Comparison of exercise blood pressure measured by technician and an automated system

We evaluated the automated system Blood Pressure Measuring System (BPMS) developed by NASA on 277 adult males who elected to have a treadmill test as part of their annual physical. The BPMS uses acoustic transduction with a computer-assisted ECG gating to detect nonsynchronous noise. The BPMS readings were compared to pressures simultaneously measured by trained technicians. For all stages of work, BPMS readings were higher for systolic and lower for diastolic than technician readings. At peak stages of work, BPMS systolic pressures were about 20 mmHg higher than technician readings. Within each 3-min workstage, BPMS readings were found to be more inconsistent than technician readings. The standard errors of measurement for BPMS were from two to three times higher than technician values. These data showed automated blood pressure readings were significantly different than technician values and subject to more random fluctuations. These findings demonstrate the need to view exercise blood pressure measured by automated systems with caution.     

Clinical evaluation of a self blood pressure monitor according to the First International Consensus Conference on Self Blood Pressure Measurement

BACKGROUND: The Calor TensioSense Bras automatic blood pressure monitor has obtained European Union certification, but the clinical validity of this new oscillometric device when handled by lay subjects has yet to be evaluated. DESIGN: The design employed prospective and blinded blood pressure measurements and a validation procedure according to the criteria set out by the First International Consensus Conference on Self Blood Pressure Measurement (1999). METHODS: Thirty-three subjects were recruited, 11 in each of three strata of systolic blood pressure (<130, 130-160 and >160 mmHg). Blood pressure was measured sequentially seven times, alternating observer and lay measurements. Two certified observers used two mercury columns and a double stethoscope; the subjects used the automatic device. All blood pressure readings and recordings were blinded. Adequate cuff sizes were used, and the subjects' position was standardized. Discrepancy analysis between manual and automatic measurements was carried out using VAPA software. RESULTS: Dispersion of the discrepancies between manual and automatic measurements showed no specific trend. Out of the 99 systolic blood pressure measurements, 53, 76 and 89 discrepancies were less than 5, 10 and 15 mmHg, respectively. Of the 99 diastolic blood pressure measurements, 62, 86 and 97 discrepancies were less than 5, 10 and 15 mmHg, respectively. The mean inter-observer discrepancy was 1 mmHg for both systolic and diastolic blood pressure comparisons. CONCLUSION: This evaluation showed that this device complies with the international validation protocol requirements. Thus, the device can, providing adequate instruction is given in the clinic, be recommended for self-measurement by patients at home, as well as for clinical or epidemiological research.     

Comparison of wrist blood pressure measurement with conventional sphygmomanometry at a cardiology outpatient clinic

OBJECTIVE: Oscillometric measurement of blood pressure at the wrist is becoming a widely used method for detection of hypertension and its control by treatment. The objective of the present study was to evaluate accuracy and suitability of wrist measurement in a clinical routine setting. PATIENTS AND METHODS: A series of 333 consecutive patients admitted to our cardiology outpatient clinic were included. Blood pressure was measured at both upper arms according to World Health Organization-International Society of Hypertension guidelines. Oscillometric measurement was performed at the contralateral wrist simultaneously. Blood pressure readings were taken by an oscillometric device applied at the wrist ('Klock'; Industrielle Entwicklung Medizintechnik, Stolberg, Germany) and a conventional mercury sphygmomanometer applied at the upper arm. RESULTS: Seventy-eight patients were excluded due to differences in blood pressure > 5 mmHg between both upper arms or due to 'error' messages of the wrist device. The data of the remaining 255 patients (149 males; mean age, 65 +/- 13 years; range, 18-95 years) are presented. Mean conventional blood pressure was significantly lower compared with the wrist device (137 +/- 20/80 +/- 11 mmHg versus 153 +/- 28/87 +/- 18 mmHg; P < 0.001 and P < 0.001). The mean difference was 16 +/- 25/6 +/- 17 mmHg. In clinical terms, differences in blood pressure exceeding +/-20/+/-10 mmHg reflecting classification of hypertension are considered important. Measurements of 101 (40%) patients were within these limits. Systolic readings of 110 (43%) and diastolic readings of 117 patients (46%) were beyond this scope. CONCLUSION: Due to low reliability of wrist blood pressure measurement, it cannot compete with the upper arm standard procedure. If ever, it should only be used if test readings in an individual comparing wrist and upper arm measurement show differences within a range of +/-20/+/-10 mmHg.     

The effect of the first office blood pressure reading on hypertension-related clinical decisions

Abstract

The effect of the first office blood pressure reading (FBPR) on hypertension-related decisions was evaluated using blood pressure (BP) readings taken with the BpTRU BPM-100 device. BP readings were grouped into three pairs: (1) single readings (first and second readings), (2) computed average of three readings (one including and one excluding the first reading), and (3) computed average of five readings (one including and one excluding the first reading). Categorisation of BP readings under JNC-7 classes and distribution into < 140/90 and ≥ 140/90 mmHg groups were selected as parameters guiding hypertension-related decisions. Readings including FBPR had strong positive correlations to those excluding FBPR (Pearson’s correlation coefficient ranged from 0.86–1.00). Also, FBPR-included and FBPR-excluded readings did not differ statistically in JNC-7 categorisation or distribution into < 140/90 or ≥ 140/90 mmHg groups. Our findings suggest that exclusion of FBPR may have no significant impact on hypertension-related clinical decisions.     

Discordant prevalence of hypertension using two different automated blood pressure measurement devices: a population-based study in Dar es Salaam (Tanzania)

OBJECTIVE: The estimation of blood pressure is dependent on the accuracy of the measurement devices. We compared blood pressure readings obtained with an automated oscillometric arm-cuff device and with an automated oscillometric wrist-cuff device and then assessed the prevalence of defined blood pressure categories. METHODS: Within a population-based survey in Dar es Salaam (Tanzania), we selected all participants with a blood pressure >/= 160/95 mmHg (n=653) and a random sample of participants with blood pressure <160/95 mmHg (n=662), based on the first blood pressure reading. Blood pressure was reassessed 2 years later for 464 and 410 of the participants, respectively. In these 874 subjects, we compared the prevalence of blood pressure categories as estimated with each device. RESULTS: Overall, the wrist device gave higher blood pressure readings than the arm device (difference in systolic/diastolic blood pressure: 6.3 +/- 17.3/3.7 +/- 11.8 mmHg, P<0.001). However, the arm device tended to give lower readings than the wrist device for high blood pressure values. The prevalence of blood pressure categories differed substantially depending on which device was used, 29% and 14% for blood pressure <120/80 mmHg (arm device versus wrist device, respectively), 30% and 33% for blood pressure 120-139/80-89 mmHg, 17% and 26% for blood pressure 140-159/90-99 mmHg, 12% and 13% for blood pressure 160-179/100-109 mmHg and 13% and 14% for blood pressure >/= 180/110 mmHg. CONCLUSIONS: A large discrepancy in the estimated prevalence of blood pressure categories was observed using two different automatic measurement devices. This emphasizes that prevalence estimates based on automatic devices should be considered with caution.     

Accuracy of oscillometric blood pressure monitoring with concurrent auscultatory blood pressure in hemodialysis patients

BACKGROUND: Oscillometric devices are commonly used to measure blood pressure and their validation entails sequential measurements of auscultated and oscillometric blood pressures. It is unknown whether simultaneous measurement of auscultated blood pressure and concurrent digitization and recording of the sounds can improve assessment of such devices. The aim of this study was to develop a technique of simultaneous measurement of blood pressure using oscillometric and auscultated measurements in the same deflation. Using such a device, we validated the Omron HEM-907 blood pressure measuring device in hemodialysis patients. METHODS: Twenty non-hypertensive subjects and 20 hemodialysis patients were studied. Six blood pressure readings were obtained in each participant; three readings were obtained using the automatic, oscillometric mode of Omron HEM-907 and three readings were obtained using the manual mode of the Omron HEM-907. In each situation, simultaneous digitized Korotkoff sounds and manometric pressures were recorded. The grading scale indicated by the British Hypertension Society protocol was used to assess the device. RESULTS: Systolic blood pressure measured simultaneously by digitized sound and pressures agreed closely for systolic pressure (Grade A for both hemodialysis and normal controls) but not for diastolic pressure (Grade C for both hemodialysis and controls). Sequential comparison of oscillometric readings with auscultated systolic and diastolic pressure yielded a Grade B for both hemodialysis patients and controls. When concurrent digitized systolic readings were used, however, Grade A was achieved for both populations for systolic readings, but Grade C for diastolic readings. The mean differences (SD) between the oscillometric and auscultatory blood pressure reading in normal controls were 4.3 (8.9) and 0.6 (8.7) for systolic and diastolic blood pressures, respectively. In hemodialysis patients, the mean differences (SD) were 2.7 (9.3) and 0.4 (7.0) for systolic and diastolic blood pressures, respectively. CONCLUSION: Simultaneous measurement of digitized Korotkoff sounds and pressure can improve the assessment of devices for systolic but not diastolic blood pressure. The Omron HEM-907 device can be recommended for use in hemodialysis patients.     

Validation of the HEM-780REL with easy wrap cuff for self-measurement of blood pressure according to the European Society of Hypertension International Protocol

OBJECTIVE: We tested the accuracy of the HEM-780REL automatic blood pressure monitor with Easy Wrap Cuff. METHODS: We used the International Protocol for validation of blood pressure measuring devices developed by the Working Group on Blood Pressure Monitoring of the European Society of Hypertension. Thirty-three adults over the age of 30 years participated to have 11 total participants in each of the three required blood pressure ranges for systolic and diastolic blood pressure. Sequential blood pressure readings were taken independently by trained observers using a mercury standard with appropriate size cuff. A third observer performed measurements with the test device. Analyses were performed according to International Protocol specifications for the 99 pairs of measurements. The device was given a pass/fail recommendation based on bands of accuracy compared with the mercury standard (within 5, 10, or 15 mmHg), as well as number of readings per participant within 5 mmHg. RESULTS: The mean blood pressure difference was 0.52+/-7.7 mmHg for systolic blood pressure and 0.39+/-4.7 mmHg for diastolic blood pressure. Twenty-four out of 33 participants had two out of three readings within 5 mmHg of the mercury standard for systolic blood pressure. Twenty-seven out of 33 participants had two out of three readings within 5 mmHg of the mercury standard for diastolic blood pressure. The device received a passing grade both for accuracy of individual measurements and for accuracy for individuals. CONCLUSION: The HEM-780REL with Easy Wrap Cuff performs accurately according to the standards of the International Protocol.     

Recommendations for blood pressure measuring devices for office/clinic use in low resource settings

This paper, which summarizes the conclusions of a WHO Expert meeting, is aimed at proposing indications to develop technical specifications for an accurate and affordable blood pressure measuring device for office/clinic use in low resource settings. Blood pressure measuring devices to be used in low resource settings should be accurate, affordable, and easily available worldwide. Given the serious inherent inaccuracy of the auscultatory technique, validated and affordable electronic devices, that have the option to select manual readings, seem to be a suitable solution for low resource settings. The agreement on the technical specifications for automated blood pressure measuring devices for office/clinic use in low resource settings included the following features: high accuracy, adoption of electronic transducers and solar batteries for power supply, standard rates of cuff inflation and deflation, adequate cuff size, digital display powered by solar batteries, facilities for adequate calibration, environmental requirements, no need of memory function, resistance to shock and temperature changes, and low cost. Availability of a device with these features should be accompanied by adequate training of health care personnel, who should guarantee implementation of the procedures recommended in recent European and American Guidelines for accurate blood pressure measurement.     

Validation of the Parama-Tech PS-501 device for office blood pressure measurement according to the international protocol

The PS-501 device (Parama-Tech, Fukuoka, Japan), an automated device for office blood pressure measurement based on the Korotkoff method and designed for professional use in clinical settings, was validated. Consecutive outpatients with hypertension and ≥30 years old at an outpatient hypertension clinic were recruited. According to the European Society of Hypertension protocol, 33 participants were included in the validation study (phase 1, n = 15; phase 2, n = 18). The cuff deflation rate can be selected manually from 2, 3, and 4 mm Hg/beat. The validation was performed with the device deflating at a rate of 2 mm Hg/beat. All blood pressure readings were measured on the left arm. The tested device passed all criteria for both systolic and diastolic blood pressure measurements. The mean (± standard deviation) differences in systolic and diastolic blood pressure between the tested device and the mean of observer readings were -1.9 ± 4.6 and -2.5 ± 2.9 mm Hg, respectively. The PS-501 device for office blood pressure measurement passed all the validation criteria of the European Society of Hypertension and can therefore be recommended for clinical use in an adult population.     

Performance of oscillometric blood pressure devices in children in resource-poor settings.

OBJECTIVE: To compare oscillometric blood pressure devices with mercury sphygmomanometry in children. PATIENTS AND METHODS: Blood pressure measurements were obtained with a mercury sphygmomanometer and one of two oscillometric devices. Correlations within each device and agreement between the two devices were evaluated. RESULTS: In children, blood pressure measured by the oscillometric device was poorly correlated and had wide limits of agreements with the sphygmomanometer. Furthermore, the oscillometric devices overestimated systolic blood pressure in children with higher readings. CONCLUSION: The applicability of automated blood pressure measuring devices in children has limitations and cannot be recommended.     

US demographic trends in mid-arm circumference and recommended blood pressure cuffs for children and adolescents: data from the National Health and Nutrition Examination Survey 1988-2004

OBJECTIVE: Mid-arm circumference measurement is a prerequisite for the selection of properly sized blood pressure cuffs for accurate blood pressure readings in children and youth. This study examined recent trends in the mid-arm circumference distribution and the distribution of corresponding recommended blood pressure cuff sizes using National Health and Nutrition Examination Survey III (1998-1994) and National Health and Nutrition Examination Survey 1999-2004 data. DESIGN: Both studies were complex, cross-sectional surveys providing nationally representative samples of the civilian noninstitutionalized US population. PARTICIPANTS: Children of 7-17 years of age were studied. A total of 2515 boys and 2596 girls participated in National Health and Nutrition Examination Survey III, and 3941 boys and 3917 girls in National Health and Nutrition Examination Survey 1999-2004. STATISTICAL ANALYSIS: Mean mid-arm circumference and recommended National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents defined blood pressure cuff sizes were assessed by sex, age, and race/ethnicity. US boys aged 7-12 years and girls aged 7-12 and 13-17 years had significant increases in mid-arm circumference (P<0.05) across the two surveys. Moreover, from 1988-1994 to 1999-2004, there were statistically significant increases in the percentage of boys (age 7-12 and 13-17 years) and girls (age 13-17 years) needing large blood pressure adult cuffs (P<0.05). National Health and Nutrition Examination Survey 1999-2004 data show that both boys and girls aged 13-17 years had a mean mid-arm circumference > or =27 cm, which requires an adult blood pressure cuff fit. Furthermore, 52% boys and 42% girls aged 13-17 years, required a standard adult cuff fit. CONCLUSION: Mean mid-arm circumference has increased among US children and adolescents, with important implications for the accuracy of blood pressure measurement in clinical practice.     

Validation of TM-2655 oscillometric device for blood pressure measurement

OBJECTIVE: To perform validation for an arm-type oscillometric TM-2655 device (A&D Company Ltd, Tokyo, Japan) for blood pressure measurement according to the British Hypertension Society protocol. METHODS: Eighty-five study participants (33 men and 52 women) were included in the study. Mean age was 52.9+/-15.0 years, systolic blood pressure range was 84-208 mmHg and diastolic blood pressure range was 48-120 mmHg. For each participant, three readings of TM-2655 were compared with sequential auscultatory measurements by two trained independent observers. The observers used a calibrated mercury sphygmomanometer and dual stethoscope. The results were graded according to the British Hypertension Society protocol 1993. RESULTS: The average difference between mercury sphygmomanometer and TM-2655 readings for systolic blood pressure was -1.0+5.2 mmHg (mean+/-SD) and for diastolic blood pressure -0.9+/-4.7 mmHg. The proportions of values agreeing to within 5, 10 and 15 mmHg were 72.5, 93.7 and 99.6% for systolic blood pressure and 78.8, 96.9 and 100% for diastolic blood pressure between the observers and the device (A/A British Hypertension Society grade). CONCLUSIONS: The TM-2655 device achieved British Hypertension Society grade A/A and therefore can be recommended for blood pressure measurement in an adult population.     

Validation of the TM-2564G device for in-hospital blood pressure measurement

OBJECTIVE: To perform clinical validation of the TM-2564G device for in-hospital blood pressure measurement according to the British Hypertension Society protocol. METHODS: The tests were carried out on 85 patients aged 19-82 years (41 male patients, mean age 50+/-19 years) with systolic blood pressure 75-219 mmHg and diastolic blood pressure 43-117 mmHg (mean 142+/-33/85+/-20 mmHg). For each patient, three readings of the TM-2564G device were compared with simultaneous auscultatory measurements by two trained independent observers. The observers used a mercury-calibrated sphygmomanometer and dual stethoscope. The results were graded according to the British Hypertension Society protocol 1993. RESULTS: The average difference was -1.85 mmHg for systolic blood pressure and -1.20 mmHg for diastolic blood pressure. The standard deviation of the difference between TM-2564G and the observers' results was 4.85 and 4.16 mmHg for systolic and diastolic blood pressures, respectively. Systolic blood pressure percentage of readings agreeing to within 5 mmHg was 75.7%, 10 mmHg 95.36% and 15 mmHg 99.6%, and for DBP 82.7, 97.6 and 99.8%, respectively. CONCLUSIONS: The TM-2564G device achieved A/A British Hypertension Society grade and can be recommended for in-hospital measurement of blood pressure.     

Task Force I: methodological aspects of blood pressure measurement

OBJECTIVE: To reach a consensus on important methodological aspects of blood pressure measurement. METHODS: A Task Force on the methodological aspects of blood pressure measurement wrote this review after the Eighth International Consensus Conference on Blood Pressure Monitoring, in Sendai, Japan (28-31 October 2001). This consensus paper is based on the papers presented by Task Force I and on the discussion sessions, and is therefore representative of a broad spectrum of expert opinion. POINTS OF CONSENSUS: Consensus was reached on the following five issues: (1) there is an urgent need for a simplified protocol for the validation of blood pressure measuring devices; (2) there is a need for a means of updating the "state of the market" for validated devices so that users can have easy access to this information; (3) new devices must be validated independently, and existing devices that have not been validated must be reappraised; (4) manufacturers should confirm when new models use algorithms which have been validated previously; (5) the Food and Drug Administration now accepts that when ambulatory blood pressure measurement is used in clinical short-term trials in which side-effects are not being assessed, a placebo arm is not required.     

Validation of the Microlife BP 3BTO-A oscillometric blood pressure monitoring device according to a modified British Hypertension Society protocol

BACKGROUND: The market for devices for the self-measurement of blood pressure is growing, and as accuracy is of prime importance, there is increasing pressure for manufacturers to provide evidence of independent testing. Recent reviews have shown that only five automated upper arm devices for self-measurement of blood pressure have been recommended for use. We tested the Microlife BP 3BTO-A, a lightweight, upper arm, automated oscillometric device, according to a modified version of the British Hypertension Society protocol and also analysed the computer-generated oscillograms for possible causes of inaccuracy. METHODS: One hundred and twenty-six subjects were recruited from general medical and specialist clinics and from amongst the staff at Guy's and St Thomas' Hospital, London, UK. Only 85 of these were included in the final analysis. Nine sequential readings were taken by two trained observers alternating between the mercury sphygmomanometer and the device. The last seven readings were analysed according to the British Hypertension Society protocol. Modifications to the protocol were: (1) the exclusion of patients whose blood pressure varied by more than 15 mmHg between sequential observer readings and (2) limited testing in the low systolic pressure range. RESULTS: The Microlife achieved a grade A for both systolic and diastolic pressure according to the British Hypertension Society protocol. The mean differences (standard deviation) between the observers and the device were -1.6 (7.7) mmHg and -2.1 (6.3) mmHg for systolic and diastolic blood pressure, respectively, therefore also fulfilling the criteria set by the Association for the Advancement of Medical Instrumentation. Sub-analysis for different pressure ranges showed that the device was less accurate in the high-pressure range (>160/100 mmHg). CONCLUSION: The Microlife can be recommended for clinical use in an adult population.     

Performance of the automated BpTRU measurement device in the assessment of white-coat hypertension and white-coat effect

OBJECTIVES: BpTRU (VSM MedTech Ltd, Vancouver, Canada) is an automated oscillometric device that provides serial blood pressure measurements in an office setting in the absence of a healthcare professional. We sought to determine whether the white-coat effect is reduced by a blood pressure measurement protocol using BpTRU compared with casual office measurements. Secondarily, we also sought to determine whether a blood pressure measurement protocol using BpTRU reduced white-coat hypertension compared with the casual office measurements, and reduced white-coat effect and white-coat hypertension compared with blood pressure obtained by a research nurse. METHODS: Blood pressure was measured in 107 adult hypertensive patients referred for ambulatory blood pressure monitoring using an ambulatory blood pressure monitor, a standardized protocol by a trained research nurse, and a protocol using BpTRU (five readings over 25 min, using the 5-min blood pressure measurement interval setting). Casual office blood pressure was also recorded in the family physicians' offices. Using the mean daytime ambulatory blood pressure as the reference standard, the proportion of patients with white-coat effect and white-coat hypertension were determined for measurements obtained by BpTRU, the research nurse, and the family physicians' offices. RESULTS: Casual office blood pressure measurements demonstrated a white-coat effect in 39 (36.4%) patients; seven (6.5%) patients demonstrated a white-coat effect using BpTRU (P<0.0001). White-coat hypertension was also less common using BpTRU than with the casual office readings (13 vs. 1 patient, P<0.0001). White-coat effect was also reduced with BpTRU compared with the research nurse measurements. Unfortunately, percentage agreement for the diagnosis of hypertension between the protocol using BpTRU and the reference standard was only 48%. This resulted in substantial misclassification of hypertension by the BpTRU measurement protocol. CONCLUSIONS: Although BpTRU reduces white-coat effect and white-coat hypertension, blood pressure is underestimated by the device, leading to misclassification of hypertension. BpTRU, when set at 5-min blood pressure measurement intervals, should not be used in clinical practice.     

Tracking of 24-hour and casual blood pressure: a 1-year follow-up study in adolescents

OBJECTIVE: Tracking of blood pressure begins in childhood but the relationship between casual blood pressure in childhood and adult levels is not strong enough to predict adult hypertension. The variability of blood pressure in children might suggest that 24 recordings would have less consistency than casual readings when repeated even a relatively short time later. This study compares the short-term tracking ability of casual versus 24-h blood pressure. DESIGN: An ambulatory blood pressure device was placed on 50 teenagers. Readings were taken at rest and the device was then worn for approximately 24 h, which included the schoolday. The protocol was repeated 1 year later. RESULTS: The correlation coefficient for systolic readings taken 1 year later were: 0.4 for casual, 0.6 for school, 0.6 for home, 0.5 for night-time and 0.8 for 24-h mean systolic blood pressures. When divided into upper and lower tertiles of systolic blood pressure the relationship between tertile ranking 1 year later was stronger for 24-h blood pressure than the casual readings. Casual diastolic pressure was more consistent than the 24-h mean diastolic measurement. CONCLUSIONS: In adolescents, in whom tracking of casual blood pressure has been shown to be poor, 24-h mean systolic blood pressure tracks better than any other time period and significantly better than the casual systolic readings. This study needs to be extended and the ability of 24-h blood pressure to track from childhood to adult life investigated.     

Is usual measurement of blood pressure meaningful?

BACKGROUND: Standardized measurement of blood pressure is widely recommended but rarely applied in usual clinical practice. OBJECTIVE: To determine the differences resulting from physicians using standardized and usual (casual) techniques for measurement of blood pressure. METHODS: Blood pressures measured by a research nurse, ambulatory blood pressure monitoring and echocardiographic estimation of left ventricular mass index were used as standards for comparison. RESULTS: Use of casual technique resulted in blood pressure readings higher than those obtained by standardized technique, namely 6.2 (3.1-9.3) systolic and 3.9 (2.4-5.4) diastolic mmHg [means (95% confidence intervals)], and readings that were more variable. Sixty-two patients (42%) were classified normotensive by standardized techniques but hypertensive by physicians casual technique. When standardized technique was used 22 patients (15%) were classified hypertensive but blood pressure readings in normal range were obtained by usual technique. Measurements obtained using standardized technique were less variable and were significantly correlated to left ventricular mass index. CONCLUSION: Using standardized technique is important if one is to classify the blood pressures of patients correctly. Use of usual or casual technique results in higher, more variable readings that are not related to left ventricular mass index. Results of this study strongly support recommendations that standardized technique should be used for assessing the cardiovascular risk of all adult patients.     

Call to action on use and reimbursement for home blood pressure monitoring: executive Summary. A joint scientific statement from the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association

Home blood pressure monitoring (HBPM) overcomes many of the limitations of traditional office blood pressure (BP) measurement and is both cheaper and easier to perform than ambulatory BP monitoring. Monitors that use the oscillometric method are currently available that are accurate, reliable, easy to use, and relatively inexpensive. An increasing number of patients are using them regularly to check their BP at home, but although this has been endorsed by national and international guidelines, detailed recommendations for their use have been lacking. There is a rapidly growing literature showing that measurements taken by patients at home are often lower than readings taken in the office and closer to the average BP recorded by 24-hour ambulatory monitors, which is the BP that best predicts cardiovascular risk. Because of the larger numbers of readings that can be taken by HBPM than in the office and the elimination of the white-coat effect (the increase of BP during an office visit), home readings are more reproducible than office readings and show better correlations with measures of target organ damage. In addition, prospective studies that have used multiple home readings to express the true BP have found that home BP predicts risk better than office BP (class IIa; level of evidence A). This call-to-action article makes the following recommendations: (1) It is recommended that HBPM should become a routine component of BP measurement in the majority of patients with known or suspected hypertension; (2) Patients should be advised to purchase oscillometric monitors that measure BP on the upper arm with an appropriate cuff size and that have been shown to be accurate according to standard international protocols. They should be shown how to use them by their healthcare providers; (3) Two to 3 readings should be taken while the subject is resting in the seated position, both in the morning and at night, over a period of 1 week. A total of > or =12 readings are recommended for making clinical decisions; (4) HBPM is indicated in patients with newly diagnosed or suspected hypertension, in whom it may distinguish between white-coat and sustained hypertension. If the results are equivocal, ambulatory BP monitoring may help to establish the diagnosis; (5) In patients with prehypertension, HBPM may be useful for detecting masked hypertension; (6) HBPM is recommended for evaluating the response to any type of antihypertensive treatment and may improve adherence; (7) The target HBPM goal for treatment is <135/85 mm Hg or <130/80 mm Hg in high-risk patients; (8) HBPM is useful in the elderly, in whom both BP variability and the white-coat effect are increased; (9) HBPM is of value in patients with diabetes, in whom tight BP control is of paramount importance; (10) Other populations in whom HBPM may be beneficial include pregnant women, children, and patients with kidney disease; and (11) HBPM has the potential to improve the quality of care while reducing costs and should be reimbursed.     

Call to Action on Use and Reimbursement for Home Blood Pressure Monitoring: Executive Summary: A Joint Scientific Statement From the American Heart Association,American Society of Hypertension,and Preventive Cardiovascular Nurses Association

Home blood pressure monitoring (HBPM) overcomes many of the limitations of traditional office blood pressure (BP) measurement and is both cheaper and easier to perform than ambulatory BP monitoring. Monitors that use the oscillometric method are currently available that are accurate, reliable, easy to use, and relatively inexpensive. An increasing number of patients are using them regularly to check their BP at home, but although this has been endorsed by national and international guidelines, detailed recommendations for their use have been lacking. There is a rapidly growing literature showing that measurements taken by patients at home are often lower than readings taken in the office and closer to the average BP recorded by 24-hour ambulatory monitors, which is the BP that best predicts cardiovascular risk. Because of the larger numbers of readings that can be taken by HBPM than in the office and the elimination of the white-coat effect (the increase of BP during an office visit), home readings are more reproducible than office readings and show better correlations with measures of target organ damage. In addition, prospective studies that have used multiple home readings to express the true BP have found that home BP predicts risk better than office BP (class IIa; level of evidence A). This call-to-action article makes the following recommendations: 1) It is recommended that HBPM should become a routine component of BP measurement in the majority of patients with known or suspected hypertension; 2) Patients should be advised to purchase oscillometric monitors that measure BP on the upper arm with an appropriate cuff size and that have been shown to be accurate according to standard international protocols. They should be shown how to use them by their healthcare providers; 3) Two to three readings should be taken while the subject is resting in the seated position, both in the morning and at night, over a period of 1 week. A total of ≥12 readings are recommended for making clinical decisions; 4) HBPM is indicated in patients with newly diagnosed or suspected hypertension, in whom it may distinguish between white-coat and sustained hypertension. If the results are equivocal, ambulatory BP monitoring may help to establish the diagnosis; 5) In patients with prehypertension, HBPM may be useful for detecting masked hypertension; 6) HBPM is recommended for evaluating the response to any type of antihypertensive treatment and may improve adherence; 7) The target HBPM goal for treatment is <135/85 mm Hg or <130/80 mm Hg in high-risk patients; 8) HBPM is useful in the elderly, in whom both BP variability and the white-coat effect are increased; 9) HBPM is of value in patients with diabetes, in whom tight BP control is of paramount importance; 10) Other populations in whom HBPM may be beneficial include pregnant women, children, and patients with kidney disease; and 11) HBPM has the potential to improve the quality of care while reducing costs and should be reimbursed.