Implementing Home Blood Pressure Into Practice

Abstract

See related article, pp 1081–1086 The growing worldwide epidemic of high blood pressure in both developed and developing nations is a challenge on many levels.1 The need for better prevention of cardiovascular disease through control of hypertension is clear.2 Public awareness of the need to treat hypertension is partly reflected by the widespread purchases of home blood pressure devices in several of the developed countries. In the United States, Japan, and Finland, the estimates are that 55% to 75% of hypertensive patients already have a home device.3 Research studies have provided a robust epidemiological basis for supporting the greater accuracy of home blood pressure monitoring (HBPM) compared with clinic pressures for prognosis of fatal and nonfatal cardiovascular disease in long-term follow-up surveys and in cross-sectional designs.4 There is a general consensus that HBPM is more convenient, available, and less costly than ambulatory blood pressure monitoring, but the superiority of ambulatory blood pressure monitoring for special clinical problems (ie, detection of nondippers or need for sleep pressures in chronic renal disease, autonomic neuropathies, and sleep apnea) is also clearly recognized.5 Surveys of both physicians6 and patients7 suggest that HBPM is both appreciated and recognized as a valuable strategy. Several experts in the field of hypertension research and care have published appeals to expand the use of HPBM for routine care and to have it supported by health care …