Home Blood Pressure Monitoring


Home blood pressure monitoring provides important diagnostic information beyond in-office blood pressure readings and offers similar results to ambulatory blood pressure monitoring. Home blood pressure monitoring involves patients independently measuring their blood pressure with an electronic device, whereas ambulatory blood pressure monitoring involves patients wearing a portable monitor for 24 to 48 hours. Although ambulatory blood pressure monitoring is the diagnostic standard for measurement, home blood pressure monitoring is more practical and accessible to patients, and its use is recommended by the U.S. Preventive Services Task Force and the American College of Cardiology/American Heart Association. Home blood pressure monitoring generally results in lower blood pressure readings than in-office measurements, can confirm the diagnosis of hypertension after an elevated office blood pressure reading, and can identify patients with white coat hypertension or masked hypertension. Best practices for home blood pressure monitoring include using an appropriately fitting upper-arm cuff on a bare arm, emptying the bladder, avoiding caffeinated beverages for 30 minutes before taking the measurement, resting for five minutes before taking the measurement, keeping the feet on the floor uncrossed and the arm supported with the cuff at heart level, and not talking during the reading. An average of multiple readings, ideally two readings in the morning and again in the evening separated by at least one minute each, is recommended for one week. Home blood pressure readings can be used in hypertension quality measures.

The home measurement of blood pressure allows patients with hypertension to become more involved in their care and allows clinicians to diagnose hypertension and monitor therapy more accurately. Evidence shows that home blood pressure measurements are generally lower than blood pressure measured in a clinician's office.1,2 The current expansion of telemedicine has increased the need to monitor blood pressure at home and decreased the number of in-office blood pressure measurements.

 Enlarge     Print


Clinical recommendationEvidence ratingComments

To diagnose hypertension based on readings from a home blood pressure monitor, patients should obtain two measurements separated by at least one minute twice per day. Patients should be instructed to record their readings over the course of three (minimum) to seven (ideal) days. These readings should then be averaged.6,912


Primary literature based on randomized controlled trials, a cross-sectional study, and disease-oriented evidence

Home blood pressure monitoring or ambulatory blood pressure monitoring can identify several hypertension patterns, including confirmed, white coat, and masked, with the goal of reducing cardiovascular events.9,14,15


U.S. Preventive Services Task Force and American College of Cardiology/American Heart Association guidelines, and primary literature based on good-quality patient-oriented evidence and limited-quality patient-oriented evidence

Patients should be encouraged to use a validated and fully automated blood pressure measurement device with an appropriately sized upper arm cuff that stores measurements.9


Expert opinion based on American Heart Association guidelines and validation protocols

Patients should be educated on proper technique to obtain the most accurate reading from a home blood pressure monitor. During the measurement, patients should be seated with their back supported, legs uncrossed, feet flat on the floor, and arm resting on a flat surface and should avoid talking and texting.9,15


Expert opinion based on American Heart Association guidelines and validation protocols

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

The Authors

show all author info

JEFFREY M. WEINFELD, MD, MBI, FAAFP, is director of medical student education and a professor in the Department of Family Medicine at Georgetown University School of Medicine, Washington, D.C....

KATHRYN M. HART, MD, FAAFP, is director of the Primary Care Leadership Track and an associate professor in the Department of Family Medicine at Georgetown University School of Medicine.

JOSE D. VARGAS, MD, PhD, is an attending physician and assistant professor in the Department of Cardiology at MedStar Georgetown University Hospital.

Address correspondence to Jeffrey M. Weinfeld, MD, MBI, FAAFP, Georgetown University School of Medicine, 3900 Reservoir Rd. NW, GM4C Pre-Clinical Sciences, Washington, DC 20007. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.


show all references

1. Piper MA, Evans CV, Burda BU, et al. Diagnostic and predictive accuracy of blood pressure screening methods with consideration of rescreening intervals: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2015;162(3):192–204....

2. Glynn LG, Murphy AW, Smith SM, et al. Interventions used to improve control of blood pressure in patients with hypertension. Cochrane Database Syst Rev. 2010;(3):CD005182.

3. Wright JT Jr, Williamson JD, Whelton PK, et al.; SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control [published correction appears in N Engl J Med. 2017;377(25):2506]. N Engl J Med. 2015;373(22):2103–2116.

4. Kronish IM, Hughes C, Quispe K, et al. Implementing ambulatory blood pressure monitoring in primary care practice. Fam Pract Manag. 2020;27(3):19–25. Accessed May 24, 2021. https://www.aafp.org/fpm/2020/0500/p19.html

5. Yang WY, Melgarejo JD, Thijs L, et al.; International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes (IDACO) Investigators. Association of office and ambulatory blood pressure with mortality and cardiovascular outcomes. JAMA. 2019;322(5):409–420.

6. Pickering TG, Miller NH, Ogedegbe G, et al.; American Heart Association; American Society of Hypertension; Preventive Cardiovascular Nurses Association. 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):1–9.

7. The Community Preventive Services Task Force. Cardiovascular disease: self-measured blood pressure monitoring interventions for improved blood pressure control – when combined with additional support. June 2015. Accessed October 10, 2020. https://www.thecommunityguide.org/findings/cardiovascular-disease-self-measured-blood-pressure-with-additional-support

8. Constanti M, Boffa R, Floyd CN, et al. Options for the diagnosis of high blood pressure in primary care: a systematic review and economic model. J Hum Hypertens. 2021;35(5):455–461.

9. Muntner P, Shimbo D, Carey RM, et al. Measurement of blood pressure in humans: a scientific statement from the American Heart Association. Hypertension. 2019;73(5):e35–e66.

10. Stergiou GS, Skeva II, Zourbaki AS, et al. Self-monitoring of blood pressure at home: how many measurements are needed? J Hypertens. 1998;16(6):725–731.

11. Stergiou GS, Nasothimiou EG, Kalogeropoulos PG, et al. The optimal home blood pressure monitoring schedule based on the Didima outcome study. J Hum Hypertens. 2010;24(3):158–164.

12. Pickering TG, Shimbo D, Haas D. Ambulatory blood-pressure monitoring. N Engl J Med. 2006;354(22):2368–2374.

13. Parati G, Stergiou GS, Asmar R, et al.; ESH Working Group on Blood Pressure Monitoring. European Society of Hypertension practice guidelines for home blood pressure monitoring. J Hum Hypertens. 2010;24(12):779–785.

14. Krist AH, Davidson KW, Mangione CM, et al. Screening for hypertension in adults: US Preventive Services Task Force reaffirmation recommendation statement. JAMA. 2021;325(16):1650–1656.

15. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in J Am Coll Cardiol. 2018;71(19):2273–2275]. J Am Coll Cardiol. 2018;71(19):2199–2269.

16. James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8) [published correction appears in JAMA. 2014;311(17):1809]. JAMA. 2014;311(5):507–520.

17. American Academy of Family Physicians. Clinical practice guideline. Hypertension. Accessed May 24, 2021. https://www.aafp.org/family-physician/patient-care/clinical-recommendations/all-clinical-recommendations/highbloodpressure.html

18. Qaseem A, Wilt TJ, Rich R, et al. Pharmacologic treatment of hypertension in adults aged 60 years or older to higher versus lower blood pressure targets: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians [published correction appears in Ann Intern Med. 2018;168(7):530–532]. Ann Intern Med. 2017;166(6):430–437.

19. Mancia G, Bombelli M, Brambilla G, et al. Long-term prognostic value of white coat hypertension: an insight from diagnostic use of both ambulatory and home blood pressure measurements. Hypertension. 2013;62(1):168–174.

20. Fagard RH, Cornelissen VA. Incidence of cardiovascular events in white-coat, masked and sustained hypertension versus true normotension: a meta-analysis. J Hypertens. 2007;25(11):2193–2198.

21. Ohkubo T, Kikuya M, Metoki H, et al. 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. 2005;46(3):508–515.

22. Ishikawa J, Carroll DJ, Kuruvilla S, et al. Changes in home versus clinic blood pressure with antihypertensive treatments: a meta-analysis. Hypertension. 2008;52(5):856–864.

23. Tholl U, Anlauf M, Lichtblau U, et al. The Stamp of Quality (Prüfsiegel) of the German Hypertension League for the clinical validation of blood pressure measuring devices. Results from the testing of 51 devices [in German]. Dtsch Med Wochenschr. 2006;131(46 Spec No):H31–H36.

24. O'Brien E, Petrie J, Littler W, et al. An outline of the revised British Hypertension Society protocol for the evaluation of blood pressure measuring devices. J Hypertens. 1993;11(6):677–679.

25. O'Brien E, Atkins N, Stergiou G, et al.; Working Group on Blood Pressure Monitoring of the European Society of Hypertension. European Society of Hypertension International Protocol revision 2010 for the validation of blood pressure measuring devices in adults [published correction appears in Blood Press Monit. 2010;10(3):171–172]. Blood Press Monit. 2010;15(1):23–38.

26. The Dabl Educational Trust. Sphygmomanometers for self-measurement of blood pressure. Accessed October 13, 2020. http://www.dableducational.org/sphygmomanometers/devices_2_sbpm.html#ArmTable

27. National Quality Forum. Controlling high blood pressure. November 20, 2020. Accessed October 13, 2020. https://bit.ly/3BrA2MF

28. eCQI Resource Center. Controlling high blood pressure. eCQMs for 2021 performance period. Accessed October 12. 2021. https://ecqi.healthit.gov/ecqm/ep/2021/cms165v9?qt-tabs_measure=0

29. eCQI Resource Center. Controlling high blood pressure. eCQMs for 2022 performance period. Accessed October 12. 2021. https://ecqi.healthit.gov/ecqm/ep/2022/cms165v10

30. Thomas SS, Nathan V, Zong C, et al. BioWatch: a noninvasive wrist-based blood pressure monitor that incorporates training techniques for posture and subject variability. IEEE J Biomed Health Inform. 2016;20(5):1291–1300.

31. Casiglia E, Tikhonoff V, Albertini F, et al. Poor reliability of wrist blood pressure self-measurement at home: a population-based study. Hypertension. 2016;68(4):896–903.

32. Alpert BS, Dart RA, Sica DA. Public-use blood pressure measurement: the kiosk quandary. J Am Soc Hypertens. 2014;8(10):739–742.

33. Al Hamarneh YN, Houle SKD, Chatterley P, et al. The validity of blood pressure kiosk validation studies: a systematic review. Blood Press Monit. 2013;18(3):167–172.

34. Ostchega Y, Hughes JP, Zhang G, et al. Mean mid-arm circumference and blood pressure cuff sizes for U.S. adults: National Health and Nutrition Examination Survey, 1999–2010. Blood Press Monit. 2013;18(3):138–143.

35. Recommended blood pressure monitors. Consumer Reports. Accessed March 3, 2021. https://www.consumerreports.org/products/blood-pressure-monitors-33078/blood-pressure-monitor-33754/recommended

36. Centers for Medicare and Medicaid Services. Decision memo for ambulatory blood pressure monitoring. Accessed October 22, 2020. https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=294

37. Centers for Medicare and Medicaid Services. Durable medical equipment (DME) coverage. Accessed October 22, 2020. https://www.medicare.gov/coverage/durable-medical-equipment-dme-coverage

38. Moore KJ, Mullins A, Solis E, et al. The 2020 Medicare documentation, coding, and payment update. Fam Pract Manag. 2020:27(1):8–13. Accessed May 24, 2021. https://www.aafp.org/fpm/2020/0100/p8.html

39. Taylor JR, Campbell KM. Home monitoring of glucose and blood pressure. Am Fam Physician. 2007;76(2):255–260. Accessed May 12, 2021. https://www.aafp.org/afp/2007/0715/p255.html



Copyright © 2021 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz

More in AFP

Editor's Collections

Related Content


Oct 2021

Access the latest issue of American Family Physician

Read the Issue

Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article