Diagnostic Value of Home Blood Pressure
Home blood pressure (BP) monitoring is a more accurate diagnostic modality for hypertension than office BP measurement. Nonetheless, home BP measurement (HBPM) must be performed at specific times (morning and evening) under specific conditions (e.g., with the subject at rest), and thus it is of limited use for detecting various forms of masked hypertension, such as daytime ambulatory hypertension and nighttime hypertension, which are better detected by ambulatory BP monitoring (ABPM). Indeed, if we use the same threshold of 135/85 mmHg for the diagnosis of hypertension by both HBPM and daytime ABPM, we find that HBPM misdiagnoses a significant number of cases of masked hypertension. On the other hand, HBPM has the important advantage of including a greater number of BP readings due to the use of repeated home measurements. In addition, out-of-office BP is not stable, but rather changes with the various day-by-day individual and environmental conditions. The diagnosis of hypertension and uncontrolled hypertension on medication, which is affected by real-world stressors and other conditions, could be detected more immediately by repeated self-measured HBPM than by the intermittent measurements used for office and/or ABPM.
KeywordsHome blood pressure monitoring Diagnostic value Day-by-day variability Masked hypertension White-coat hypertension
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