The reason why home blood pressure measurements are preferred over clinic or ambulatory blood pressure in Japan

Abstract

Data regarding ambulatory blood pressure (ABP) or self-BP measurements at home (HBP) have been accumulated. The difference between ABP and HBP is that ABP monitoring (ABPM) provides BP information at many time points on a particular day during unrestricted routine daily activities, whereas HBP provides extensive amounts of BP information obtained under fixed times and conditions over a long period of time; thus, the mean values of HBP are stable, and the reproducibility are high. The high reproducibility of HBP is the rationale for its overall superiority over HBP compared with ABP and clinic BP (CBP). The higher practicality of HBPM over ABPM is definitely recognized. HBPM allows for ongoing disease monitoring by patients and can provide health-care providers with timely clinical data and direct and immediate feedback regarding the diagnosis and treatment of hypertension. HBP is better able than CBP to predict hypertensive target organ damage and a prognosis of cardiovascular disease. Unlike CBPM, HBPM provides BP information in relation to time, that is, BP in the morning, in the evening and at night during sleep. HBPM is an essential tool for the diagnosis of white-coat hypertension and masked hypertension. Day-to-day variability of HBP has clinical significance. HBPM yields minimal alerting effects and placebo effects. HBPM can distinguish small but significant serial changes in BP and is the most practical way to monitor BP in the day-by-day management of hypertension. HBPM improves compliance with antihypertensive medication. The operational threshold of HBP has been established. HBPM is suspected to have a great effect on the medical economy. The superiority of HBPM over ABPM and CBPM is apparent from almost all practical and clinical research perspectives. These characteristics of HBPM indicate that this method is ideal for the diagnosis and treatment of hypertension in daily practice.