for Home Blood Pressure Monitoring



Recommendation on main indications for clinical use

ASH [2]


Confirm elevated office BP by HBPM. If they disagree confirm by ABPM

CHS [12]


When HBPM is used to assess WCH, the latter should be confirmed by ABPM if available

Australia [13]


Vague recommendations for detecting and following WCH and the treatment effects

FSH [14]


HBPM could be used for screening subjects with office hypertension, but if low ABPM is required. Seems appropriate for following WCH

ESH [15]


Unclear recommendation for detecting and following WCH

JSH [16]


HBPM suitable for the diagnosis of intractable hypertension and WCH and to assess treatment effects

ESH [17]


Can be used as screening method for WCH but requires confirmation by ABPM

AHA [18]


HBPM can be used for initial diagnosis and treatment evaluation

ASH [19]


Use HBPM to confirm office hypertension: If low continue to monitor; if high treat; if borderline confirm by ABPM

ESH [3, 20]

2008 2010

HBPM to be used by all treated hypertensives and to detect WCH and MH. If disagrees with ABPM, the latter should probably take precedence

AHA, ASH [21]


HBPM should be reimbursed and routinely used in most patients with known or suspected hypertension. Confirm office hypertension by HBPM: if low continue to monitor; if high treat; if borderline confirm by ABPM

JSH [9]


HBPM is essential for the diagnosis of WCH and MH and extremely effective for the evaluation of drug effects and facilitates long-term BP control



HBPM may be acceptable for confining hypertension (ABPM preferred)

Australia [23]


HBPM can be used to detect WCH and MH and to estimate the effectiveness of treatment

HOPE Asia [24]


Base diagnoses on office BP and HBPM. When they disagree give priority to HBPM and if possible confirm by ABPM

ABPM ambulatory blood pressure monitoring, ACC American College of Cardiology, AHA American Heart Association, ASH American Society of Hypertension, CHS Canadian Hypertension Society, ESC European Society of Cardiology, ESH European Society of Hypertension, FSH French Society of Hypertension, HBPM home blood pressure monitoring, HOPE Asia Network Hypertension Cardiovascular Outcome Prevention and Evidence in Asia, JSH Japanese Society of Hypertension, MH masked hypertension, WCH white coat hypertension

In 1999, the Canadian Hypertension Society adopted a similar approach for the use of HBPM [12], and in 2005 the Canadian Hypertension Education Program included HBPM in their recommended algorithm for the diagnosis of hypertension [25]. In 2006, the UK National Institute for Health and Clinical Excellence (NICE) guidelines for management of hypertension stated that HBPM and ABPM should not be used because their value had not been adequately established and further research was necessary (partial update of NICE clinical guideline 18, June 2006). However, in 2011 the NICE made the landmark recommendation that ABPM is necessary to confirm the diagnosis of hypertension in subjects with office hypertension at stages 1–2, but indicated that HBPM was a suitable alternative in those unable to tolerate ABPM [26]. Meanwhile, other organizations such as the European Society of Hypertension (ESH) [3, 15, 17], the American Heart Association [18], the American Society of Hypertension [19], the French Society of Hypertension [14], the Japanese Society of Hypertension [9, 16], and Australian organizations [13, 23] published scientific statements and guidelines specific for HBPM, in which this method was strongly supported for a major role in the diagnosis and management of hypertension (Table 16.1). In 2008, Thomas Pickering led a joint scientific statement by the American Heart Association and the American Society of Hypertension calling for the wide use of HBPM in most subjects with suspected or treated hypertension and recommended reimbursement for the method [21]. In the same year the ESH Working Group on Blood Pressure Monitoring also published HBPM guidelines which were very much in line with the American ones [3, 21, 27].

The 2017 American College of Cardiology/American Heart Association blood pressure guidelines [6] and the 2018 guidelines by the European Society of Cardiology/European Society of Hypertension [7] highlighted the role of HBPM as well as ABPM in the diagnosis and management of hypertension and started a new era in hypertension management on both sides of the Atlantic by endorsing out-of-office blood pressure measurement as mandatory for most diagnostic and treatment decisions (Table 16.2). However, the European guidelines still gave the option of basing the diagnosis of hypertension on repeated office blood pressure measurements taken on several visits, which probably presents a realistic approach given the limitations in the availability of HBPM and especially for ABPM [7].
Oct 30, 2020 | Posted by in Uncategorized | Comments Off on for Home Blood Pressure Monitoring
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