Skip to main content

Home Blood Pressure Monitoring in Hypertension

  • Chapter
  • First Online:
Special Issues in Hypertension

Abstract

Hypertension is highly prevalent in the general population and represents a major risk factor for cardiovascular disease. The early identification of hypertension and the achievement of tight blood pressure (BP) control is thus a mainstay of cardiovascular prevention. Although routine BP measurements obtained in the clinic/office setting continue to be the basis for the diagnosis and management of hypertension, they are unable to provide a representative measure of patients’ actual BP burden, leading to misclassification of hypertension and being thus imperfect indicators of BP control. Recently available methodologies for home BP monitoring have been proposed as viable solutions for a better assessment and management of hypertension when combined with conventional office BP measurements. The availability of automated devices for BP measurement at home, the increasing awareness of the importance of regular BP monitoring, and the recognition of the benefits of clinical implementation of home BP monitoring by international hypertension management guidelines, have led to a wide diffusion of this technique. In spite of this, home BP monitoring in clinical practice is not always properly used, in part because of the limited information so far available from properly designed, randomized, controlled trials, which has prevented formally graded recommendations to be issued. The purpose of this chapter is to provide a critical review of the current evidence comparing the prognostic value of home BP monitoring with that of office BP monitoring as well as the advantages of home BP monitoring for the diagnostic and therapeutic approach to hypertension. Additionally, key methodological aspects are highlighted, which should be considered to better exploit the potential clinical benefits of home BP monitoring.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. MacMahon S, Peto R, Cutler J et al (1990) Blood pressure, stroke, and coronary heart disease. Part 1, prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 335:765–774

    Article  PubMed  CAS  Google Scholar 

  2. Mancia G, De Backer G, Dominiczak A et al (2007) 2007 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 25:1105–1187

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  4. Parati G, Mancia G (2003) White coat effect: semantics, assessment and pathophysiological implications. J Hypertens 21:481–486

    Article  PubMed  CAS  Google Scholar 

  5. Pickering TG, Miller NH, Ogedegbe G et al (2008) 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 52:10–29

    Article  PubMed  CAS  Google Scholar 

  6. National Institute for Health and Clinical Excellence (2011) Hypertension: clinical management of primary hypertension in adults. CG127. http://guidance.nice.org.uk/CG127/Guidance/pdf/English

  7. Parati G, Stergiou GS, Asmar R et al (2008) 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 26:1505–1526

    Article  PubMed  CAS  Google Scholar 

  8. Chobanian AV, Bakris GL, Black HR et al (2003) Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 42:1206–1252

    Article  PubMed  CAS  Google Scholar 

  9. Parati G, Stergiou GS, Asmar R et al (2010) European Society of Hypertension practice guidelines for home blood pressure monitoring. J Hum Hypertens 24:779–785

    Article  PubMed  CAS  Google Scholar 

  10. Parati G, Pickering TG (2009) Home blood-pressure monitoring: US and European consensus. Lancet 373:876–878

    Article  PubMed  Google Scholar 

  11. Parati G, Omboni S, Bilo G (2009) Why is out-of-office blood pressure measurement needed? Home blood pressure measurements will increasingly replace ambulatory blood pressure monitoring in the diagnosis and management of hypertension. Hypertension 54:181–187

    Article  CAS  Google Scholar 

  12. Sega R, Facchetti R, Bombelli M et al (2005) 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 111:1777–1783

    Article  PubMed  Google Scholar 

  13. Fagard RH, Celis H (2004) Prognostic significance of various characteristics of out-of-the-office blood pressure. J Hypertens 22:1663–1666

    Article  PubMed  CAS  Google Scholar 

  14. Mancia G, Facchetti R, Bombelli M et al (2006) Long-term risk of mortality associated with selective and combined elevation in office, home, and ambulatory blood pressure. Hypertension 47:846–853

    Article  PubMed  CAS  Google Scholar 

  15. Bobrie G, Chatellier G, Genes N et al (2004) Cardiovascular prognosis of “masked hypertension” detected by blood pressure self-measurement in elderly treated hypertensive patients. JAMA 291:1342–1349

    Article  PubMed  CAS  Google Scholar 

  16. Mancia G, Zanchetti A, Agabiti-Rosei E et al (1997) 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 95:1464–1470

    Article  PubMed  CAS  Google Scholar 

  17. Fagard RH, Van Den Broeke C, De Cort P (2005) Prognostic significance of blood pressure measured in the office, at home and during ambulatory monitoring in older patients in general practice. J Hum Hypertens 19:801–807

    Article  PubMed  CAS  Google Scholar 

  18. Ohkubo T, Imai Y, Tsuji I et al (1998) 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 16:971–975

    Article  PubMed  CAS  Google Scholar 

  19. Hozawa A, Ohkubo T, Nagai K et al (2000) Prognosis of isolated systolic and isolated diastolic hypertension as assessed by self-measurement of blood pressure at home: the Ohasama study. Arch Intern Med 160:3301–3306

    Article  PubMed  CAS  Google Scholar 

  20. Ohkubo T, Asayama K, Kikuya M et al (2004) 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 22:1099–1104

    Article  PubMed  CAS  Google Scholar 

  21. Asayama K, Ohkubo T, Kikuya M et al (2005) Use of 2003 European Society of Hypertension–European Society of Cardiology guidelines for predicting stroke using self-measured blood pressure at home: the Ohasama study. Eur Heart J 26:2026–2031

    Article  PubMed  Google Scholar 

  22. Ohkubo T, Asayama K, Kikuya M et al (2004) Prediction of ischaemic and haemorrhagic stroke by self-measured blood pressure at home: the Ohasama study. Blood Press Monit 9:315–320

    Article  PubMed  Google Scholar 

  23. Asayama K, Ohkubo T, Kikuya M et al (2004) Prediction of stroke by self-measurement of blood pressure at home versus casual screening blood pressure measurement in relation to the Joint National Committee 7 classification: the Ohasama study. Stroke 35:2356–2361

    Article  PubMed  Google Scholar 

  24. Nishinaga M, Takata J, Okumiya K et al (2005) High morning home blood pressure is associated with a loss of functional independence in the community-dwelling elderly aged 75 years or older. Hypertens Res 28:657–663

    Article  PubMed  Google Scholar 

  25. Okumiya K, Matsubayashi K, Wada T et al (1999) A U-shaped association between home systolic blood pressure and four-year mortality in community-dwelling older men. J Am Geriatr Soc 47:1415–1421

    PubMed  CAS  Google Scholar 

  26. Stergiou GS, Baibas NM, Kalogeropoulos PG (2007) Cardiovascular risk prediction based on home blood pressure measurement: the Didima study. J Hypertens 25:1590–1596

    Article  PubMed  CAS  Google Scholar 

  27. Agarwal R, Andersen MJ (2006) Prognostic importance of clinic and home blood pressure recordings in patients with chronic kidney disease. Kidney Int 69:406–411

    Article  PubMed  CAS  Google Scholar 

  28. Stergiou GS, Argyraki KK, Moyssakis I et al (2007) Home blood pressure is as reliable as ambulatory blood pressure in predicting target-organ damage in hypertension. Am J Hypertens 20:616–621

    Article  PubMed  Google Scholar 

  29. Tachibana R, Tabara Y, Kondo I et al (2004) Home blood pressure is a better predictor of carotid atherosclerosis than office blood pressure in community-dwelling subjects. Hypertens Res 27:633–639

    Article  PubMed  Google Scholar 

  30. Hara A, Ohkubo T, Kikuya M et al (2007) Detection of carotid atherosclerosis in individuals with masked hypertension and white-coat hypertension by self-measured blood pressure at home: the Ohasama study. J Hypertens 25:321–327

    Article  PubMed  CAS  Google Scholar 

  31. Niiranen T, Jula A, Kantola I et al (2007) Home-measured blood pressure is more strongly associated with atherosclerosis than clinic blood pressure: the Finn-HOME study. J Hypertens 25:1225–1231

    Article  PubMed  CAS  Google Scholar 

  32. Tsunoda S, Kawano Y, Horio T et al (2002) Relationship between home blood pressure and longitudinal changes in target organ damage in treated hypertensive patients. Hypertens Res 25:167–173

    Article  PubMed  Google Scholar 

  33. Tomiyama M, Horio T, Yoshii M et al (2006) Masked hypertension and target organ damage in treated hypertensive patients. Am J Hypertens 19:880–886

    Article  PubMed  Google Scholar 

  34. Agarwal R, Brim NJ, Mahenthiran J et al (2006) Out-of-hemodialysis-unit blood pressure is a superior determinant of left ventricular hypertrophy. Hypertension 47:62–68

    Article  PubMed  CAS  Google Scholar 

  35. Rave K, Bender R, Heise T, Sawicki PT (1999) Value of blood pressure self-monitoring as a predictor of progression of diabetic nephropathy. J Hypertens 17:597–601

    Article  PubMed  CAS  Google Scholar 

  36. Suzuki H, Nakamoto H, Okada H et al (2002) Self-measured systolic blood pressure in the morning is a strong indicator of decline of renal function in hypertensive patients with non-diabetic chronic renal insufficiency. Clin Exp Hypertens 24:249–260

    Article  PubMed  CAS  Google Scholar 

  37. Agarwal R, Andersen MJ (2006) Blood pressure recordings within and outside the clinic and cardiovascular events in chronic kidney disease. Am J Nephrol 26:503–510

    Article  PubMed  Google Scholar 

  38. Alborzi P, Patel N, Agarwal R (2007) Home blood pressures are of greater prognostic value than hemodialysis unit recordings. Clin J Am Soc Nephrol 2:1228–1234

    Article  PubMed  Google Scholar 

  39. Agarwal R (2010) Blood pressure and mortality among hemodialysis patients. Hypertension 55:762–768

    Article  PubMed  CAS  Google Scholar 

  40. Rothwell PM, Howard SC, Dolan E et al (2010) Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet 375:895–905

    Article  PubMed  Google Scholar 

  41. Muntner P, Shimbo D, Tonelli M et al (2011) The relationship between visit-to-visit variability in systolic blood pressure and all-cause mortality in the general population: findings from NHANES III, 1988 to 1994. Hypertension 57:160–166

    Article  PubMed  CAS  Google Scholar 

  42. Parati G, Bilo G (2008) Clinical relevance of day-by-day blood pressure and heart rate variability: new information from home self-measurements. Hypertension 52:1006–1008

    Article  PubMed  CAS  Google Scholar 

  43. Kikuya M, Ohkubo T, Metoki H et al (2008) Day-by-day variability of blood pressure and heart rate at home as a novel predictor of prognosis: the Ohasama study. Hypertension 52:1045–1050

    Article  PubMed  CAS  Google Scholar 

  44. Stryker T, Wilson M, Wilson TW (2004) Accuracy of home blood pressure readings: monitors and operators. Blood Press monit 9:143–147

    Article  PubMed  Google Scholar 

  45. Pickering TG, Gerin W, Holland JK (1999) Home blood pressure teletransmission for better diagnosis and treatment. Curr Hypertens Rep 1:489–494

    Article  PubMed  CAS  Google Scholar 

  46. Parati G, Omboni S (2010) Role of home blood pressure telemonitoring in hypertension management: an update. Blood Press Monit 15:285–295

    Article  PubMed  Google Scholar 

  47. De Luca N, Izzo R, Iaccarino G et al (2005) The use of a telematic connection for the follow-up of hypertensive patients improves the cardiovascular prognosis. J Hypertens 23:1417–1423

    Article  PubMed  Google Scholar 

  48. Mengden T, Ewald S, Kaufmann S et al (2004) Telemonitoring of blood pressure self measurement in the OLMETEL study. Blood Press Monit 9:321–325

    Article  PubMed  Google Scholar 

  49. Parati G, Omboni S, Albini F et al (2009) Home blood pressure telemonitoring improves hypertension control in general practice. The TeleBPCare study. J hypertens 27:198–203

    Article  PubMed  CAS  Google Scholar 

  50. Bobrie G, Postel-Vinay N, Delonca J, Corvol P, Investigators S (2007) Self-measurement and self-titration in hypertension: a pilot telemedicine study. Am J Hypertens 20:1314–1320

    Article  PubMed  Google Scholar 

  51. Mancia G, Parati G, Bilo G et al (2007) Assessment of long-term antihypertensive treatment by clinic and ambulatory blood pressure: data from the European lacidipine study on atherosclerosis. J Hypertens 25:1087–1094

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  53. Thijs L, Staessen JA, Celis H et al (1999) The international database of self-recorded blood pressures in normotensive and untreated hypertensive subjects. Blood Press Monit 4:77–86

    PubMed  CAS  Google Scholar 

  54. Asayama K, Ohkubo T, Kikuya M et al (2006) Prediction of stroke by home “morning” versus “evening” blood pressure values: the Ohasama study. Hypertension 48:737–743

    Article  PubMed  CAS  Google Scholar 

  55. Tsuji I, Imai Y, Nagai K et al (1997) Proposal of reference values for home blood pressure measurement: prognostic criteria based on a prospective observation of the general population in Ohasama, Japan. Am J hypertens 10:409–418

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  57. Verberk WJ, Kroon AA, Lenders JW et al (2007) Self-measurement of blood pressure at home reduces the need for antihypertensive drugs: a randomized, controlled trial. Hypertension 50:1019–1025

    Article  PubMed  CAS  Google Scholar 

  58. Saito S, Asayama K, Ohkubo T et al (2004) The second progress report on the hypertension objective treatment based on measurement by electrical devices of blood pressure (HOMED-BP) study. Blood Press Monit 9:243–247

    Article  PubMed  Google Scholar 

  59. Mancia G, Laurent S, Agabiti-Rosei E et al (2009) Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens 27:2121–2158

    Article  PubMed  CAS  Google Scholar 

  60. Ohkubo T, Kikuya M, Metoki H et al (2005) Prognosis of “masked” hypertension and “white-coat” hypertension detected by 24-h ambulatory blood pressure monitoring 10-year follow-up from the Ohasama study. J Am Coll Cardiol 46:508–515

    Article  PubMed  Google Scholar 

  61. Pickering TG, Davidson K, Gerin W, Schwartz JE (2002) Masked hypertension. Hypertension 40:795–796

    Article  PubMed  CAS  Google Scholar 

  62. Parati G, Ulian L, Santucciu C et al (1998) Difference between clinic and daytime blood pressure is not a measure of the white coat effect. Hypertension 31:1185–1189

    Article  PubMed  CAS  Google Scholar 

  63. Fagard RH, Cornelissen VA (2007) Incidence of cardiovascular events in white-coat, masked and sustained hypertension versus true normotension: a meta-analysis. J Hypertens 25:2193–2198

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  65. Williams B, Poulter NR, Brown MJ, Davis M et al (2004) British Hypertension Society guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004-BHS IV. J Hum Hypertens 18:139–185

    Google Scholar 

  66. Whitworth JA, World Health Organization ISoHWG (2003) World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens 21:1983–1992

    Google Scholar 

  67. Imai Y, Otsuka K, Kawano Y et al (2003) Japanese society of hypertension (JSH) guidelines for self-monitoring of blood pressure at home. Hypertens Res 26:771–782

    Google Scholar 

  68. Pickering TG, Hall JE, Appel LJ et al (2005) 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. Hypertension 45:142–161

    PubMed  CAS  Google Scholar 

  69. Cappuccio FP, Kerry SM, Forbes L, Donald A (2004) Blood pressure control by home monitoring: meta-analysis of randomised trials. BMJ 329:145

    Article  PubMed  Google Scholar 

  70. Rogers MA, Small D, Buchan DA et al (2001) Home monitoring service improves mean arterial pressure in patients with essential hypertension. A randomized, controlled trial. Ann Intern Med 134:1024–1032

    PubMed  CAS  Google Scholar 

  71. McManus RJ, Mant J, Roalfe A et al (2005) Targets and self monitoring in hypertension: randomised controlled trial and cost effectiveness analysis. BMJ 331:493

    Article  PubMed  CAS  Google Scholar 

  72. Ohkubo T, Obara T, Funahashi J et al (2004) Control of blood pressure as measured at home and office, and comparison with physicians’ assessment of control among treated hypertensive patients in Japan: First Report of the Japan Home versus Office Blood Pressure Measurement Evaluation (J-HOME) study. Hypertens Res 27:755–763

    Article  PubMed  Google Scholar 

  73. Denolle T, Waeber B, Kjeldsen S et al (2000) Self-measurement of blood pressure in clinical trials and therapeutic applications. Blood Press Monit 5:145–149

    PubMed  CAS  Google Scholar 

  74. Oikawa T, Obara T, Ohkubo T et al (2006) Characteristics of resistant hypertension determined by self-measured blood pressure at home and office blood pressure measurements: the J-HOME study. J Hypertens 24:1737–1743

    Article  PubMed  CAS  Google Scholar 

  75. Staessen JA, Thijs L, Fagard R et al (1999) Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension. Systolic hypertension in Europe trial investigators. JAMA 282:539–546

    Article  PubMed  CAS  Google Scholar 

  76. Kikuya M, Ohkubo T, Asayama K et al (2005) Ambulatory blood pressure and 10-year risk of cardiovascular and noncardiovascular mortality: the Ohasama study. Hypertension 45:240–245

    Article  PubMed  CAS  Google Scholar 

  77. Fagard RH, Celis H, Thijs L et al (2008) Daytime and nighttime blood pressure as predictors of death and cause-specific cardiovascular events in hypertension. Hypertension 51:55–61

    Article  PubMed  CAS  Google Scholar 

  78. Boggia J, Li Y, Thijs L et al (2007) Prognostic accuracy of day versus night ambulatory blood pressure: a cohort study. Lancet 370:1219–1229

    Article  PubMed  Google Scholar 

  79. Lacson E Jr, Lazarus JM (2007) The association between blood pressure and mortality in ESRD-not different from the general population? Semin Dial 20:510–517

    Article  PubMed  Google Scholar 

  80. Mallion JM, Clerson P, Bobrie G et al (2006) Predictive factors for masked hypertension within a population of controlled hypertensives. J Hypertens 24:2365–2370

    Article  PubMed  CAS  Google Scholar 

  81. Edmonds D, Foerster E, Groth H et al (1985) Does self-measurement of blood pressure improve patient compliance in hypertension? J Hypertens Suppl 3:S31–S34

    Article  PubMed  CAS  Google Scholar 

  82. Ogedegbe G, Schoenthaler A (2006) A systematic review of the effects of home blood pressure monitoring on medication adherence. J Clin Hypertens 8:174–180

    Article  Google Scholar 

  83. Logan AG, Dunai A, McIsaac WJ et al (2008) Attitudes of primary care physicians and their patients about home blood pressure monitoring in Ontario. J Hypertens 26:446–452

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Gianfranco Parati .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer-Verlag Italia

About this chapter

Cite this chapter

Parati, G., Ochoa, J.E., Bilo, G. (2012). Home Blood Pressure Monitoring in Hypertension. In: Berbari, A., Mancia, G. (eds) Special Issues in Hypertension. Springer, Milano. https://doi.org/10.1007/978-88-470-2601-8_9

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-2601-8_9

  • Published:

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-2600-1

  • Online ISBN: 978-88-470-2601-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics