Devices for Home Blood Pressure Monitoring

Abstract

While home blood pressure (BP) monitoring (HBPM) for hypertension management is recommended by recent guidelines, very few recommendations are provided on the proper choices for devices. In the absence of guidance on how to choose reliable HBPM, the home BP device market has evolved into an uncontrolled one with a majority of devices either not validated or with questionable accuracy.

Several techniques for measuring BP are used by HBPM devices: the auscultatory approach, oscillometry, plethysmography, tonometry, pulse transit time, pulse wave velocity and other algorithms. The oscillometric arm-cuff method remains the most common validated approach for HBPM. HBPM can also be performed at different arterial sites: brachial, radial, and digit. Some home BP devices also provide central BP and other arterial parameters. Even if the brachial oscillometric method remains the preferred method, the use of wrist devices has potential for people with very large arms where the upper-arm measurements may be problematic for obese upper arm cuff sizes.

Most HBPM devices include several features to facilitate the precision of home BP values. Devices with memory, position sensor, atrial fibrillation detection and connectivity, have utility. Only devices fulfilling the regulatory requirements and validated independently according to established protocols should be used in practice. A unique validation protocol (Universal) has been established recently and will constitute the future standard for home BP devices. Updated lists of validated devices are available at several websites. These lists can be viewed before purchasing or prescribing HBPM devices which must suit the individual phenotype.