. Lancet. 2010;376:163–72.

    PubMed  Google Scholar 

  38. Niiranen TJ, Kantola IM, Vesalainen R, Johansson J, Ruuska MJ. A comparison of home measurement and ambulatory monitoring of blood pressure in the adjustment of antihypertensive treatment. Am J Hypertens. 2006;19:468–74.

    PubMed  Google Scholar 

  39. Stergiou GS, Karpettas N, Destounis A, Tzamouranis D, Nasothimiou E, Kollias A, et al. Home blood pressure monitoring alone vs. combined clinic and ambulatory measurements in following treatment-induced changes in blood pressure and organ damage. Am J Hypertens. 2014;27:184–92. Randomized trial showing no difference in blood pressure decline, hypertension control, and preclinical organ damage regression by using home blood pressure alone or combined office and ambulatory blood pressure for treatment initiation and titration for 1 year.

    CAS  PubMed  Google Scholar 

  40. Ogedegbe G, Schoenthaler A. A systematic review of the effects of home blood pressure monitoring on medication adherence. J Clin Hypertens (Greenwich). 2006;8:174–80.

    Google Scholar 

  41. Agarwal R, Bills JE, Hecht TJ, Light RP. Role of home blood pressure monitoring in overcoming therapeutic inertia and improving hypertension control: a systematic review and meta-analysis. Hypertension. 2011;57:29–38. Systematic review and meta-analysis of 37 randomized trials showing that home blood pressure monitoring is associated with more frequent antihypertensive medication reductions, less therapeutic inertia and improved hypertension control and can be further enhanced by telemonitoring.

    CAS  PubMed  Google Scholar 

  42. Glynn LG, Murphy AW, Smith SM, Schroeder K, Fahey T. Self-monitoring and other non-pharmacological interventions to improve the management of hypertension in primary care: a systematic review. Br J Gen Pract. 2010;60:e476–88.

    PubMed  PubMed Central  Google Scholar 

  43. Fuchs SC, Ferreira-da-Silva AL, Moreira LB, Neyeloff JL, Fuchs FC, Gus M, et al. Efficacy of isolated home blood pressure monitoring for blood pressure control: randomized controlled trial with ambulatory blood pressure monitoring - MONITOR study. J Hypertens. 2012;30:75–80.

    CAS  PubMed  Google Scholar 

  44. Cuspidi C, Meani S, Fusi V, Salerno M, Valerio C, Severgnini B, et al. Home blood pressure measurement and its relationship with blood pressure control in a large selected hypertensive population. J Hum Hypertens. 2004;18:725–31.

    CAS  PubMed  Google Scholar 

  45. Bloch MJ, Basile JN. UK guidelines call for routine 24-hour ambulatory blood pressure monitoring in all patients to make the diagnosis of hypertension - not ready for prime time in the United States. J Clin Hypertens. 2011;13:871–2.

    Google Scholar 

  46. James K, Dolan E, O’Brien E. Making ambulatory blood pressure monitoring accessible in pharmacies. Blood Press Monit. 2014;19:134–9.

    PubMed  Google Scholar 

  47. Little P, Barnett J, Barnsley L, Marjoram J, Fitzgerald-Barron A, Mant D. Comparison of acceptability of and preferences for different methods of measuring blood pressure in primary care. Br Med J. 2002;325:358–9.

    Google Scholar 

  48. Nasothimiou EG, Karpettas N, Dafni MG, Stergiou GS. Patients’ preference for ambulatory versus home blood pressure monitoring. J Hum Hypertens. 2014;28:224–9.

    CAS  PubMed  Google Scholar 

  49. Myers MG, Stergiou GS. Reporting bias: Achilles’ heel of home blood pressure monitoring. J Am Soc Hypertens. 2014;8:350–7. A review of the evidence on the main drawback of home blood pressure monitoring, its impact on decision-making, and measures for its prevention.

    PubMed  Google Scholar 

  50. Pickering TG, Miller NH, Ogedegbe G, Krakoff LR, Artinian NT, Goff D, et al. Call to action on use and reimbursement for home blood pressure monitoring: executive summary: a joint scientific statement from the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association. Hypertension. 2008;52:1–9.

    CAS  PubMed  Google Scholar 

  51. Stergiou GS, Jaenecke B, Giovas PP, Chang A, Chung-Yueh Y, Tan TM. A tool for reliable self-home blood pressure monitoring designed according to the European Society of Hypertension recommendations: the Microlife WatchBP Home monitor. Blood Press Monit. 2007;12:127–31.

    PubMed  Google Scholar 

  52. AbuDagga A, Resnick HE, Alwan M. Impact of blood pressure telemonitoring on hypertension outcomes: a literature review. Telemed J E Health. 2010;16:830–8.

    PubMed  Google Scholar 

  53. Zullig LL, Melnyk SD, Goldstein K, Shaw RJ, Bosworth HB. The role of home blood pressure telemonitoring in managing hypertensive populations. Curr Hypertens Rep. 2013;15:346–55.

    PubMed  PubMed Central  Google Scholar 

  54. Omboni S, Gazzola T, Carabelli G, Parati G. Clinical usefulness and cost effectiveness of home blood pressure telemonitoring: meta-analysis of randomized controlled studies. J Hypertens. 2013;31:455–67. Systematic review and meta-analysis of 23 randomized trials (n = 7037 patients) showing that home blood pressure telemonitoring may improve hypertension control and associated healthcare outcomes.

    CAS  PubMed  Google Scholar 

  55. Stergiou GS, Nasothimiou EG. Hypertension: Does home telemonitoring improve hypertension management? Nat Rev Nephrol. 2011;7:493–5.

    PubMed  Google Scholar 

  56. National Institute for Health and Clinical Excellence (NICE). Hypertension. The clinical management of primary hypertension in adults. Clinical Guideline 127. 2011. www.nice.org.uk/guidance/CG127. Accessed 12 Apr 2014.

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Correspondence to George S. Stergiou.

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Conflict of Interest Anastasios Kollias, Marilena Zeniodi, Nikos Karpettas, and Angeliki Ntineri declare that they have no conflicts of interest.

George S. Stergiou has received honoraria for educational lectures from Omron and consultation fees from Microlife.

Human and Animal Rights and Informed Consent This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Blood Pressure Monitoring and Management

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Stergiou, G.S., Kollias, A., Zeniodi, M. et al. Home Blood Pressure Monitoring: Primary Role in Hypertension Management. Curr Hypertens Rep 16, 462 (2014). https://doi.org/10.1007/s11906-014-0462-8

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