Home Blood Pressure Monitoring
Should You Be Doing It?

The key points in this “Call to Action” included the following:

• Home blood pressure monitoring (HBPM) overcomes many of the limitations of traditional, doctor’s office–based blood pressure measurement.
• HBPM is cheaper and easier than ambulatory blood pressure monitoring, in which a person wears a small machine that measures blood pressure every 15–30 minutes for 24 hours. Ambulatory blood pressure monitoring requires at least two visits to the health-care provider’s office: one to have the device put on, and one to return it the next day. Some health insurance plans cover the cost of ambulatory blood pressure monitoring, and some do not.
• Accurate, reliable, easy-to-use, and relatively inexpensive home blood pressure monitors are widely available. Many home monitors use the preferred oscillometric method to measure blood pressure (which uses an electronic pressure sensor), and most are fully automatic, meaning the user attaches the cuff, presses a button, and waits for the machine to do the rest. They can be cord- or battery-operated. An increasing number of people are using these monitors to regularly check their blood pressure at home.
• While HBPM has been endorsed by national and international guidelines, detailed recommendations for it have been lacking.
• There is a growing body of evidence that blood pressure readings done at home tend to be lower than those taken in a doctor’s office. The home measurements also tend to be closer to the average blood pressure recorded by 24-hour ambulatory monitors, which tends to be the best predictor of cardiovascular risk.
• A larger number of blood pressure readings can be taken by using HBPM than by measuring blood pressure only in the doctor’s office during appointments.
• White-coat hypertension, a temporary rise in blood pressure that occurs in many people during doctor’s office visits, is eliminated with home measurement.
• Scientific studies using multiple home readings have found that home blood pressure readings predict cardiovascular risk better than medical office readings.

Home monitoring recommendations
The following recommendations are based on the “Call to Action”:

1. Most people with known or suspected high blood pressure should make HBPM a routine part of blood pressure management.

2. Purchase an oscillometric monitor that measures blood pressure on the upper arm. It is of utmost importance for an accurate reading that the cuff fit your arm. If you are significantly under- or overweight, you may need to purchase a cuff that fits your arm separately from the monitor.

Check the cuff size when you purchase your monitor. If you’re unsure whether it will fit, ask your pharmacist, the retailer selling the monitor, or the manufacturer. You can special-order cuffs for some monitors.

3. While resting in a seated position, take two to three readings in a row, then average the numbers you get from these readings (some monitors will do this for you). Do this every day for a week, both in the morning and at night. Your health-care provider will need at least 12 readings to make any decisions about your care.

4. HBPM is recommended for people with newly diagnosed high blood pressure. It is also recommended if high blood pressure is suspected — that is, if home monitoring may help to distinguish between white-coat hypertension and sustained high blood pressure. If the results are equal, ambulatory blood pressure monitoring can be used to find out whether blood pressure is consistently high.

5. In people with prehypertension (blood pressure between 120/80 mm Hg and 139/89 mm Hg), HBPM may be useful to detect masked hypertension, in which blood pressure is lower in the doctor’s office than at other times.