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#9 Home in the Range – Home Blood Pressure Monitoring

Is home blood pressure monitoring (HBPM) helpful in the management of adult hypertension?

HBPM appears to provide some advantages over office BP assessment and may be a helpful addition for willing patients.

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Multiple meta-analyses1-4 have assessed the effect of HBPM on the management of hypertension.
  • One meta-analysis1 of 26 studies (5,651 patients) comparing HBPM versus usual care.
    • At six months, systolic BP and diastolic BP improved by 3.9/2.4 mmHg.
      • Not statistically significant at 12 months and beyond.
    • No difference in quality of life.
    • Medication adherence was statistically significantly improved in three trials, but not in five others.
    • No trials have looked into hard cardiovascular outcomes.
  • European,5 US6 and Canadian7 guidelines all recommend HBPM.
  • Home and office-based BP monitoring perform similarly overall in diagnosing hypertension.8
    • The threshold for hypertension with HBPM is ≥135/85 mmHg.
  • Disagreement between OBP and HBPM:5,6
    • “White coat hypertension”:
      • Office BP ≥140/90 mmHg and HBPM <135/85 mmHg.
      • Occurs in <20%.
      • Prognosis may be modestly worse than being normotensive.
    • “Masked hypertension”:
      • Office BP <140/90 mmHg but HBPM ≥135/85 mmHg.
      • Occurs in <15%.
      • Prognosis may be similar to being hypertensive.
    • If available, consider ambulatory BP to help sort these out.
      • Ambulatory BP should probably be given precedent as it has the larger volume of outcome data.
      • If ambulatory BP disagrees with HBPM and office BP, repeat testing and followup should be considered as reproducibility is low in white coat and masked hypertension.
    • HBPM is superior to office BP measurements in predicting cardiovascular risk.9
    • HBP is generally lower than office BP (averaging 7 mmHg systolic/5 mmHg diastolic lower).10 The difference:
      • Increases with age and in men (for systolic, not diastolic).
      • Decreases in treated subjects.
        • Interventions to improve BP (e.g. medications) result in smaller reductions in HBPM than OBP (in one systematic review,4 medications reduced OBP by 20.1/13.6 mmHg and HBPM 13.9/9.1 mmHg).
    • Approach:5-7
      • Oscillometric device approved by the Canadian Hypertension Society. For details on HBPM including video and written instructions, encourage patients to consult For a list of approved devices (cost $80-130) see:
        • Arm-only (not wrist or finger) models.
        • Educate patients to proper measurement technique.
        • Preferable if device stores readings.
        • Most recommend monitoring as duplicate readings twice daily for seven days (and discard first day)
        • HBPM may not work well in patients with arrhythmia.
July 13 2016 by Ricky

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  • G. Michael Allan
  • Kathleen Hegan B.Sc.Hon (medical student)

1. Uhlig K, Patel K, Ip S, et al. Ann Intern Med. 2013; 159:185-94.

2. Agarwal R, Bills JE, Hecht TJW, et al. Hypertension. 2011; 57(1):29-38.

3. Glynn LG, Murphy AW, Smith SM, et al. Cochrane Database Syst Rev. 2010; (3):CD005182.

4. Bray EP, Holder R, Mant J, et al. Ann Med. 2010; 42:371-86.

5. Parati G, Stergiou GS, Asmar R, et al. J Hum Hypertens. 2010; 24:779-85.

6. Pickering TG, Houston Miller N, Ogedegbe G, et al. Hypertension. 2008; 52:1-9.

7. Hackam DG, Quinn RR, Ravani P, et al. Can J Cardiol. 2013; 29:528-42.

8. Hodgkinson J, Mant J, Martin U, et al. BMJ. 2011; 342:d3621.

9. Ward AM, Takahashi O, Stevens R, et al. J Hypertens. 2012; 30:449-56.

10. Verberk WJ, Kroon AA, Kessels AGH, et al. J Am Coll Cardiol. 2005; 46:743-51.

Authors do not have any conflicts of interest to declare.

Les auteurs n’ont aucun conflit d’intérêts à déclarer.