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.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

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

C

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

A

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

C

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

C

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

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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.

References

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