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Role of ambulatory and home blood pressure recording in clinical practice

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Abstract

Because of shortcomings of the office blood pressure (BP) measurement in individuals with hypertension (eg, white coat and masked hypertension effects, terminal digit bias, and large variability in BP among a small number of readings), use of out-of-office blood pressure measurements has become more common in clinical practice. The presence of the syndromes of white-coat and masked hypertension creates the concern that the office BP measurements are not reflective of an individual patient’s true BP values. Home (or self) and ambulatory BP assessments have been used in numerous types of clinical trials and have demonstrated their usefulness as reliable research and clinical tools. In this article, we review the recent literature on the benefits and limitations of home (self) and ambulatory monitoring of the BP in clinical practice. In particular, how it relates to the diagnosis of patients with various presentations of hypertension and to cardiovascular outcomes with long-term follow-ups of population cohorts.

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References and Recommended Reading

  1. White WB: Ambulatory blood pressure monitoring in clinical practice. N Engl J Med 2003, 348:2377–2378.

    Article  PubMed  Google Scholar 

  2. Thavarajah S, White WB, Mansoor GA: Terminal digit bias in a specialty hypertension faculty practice. J Hum Hyperten 2003, 17:819–822.

    Article  CAS  Google Scholar 

  3. Yarows SA, Staessen JA: How to use home blood pressure monitors in clinical practice. Am J Hypertens 2002, 15:93–96.

    Article  PubMed  Google Scholar 

  4. Chobanian AV, Bakris GL, Black HR, et al.: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003, 289:2560–2571.

    Article  CAS  PubMed  Google Scholar 

  5. O’Brien E, Asmar R, Beilin L, et al.: European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure measurement. J Hypertens 2003, 21:821–848.

    Article  PubMed  Google Scholar 

  6. Yarows SA, Julius S, Pickering TG: Home blood pressure monitoring. Arch Intern Med 2000, 160:1251–1257.

    Article  CAS  PubMed  Google Scholar 

  7. Association for the Advancement of Medical Instrumentation: American National Standard. Electronic or Automated Sphygmomanometers. ANSI/AAMI SP 10-1992. Arlington, VA: Association for the Advancement of Medical Instrumentation; 1993:40.

    Google Scholar 

  8. O’Brien E, Petrie J, Littler WA, et al.: The British Hypertension Society Protocol for the evaluation of blood pressure measuring devices. J Hypertens 1993, 11:S43–S63.

    Google Scholar 

  9. O’Brien E, Waeber B, Parati G, et al.: Blood pressure measuring devices: recommendations of the European Society of Hypertension. BMJ 2001, 322:531–536.

    Article  PubMed  Google Scholar 

  10. Pickering TG, White WB; American Society of Hypertension Writing Group: ASH Position Paper: Home and ambulatory blood pressure monitoring. When and how to use self (home) and ambulatory blood pressure monitoring. J Am Soc Hypertens 2008, 2:119–124.

    Article  Google Scholar 

  11. Staessen JA, Den Hond E, Celis H, et al.: Antihypertensive treatment based on blood pressure measurement at home or in the physician’s office: a randomized controlled trial. JAMA 2004, 291:955–964.

    Article  CAS  PubMed  Google Scholar 

  12. Chatellier G, Dutrey-Dupagne C, Vaur L, et al.: Home self blood pressure measurement in general practice. The SMART study. Self-measurement for the assessment of the response to trandolapril. Am J Hypertens 1996, 9:644–652.

    Article  CAS  PubMed  Google Scholar 

  13. Stergiou GS, Skeva II, Zourbaki AS, Mountokalakis TD: Self-monitoring of blood pressure at home: how many measurements are needed? J Hypertens 1998, 16:725–731.

    Article  CAS  PubMed  Google Scholar 

  14. Celis H, Den Hond E, Staessen JA: Self-measurement of blood pressure at home in the management of hypertension. Clin Med Res 2005, 3:19–26.

    Article  PubMed  Google Scholar 

  15. Stergiou GS, Thomopoulou GC, Skeva II, Mountokalakis TD: Home blood pressure normalcy: the Didima Study. Am J Hypertens 2000, 13:678–685.

    Article  CAS  PubMed  Google Scholar 

  16. Ohkubo T, Asayama K, Kikuya M, et al.: How many times should blood pressure be measured at home for better prediction of stroke risk? Ten-year follow-up results from the Ohasama study. J Hypertens 2004, 22:1099–1104.

    Article  CAS  PubMed  Google Scholar 

  17. Mansoor GA, White WB: Self-measured home blood pressure in predicting ambulatory hypertension. Am J Hypertens 2004, 17:1017–1022.

    Article  PubMed  Google Scholar 

  18. Thijs L, Staessen JA, Celis H, et al.: Reference values for selfrecorded blood pressure: a meta-analysis of summary data. Arch Intern Med 1998, 158:481–488.

    Article  CAS  PubMed  Google Scholar 

  19. Den Hond E, Celis H, Vandenhoven G, O’Brien E, Staessen J: Determinants of white-coat syndrome assessed by ambulatory blood pressure or self-measured home blood pressure. Blood Press Monit 2003, 8:37–40.

    Article  Google Scholar 

  20. Stergiou GS, Alamara CV, Skeva II, Mountokalis TD: Diagnostic value of strategy for the detection of white coat hypertension based on ambulatory and home blood pressure monitoring. J Hum Hypertens 2004, 18:85–89.

    Article  CAS  PubMed  Google Scholar 

  21. Verdecchia P, Porcellati C, Schillaci G, et al.: Ambulatory blood pressure. An independent predictor of prognosis in essential hypertension. Hypertension 1994, 24:793–801.

    CAS  PubMed  Google Scholar 

  22. Kario K, Shimada K, Schwartz JE, et al.: Silent and clinically overt stroke in older Japanese subjects with white-coat and sustained hypertension. J Am Coll Cardiol 2001, 38:238–245.

    Article  CAS  PubMed  Google Scholar 

  23. Khattar RS, Senior R, Lahiri A: Cardiovascular outcome in white-coat versus sustained mild hypertension. Circulation 1998, 98:1892–1897.

    CAS  PubMed  Google Scholar 

  24. Gustavsen PH, Høegholm A, Bank LE, Kristensen KS: White coat hypertension is a cardiovascular risk factor: a 10-year follow-up study. J Human Hypertens 2003, 17:811–817.

    Article  CAS  Google Scholar 

  25. Parati G, Stergiou GS: Self measured and ambulatory blood pressure in assessing the ‘white-coat’ phenomenon. J Hypertens 2003, 21:677–682.

    Article  CAS  PubMed  Google Scholar 

  26. 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, 11:820–827.

    Article  CAS  PubMed  Google Scholar 

  27. Stergiou GS, Skeva II, Baibas NM, et al.: Diagnosis of hypertension using home or ambulatory blood pressure monitoring: comparison with conventional strategy based on repeated clinic blood pressure measurements. J Hypertens 2000, 18:1745–1751.

    Article  CAS  PubMed  Google Scholar 

  28. Bombelli M, Sega R, Facchetti R, et al.: Prevalence and clinical significance of a greater ambulatory versus office blood pressure (’reversed white coat’ condition) in a general population. J Hypertens 2005, 23:513–520.

    Article  CAS  PubMed  Google Scholar 

  29. Bobrie G, Genès N, Vaur L, et al.: Is “isolated home” hypertension as opposed to “isolated office” hypertension a sign of greater cardiovascular risk? Arch Intern Med 2001, 161:2205–2211.

    Article  CAS  PubMed  Google Scholar 

  30. Stergiou GS, Salgami EV, Tzamouranis DG, Roussais LG: Masked hypertension assessed by ambulatory blood pressure versus home blood pressure monitoring: is it the same phenomenon? Am J Hypertens 2005, 18:772–778.

    Article  PubMed  Google Scholar 

  31. Ohkubo T, Imai Y, Tsuji I, et al.: Home blood pressure measurement has a stronger predictive power for mortality than does screening blood pressure measurement: a population-based observation in Ohasama, Japan. J Hypertens 1998, 16:971–975.

    Article  CAS  PubMed  Google Scholar 

  32. Pickering TG, Miller NH, Ogedegbe G, et al.: Call to action on use and reimbursement for home blood pressure monitoring: a joint scientific statement from the American Heart Association, American Society of Hypertension and Preventive Cardiovascular Nurses Association. Hypertension 2008, 52:10–29.

    Article  CAS  PubMed  Google Scholar 

  33. Pickering TG, Hall JE, Appel LJ, et al.: Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Circulation 2005, 111:697–716.

    Article  PubMed  Google Scholar 

  34. Hansen TW, Jeppesen J, Rasmussen S, et al.: Ambulatory blood pressure and mortality: a population-based study. Hypertension 2005, 45:499–504.

    Article  CAS  PubMed  Google Scholar 

  35. Cuspidi C, Meani S, Fusi V, et al.: Isolated ambulatory hypertension and changes in target organ damage in treated hypertensive patients. J Hum Hypertens 2005, 19:471–477.

    Article  CAS  PubMed  Google Scholar 

  36. Björklund K, Lind L, Zethelius B, et al.: Isolated ambulatory hypertension predicts cardiovascular morbidity in elderly men. Circulation 2003, 107:1297–1230.

    Article  PubMed  Google Scholar 

  37. Clement DL, De Buyzere ML, De Bacquer DA, et al.: Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension. N Engl J Med 2003, 348:2407–2415.

    Article  PubMed  Google Scholar 

  38. Ohkubo T, Imai Y, Tsuji I, et al.: Prediction of mortality by ambulatory blood pressure monitoring versus screening blood pressure measurements: a pilot study in Ohasama. J Hypertens 1997, 15:357–364.

    Article  CAS  PubMed  Google Scholar 

  39. Ohkubo T, Hozawa A, Nagai K, et al.: Prediction of stroke by ambulatory blood pressure monitoring versus screening blood pressure measurements in a general population: the Ohasama study. J Hypertens 2000, 18:847–854.

    Article  CAS  PubMed  Google Scholar 

  40. Sega R, Facchetti R, Bombelli M, et al.: Prognostic value of ambulatory and home blood pressures compared with office blood pressure in the general population: follow-up results from the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) Study. Circulation 2005, 111:1777–1783.

    Article  PubMed  Google Scholar 

  41. Pickering T G, Shimbo D, Haas D: Ambulatory blood-pressure monitoring. N Engl J Med 2006, 354:2368–2374.

    Article  CAS  PubMed  Google Scholar 

  42. Frattola A, Parati G, Cuspidi C, et al.: Prognostic value of 24-hour blood pressure variability. J Hypertens 1993, 11:1133–1137.

    Article  CAS  PubMed  Google Scholar 

  43. Sierra A, Redon J, Banegas J, et al.; Spanish Society of Hypertension Ambulatory Blood Pressure Monitoring Registry Investigators: Prevalence and factors associated with circadian blood pressure patterns in hypertensive patients. Hypertension 2009, 53:466–472.

    Article  PubMed  Google Scholar 

  44. Hernandez-del Rey R, Martin-Baranerab M, Sobrinoc J, et al.; Spanish Society of Hypertension Ambulatory Blood Pressure Monitoring Registry Investigators: Reproducibility of the circadian blood pressure pattern in 24-h versus 48-h recordings: the Spanish Ambulatory Blood Pressure Monitoring Registry. J Hypertens 2007, 25:2406–2412.

    Article  CAS  PubMed  Google Scholar 

  45. Perez-Lloret S, Toblli J, Cardinali DP, et al.: Nocturnal hypertension defined by fixed cut-off limits is a better predictor of left ventricular hypertrophy than non-dipping. Int J Cardiol 2008, 127:387–389.

    Article  PubMed  Google Scholar 

  46. White WB, LaRocca G: Improving the utility of the nocturnal hypertension definition by using absolute sleep blood pressure rather than the ‘dipping’ proportion. Am J Cardiol 2003, 92:1439–1441.

    Article  PubMed  Google Scholar 

  47. Boggia J, Li Y, Thijs L, et al.: Prognostic accuracy of day versus night ambulatory blood pressure: a cohort study. Lancet 2007, 370:1218–1229.

    Article  Google Scholar 

  48. Dolan E, Stanton A, Thijs L, et al.: Superiority of ambulatory over clinic blood pressure measurement in predicting mortality: the Dublin Outcome Study. Hypertension 2005, 46:156–161.

    Article  CAS  PubMed  Google Scholar 

  49. Kario K, Pickering TG, Umeda Y, et al.: Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives: a prospective study. Circulation 2003, 107:1401–1406.

    Article  PubMed  Google Scholar 

  50. Kuwajima I, Mitani K, Miyao M, et al.: Cardiac implication of the morning surge in blood pressure in elderly hypertensive patients: relation to arising time. Am J Hypertens 1995, 8:29–33.

    Article  CAS  PubMed  Google Scholar 

  51. Grin JM, McCabe EJ, White WB: Management of hypertension after ambulatory blood pressure monitoring. Ann Intern Med 1993, 118:833–837.

    CAS  PubMed  Google Scholar 

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Correspondence to William B. White.

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Ghuman, N., Campbell, P. & White, W.B. Role of ambulatory and home blood pressure recording in clinical practice. Curr Cardiol Rep 11, 414–421 (2009). https://doi.org/10.1007/s11886-009-0060-6

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