Home Blood Pressure Monitoring

Abstract

See related article, p 675–682 Measurement of blood pressure outside of the clinic is recognized for providing superior accuracy in predicting future fatal and nonfatal cardiovascular and renal disease. The gold standard for these predictions is 24-hour ambulatory blood pressure monitoring that measures daytime and night- time pressures.1 Home blood pressure monitoring has rapidly made progress because devices for recording pressures taken at home have improved and become widely available.2 The advantages for this strategy are that pressures can be recorded during many days, weeks, and months. The newer devices can send results to a data center or individual care providers for review and management.3 In this sense, telemedicine has arrived for care of hypertension and seems to have made a successful landing. With the increasing need for primary care physicians, especially in the United States, telemedicine for hypertension may become a valuable alternative for management of hypertension.4 An important issue for management of hypertension has been whether the relationship between the clinic pressures and out-of-clinic pressures provides useful information. When this comparison discloses that clinic pressure is significantly higher than out-of-office pressure, that is, a white- coat effect, is the prognosis truly better? When the office pressure is lower than the out-of-office pressure (masked effect), is the predicted outcome worse? The accuracy of these classifications …