Poor Blood Pressure and Urinary Albumin Excretion Responses to Home Blood Pressure-Based Antihypertensive Therapy in Depressive Hypertensive Patients

J Clin Hypertens (Greenwich). There has been no report comparing the changes in home blood pressure (HBP) and target organ damage between depressive and nondepressive hypertensives receiving antihypertensive therapy based on HBP monitoring. This study was a multicenter prospective study conducted by 7 doctors at 2 institutions. The authors prospectively studied 42 hypertensive patients with home systolic blood pressure >135 mm Hg. Participants were divided into a depression group (Beck Depression Inventory score >10; n=21) and a nondepression group (Beck Depression Inventory score <9, matched for HBP level; n=21). The authors performed antihypertensive therapy to reduce home systolic blood pressure to below 135 mm Hg and, 6 months later, evaluated the urinary albumin/creatinine ratio (UACR). Although patients in the depression group tended to require the addition of a greater number of medications than those in the nondepression group (2.3±1.0 vs 1.7±1.0 drugs, P<.05), HBP was reduced similarly in both groups at 6 months (depression group: 150±17/78±11 mm Hg to 139±11/73±8 mm Hg, P<.001; nondepression group: 150±11/76±9 mm Hg to 135±9/70±8 mm Hg, P<.01). The reduction of UACR was smaller in the depression group than in the nondepression group (2.4 vs 10.1 mg/gCr, P<.05). Depressive hypertensive patients required a larger number of antihypertensive drugs to control HBP, and showed a smaller reduction in UACR than nondepressive hypertensives.     

Masked Hypertension Defined by Ambulatory Blood Pressure Monitoring Is Associated With an Increased Serum Glucose Level and Urinary Albumin‐Creatinine Ratio

J Clin Hypertens(Greenwich). 2010;12:578–587. © 2010 Wiley Periodicals, Inc. The authors evaluated the relationship of hypertensive target organ damage to masked hypertension assessed by ambulatory blood pressure (BP) and home blood pressure (HBP) monitoring in 129 participants without taking antihypertensive medication. Masked hypertension was defined as office BP ≤140/90 mm Hg and 24-hour ambulatory BP ≥130/80 mm Hg. The masked hypertensive participants defined by 24-hour ambulatory BP (n=13) had a higher serum glucose level (126 vs 96 mg/dL, P=.001) and urinary albumin-creatinine ratio (38.0 vs 7.5 mg/gCr, P<.001) than the normotensive participants (n=74); however, these relationships were not observed when the authors defined groups using HBP (≥135/85 mm Hg). Masked hypertension by both 24-hour ambulatory BP and HBP had a higher urinary albumin-creatinine ratio than normotension by both 24-hour ambulatory BP and HBP (62.1 vs 7.4 mg/gCr, P=.001), and than masked hypertension by HBP alone (9.3 mg/gCr, P=.009). Masked hypertension defined by 24-hour ambulatory BP is associated with an increased serum glucose level and urinary albumin-creatinine ratio, but these relationships are not observed in masked hypertension defined by HBP.     

Blood Pressure Control in Hypertensive Patients in Irish Primary Care Practices

In Ireland, cardiovascular disease is a major cause of death. However, blood pressure (BP) goal achievement is unsatisfactory. The authors aimed to document BP control and increase awareness. A total of 1534 patients were enrolled in the study, with a mean age of 64.7±11.9 years (53.8% women). Duration of hypertension was 8.7±7.7 years, and 14.6% had diabetes, 13.8% had coronary artery disease, and 40.5% were taking antihypertensive monotherapy. β-Blockers (39.8%), angiotensin-converting enzyme inhibitors (32.2%), and angiotensin receptor blockers (22.0%) were prescribed most frequently. Mean BP was 136.0±6.1 mm Hg/89.5±5.0 mm Hg in nondiabetic patients (48.6% <140/90 mm Hg) and 131.0±7.4 mm Hg/81.7±4.6 mm Hg in diabetic patients (16.7% <130/80 mm Hg). Diet, exercise, and lifestyle modifications (63.5%) were frequently recommended. Increased patient awareness and compliance together with the adherence of physicians to current guidelines and greater willingness to take action in patients with uncontrolled hypertension should help in improving BP control and thus reduce cardiovascular risk.     

Sleep Blood Pressure Self‐Measured at Home as a Novel Determinant of Organ Damage: Japan Morning Surge Home Blood Pressure (J‐HOP) Study

To study whether sleep blood pressure (BP) self‐measured at home is associated with organ damage, the authors analyzed the data of 2562 participants in the J‐HOP study who self‐measured sleep BP using a home BP monitoring (HBPM) device, three times during sleep (2 am , 3 am , 4 am ), as well as the home morning and evening BPs. The mean sleep home systolic BPs (SBPs) were all correlated with urinary albumin/creatinine ratio (UACR), left ventricular mass index (LVMI), brachial‐ankle pulse wave velocity (baPWV), maximum carotid intima‐media thickness, and plasma N‐terminal pro‐hormone pro–brain‐type natriuretic peptide (NTproBNP) (all P<.001). After controlling for clinic SBP and home morning and evening SBPs, associations of home sleep SBP with UACR, LVMI, and baPWV remained significant (all P<.008). Even in patients with home morning BP <135/85 mm Hg, 27% exhibited masked nocturnal hypertension with home sleep SBP ≥120 mm Hg and had higher UACR and NTproBNP. Masked nocturnal hypertension, which is associated with advanced organ damage, remains unrecognized by conventional HBPM.     

Add‐On Use of Eplerenone Is Effective for Lowering Home and Ambulatory Blood Pressure in Drug‐Resistant Hypertension

The authors aimed to investigate the blood pressure (BP)–lowering ability of eplerenone in drug‐resistant hypertensive patients. A total of 57 drug‐resistant hypertensive patients whose home BP was ≥135/85 mm Hg were investigated. The patients were randomized to either an eplerenone group or a control group and followed for 12 weeks. The efficacy was evaluated by clinic, home, and ambulatory BP monitoring. Urinary albumin, pulse wave velocity, and flow‐mediated vasodilation (FMD) were also evaluated. Home morning systolic BP (148±15 vs 140±15 mm Hg) and evening systolic BP (137±16 vs 130±16 mm Hg) were significantly lowered in the eplerenone group (n=35) compared with baseline (both P<.05), while unchanged in the control group (n=22). BP reductions in the eplerenone group were most pronounced for ambulatory awake systolic BP (P=.04), awake diastolic BP (P=.004), and 24‐hour diastolic BP (P=.02). FMD was significantly improved in the eplerenone group. In patients with drug‐resistant hypertension, add‐on use of eplerenone was effective in lowering BP, especially home and ambulatory awake BP.     

Early Morning Surge and Dipping Status of Blood Pressure: Are These of Predictive Value for Silent Myocardial Ischemia?

To investigate the predictive value of morning surge (MS) and dipping status of blood pressure (BP) for ST-segment depression (ST depression) in hypertensive persons, the combined 24-hour ambulatory BP measurement and Holter electrocardiographic recordings of 344 patients (132 women and 212 men, 60±12 years) were analyzed. The morning BP surge was calculated as mean systolic BP during the 2 hours after awaking minus the mean systolic BP during the 1 hour that included the lowest sleep BP. Depending on the percentage decrease in systolic BP at night, patients were subdivided into extreme dippers, dippers, nondippers, and risers. ST depression was defined as horizontal or descending ST depression of 1 mm of 1 minute duration and a 1-minute interval after the previous episode or 24-hour mean ST-segment value <−0.1 mV. ST depression was observed in 76 (22.1%) of 344 patients. The mean MS in patients with ST depression was with 25±15 mm Hg and not significantly different when compared with patients without ST depression (26±15 mm Hg). The prevalence of ST depression was not significantly different in dippers, extreme dippers, nondippers, and risers (20%, 23.5%, 23%, and 25.5%, respectively). Systolic and diastolic BP values during ST depression were significantly higher in the morning as compared with ST depression in the evening (149/84 mm Hg vs 138/78 mm Hg, P <.05). In the present study, MS and dipping status of BP were not associated with ST depression. ST depression was, however, characterized by significantly higher BP peaks in the early morning hours.     

The Effects of an Olmesartan Medoxomil–Based Treatment Algorithm on 24-Hour Blood Pressure Levels in Elderly Patients Aged 65 and Older

This study examined the effect of olmesartan medoxomil (OM) ± hydrochlorothiazide (HCTZ) on mean 24-hour ambulatory blood pressure, mean seated cuff (Se) blood pressure (BP), and SeBP goal achievement in elderly (65 years and older) patients with hypertension. After a 2- to 3-week placebo run-in period, patients received OM 20 mg, up-titrated to OM 40 mg, and then added HCTZ 12.5  mg to 25 mg in a stepwise manner at 3-week intervals if SeBP remained ≥120/70 mm Hg. The primary end point was change from baseline in mean 24-hour ambulatory systolic BP. At study end, mean 24-hour ambulatory BP had decreased by 25.7/12.3 mm Hg (n=150) and mean SeBP by 25.4/10.5 mm Hg (n=176; all P <.00001 vs baseline). Drug-related treatment-emergent adverse events, most commonly dizziness (3.4%), hypotension (2.2%), and headache (1.1%), were observed in 11.8% of patients. An OM-based treatment algorithm effectively lowers BP in an elderly patient population throughout the 24-hour dosing interval without compromising tolerability.     

Blood pressure response to metoprolol and chlorthalidone in European and African Americans with hypertension

Despite the availability of many antihypertensive drug classes, half of patients with hypertension have uncontrolled blood pressure (BP). The authors sought to assess the effect of age on BP response in European American and African American patients with hypertension. Clinic BP from the PEAR2 (Pharmacogenomics Evaluation of Antihypertensive Responses 2) study was used to estimate BP responses from baseline following sequential treatment with metoprolol 100 mg twice daily and chlorthalidone 25 mg daily for 8 to 9 weeks each, with a minimum 4‐week washout between treatments. BP responses to both drugs were compared in 159 European Americans and 119 African Americans by age with adjustment for baseline BP and sex. European Americans younger than 50 years responded better to metoprolol than chlorthalidone (diastolic BP: ?9.6 ± 8.0 vs ?5.9 ± 6.8 mm Hg, adjusted P = .003), whereas patients 50 years and older responded better to chlorthalidone than metoprolol (systolic BP: ?18.7 ± 13.8 vs ?13.6 ± 14.8 mm Hg, adjusted P = .008). African Americans younger than 50 years responded similarly to both drugs, whereas those 50 years and older responded better to chlorthalidone than metoprolol (?17.0 ± 13.2/?9.6 ± 7.5 vs ?7.0 ± 18.6/?6.7 ± 9.3 mm Hg, adjusted P<.0001/.008). Therefore, age should be considered when selecting antihypertensive therapy in European and African American populations with hypertension.     

Comparison of Office, Ambulatory, and Home Blood Pressure Antihypertensive Response to Atenolol and Hydrochlorthiazide

J Clin Hypertens (Greenwich). 2010;12:14–21. ^© 2009 Wiley Periodicals, Inc.
Office, home, and ambulatory blood pressure (BP) demonstrate variable associations with outcomes. The authors sought to compare office BP (OBP), home BP (HBP), and ambulatory BP (ABP) for measuring responses to hydrochlorothiazide (HCTZ), atenolol, and their combination. After completing washout, eligible patients were randomized to atenolol 50 mg or HCTZ 12.5 mg daily. Doses were doubled after 3 weeks and the alternate drug was added after 6 weeks if BP was >120/70 mm Hg (chosen to allow maximum opportunity to assess genetic associations with dual BP therapy in the parent study). OBP (in triplicate), HBP (twice daily for 5 days), and 24-hour ABP were measured at baseline, after monotherapy, and after combination therapy. BP responses were compared between OBP, HBP, and ABP for each monotherapy and combination therapy. In 418 patients, OBP overestimated BP response compared with HBP, with an average 4.6 mm Hg greater reduction in systolic BP ( P <.0001) and 2.1 mm Hg greater reduction in diastolic BP ( P <.0001) across all therapies. Results were similar for atenolol and HCTZ monotherapy. ABP response was more highly correlated with HBP response ( r =0.58) than with OBP response ( r =0.47; P =.04). In the context of a randomized clinical trial, the authors have identified significant differences in HBP, OBP, and ABP methods of measuring BP response to atenolol and HCTZ monotherapy.     

White‐Coat Effect Among Older Adults: Data From the Jackson Heart Study

Many adults with elevated clinic blood pressure (BP) have lower BP when measured outside the clinic. This phenomenon, the “white‐coat effect,” may be larger among older adults, a population more susceptible to the adverse effects of low BP. The authors analyzed data from 257 participants in the Jackson Heart Study with elevated clinic BP (systolic/diastolic BP [SBP/DBP] ≥140/90 mm Hg) who underwent ambulatory BP monitoring (ABPM). The white‐coat effect for SBP was larger for participants 60 years and older vs those younger than 60 years in the overall population (12.2 mm Hg, 95% confidence interval [CI], 9.2–15.1 mm Hg and 8.4 mm Hg, 95% CI, 5.7–11.1, respectively; P=.06) and among those without diabetes or chronic kidney disease (15.2 mm Hg, 95% CI, 10.1–20.2 and 8.6 mm Hg, 95% CI, 5.0–12.3, respectively; P=.04). After multivariable adjustment, clinic SBP ≥150 mm Hg vs <150 mm Hg was associated with a larger white‐coat effect. Studies are needed to investigate the role of ABPM in guiding the initiation and titration of antihypertensive treatment, especially among older adults.     

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.     

The Effect of Numeracy Level on Completeness of Home Blood Pressure Monitoring

Home blood pressure monitoring (HBPM) readings predict the increased risks of cardiovascular events and end‐organ damage independent of office blood pressure (BP). Numeracy (the ability to handle numbers) may limit the feasibility of patients' performing HBPM. The authors analyzed data from 409 adults recruited from 12 North Carolina primary care clinics who completed a three‐item numeracy assessment, the Rapid Estimate of Adult Literacy in Medicine–Short Form health literacy assessment, and HBPM over 2 weeks. Among the 409 participants, 73% were college graduates and 69% had adequate numeracy. Completion of HBPM was greater among those with adequate numeracy (96.2% vs 93.7%; P=.009) and did not correlate with health literacy scores. More participants with adequate numeracy reported completion of ≥85% of readings than those with low numeracy (95% vs 88%; P=.018). Adequate numeracy, but not high literacy, is associated with more complete HBPM reporting. Whether higher numeracy is associated with more accurate self‐reported readings is an area of future research.     

家庭血压监测的临床应用

血压测量是诊断高血压病的基本手段,目前主要有三种方法评价血压：诊所偶测血压、动态血压监测和家庭血压监测。家庭血压监测方便、经济,已有大量数据表明：与诊所偶测血压相比,家庭血压监测是评估心血管疾病风险的一个更好的预测因子。同时它能改善高血压患者的治疗依从性,有利于血压控制,监测降压药物疗效,减少医疗费用。另外对鉴别白大衣高血压和隐性高血压也很有帮助。     

Blood Pressure Goals and Arterial Stiffness in Chronic Kidney Disease

The association of optimal blood pressure (BP) control and arterial stiffness was evaluated in 172 patients with chronic kidney disease. The authors compared the augmentation index (AIx) of patients who achieved a recommended BP goal (<130/80 mm Hg) with those who did not (≥130/80 mm Hg). The median age was 57 years, 60% were male, and 70% were Caucasian. One-third of patients had achieved a BP goal of <130/80 mm Hg. AIx was significantly lower in patients who achieved BP goal than in those who did not (median AIx, 19% vs 23%; P =.04). AIx remained significantly lower in patients who achieved the BP goal, after adjusting for age, sex, and height (mean effect on AIx, −3.3%; 95% confidence interval, −6.1% to −0.4%; P =.03). Achievement of BP goal of <130/80 mm Hg in chronic kidney disease patients is associated with significantly lower AIx and may reflect a reduction in overall arterial stiffness.     

Weekly Variation of Home and Ambulatory Blood Pressure and Relation Between Arterial Stiffness and Blood Pressure Measurements in Community-Dwelling Hypertensives

Although blood pressure (BP) is a major determinant of pulse wave velocity (PWV), some treatments have independent effects on BP and arterial stiffness. Although both ambulatory BP (ABP) and self-measured BP at home (HBP) have become important measures for the diagnosis and management of hypertension, single day recordings may be insufficient for a proper diagnosis of hypertension or the evaluation of treatment efficacy. To evaluate weekly variations in BP using 7-day HBP and 7-day ABP monitoring and to determine the relation between arterial stiffness and BP measurements in community-dwelling patients with hypertension. We enrolled 68 community-dwelling hypertensive subjects in this study. Significant weekly variations in systolic blood pressure (SBP) and diastolic blood pressure (DBP) were found in the awake ABP data (p < .01, respectively), while no significant weekly variations in the asleep ABP or the morning and evening HBP data were observed. In untreated subjects, significant correlations were obtained between the brachial-ankle PWV and the average awake SBP, the average asleep SBP and the average SBP measured by HBP in the evening. In treated subjects, only the average SBP measured by HBP in the morning was significantly correlated with the baPWV. Differences in the weekly variations in BP were observed between HBP and ABP monitoring. In addition, the morning systolic HBP was not correlated with arterial stiffness in untreated subjectswith hypertension but was correlated in treated subjects. Relations between the morning HBP and arterial stiffness might be attributed to morning surges in BP and/or trough levels of antihypertensive drugs.     

Long-term Antihypertensive Efficacy of Losartan/Hydrochlorothiazide Combination Therapy on Home Blood Pressure Control

Angiotensin receptor blocker (ARB)/hydrochlorothiazide (HCTZ) combination therapy has been shown to produce a prompt reduction in clinic blood pressure (BP) without serious adverse effects; however, long-term antihypertensive efficacy on home BP has not been fully investigated. In this open-label multicenter observational study, a total of 151 hypertensive patients uncontrolled with antihypertensive regimens including standard dose of ARBs were switched to the fixed-dose combination of losartan (50 mg)/HCTZ (12.5 mg) (mean age 66.9 ± 9.5 years, 51% male, 19% with diabetes mellitus, and 57% with dyslipidemia). After 3 months, losartan/HCTZ treatment significantly reduced mean home systolic BP/diastolic BP from a baseline level of 153 ± 11/85 ± 9 mm Hg to 136 ± 12/77 ± 10 mm Hg (P < .001) and mean clinic BP from 158 ± 9/87 ± 9 to 136 ± 12/77 ± 10 (P < .001), which were maintained through the study period of 12 months (132 ± 11/75 ± 9 and 136 ± 12/77 ± 10; home and clinic BP at 12 months, respectively, P < .001). Furthermore, younger patients (<65 years) receiving ARB monotherapy at the start of the study showed a significantly greater reduction in home BP, but not in clinic BP, compared with elderly patients (≥65 years). In conclusion, losartan/HCTZ combination therapy exerted a 1-year long-term efficacy on home BP as well as clinic BP. In patients uncontrolled with ARB monotherapy, the antihypertensive efficacy on home BP is more pronounced in younger patients compared with that in elderly patients.     

Elevated preoperative blood pressures in adult surgical patients are highly predictive of elevated home blood pressures

Blood pressure (BP) measurement during the presurgical assessment has been suggested as a way to improve longitudinal detection and treatment of hypertension. The relationship between BP measured during this assessment and home blood pressure (HBP), a better indicator of hypertension, is unknown. The purpose of the present study was to determine the positive predictive value of presurgical BP for predicting elevated HBP. We prospectively enrolled 200 patients at a presurgical evaluation clinic with clinic blood pressures (CBPs) ≥130/85 mm Hg, as measured using a previously validated automated upper-arm device (Welch Allyn Vital Sign Monitor 6000 Series), to undergo daily HBP monitoring (Omron Model BP742N) between the index clinic visit and their day of surgery. Elevated HBP was defined, per American Heart Association guidelines, as mean systolic HBP ≥135 mm Hg or mean diastolic HBP ≥85 mm Hg. Of the 200 participants, 188 (94%) returned their home blood pressure monitors with valid data. The median number of HBP recordings was 10 (interquartile range, 7–14). Presurgical CBP thresholds of 140/90, 150/95, and 160/100 mm Hg yielded positive predictive values (95% confidence interval) for elevated HBP of 84.1% (0.78–0.89), 87.5% (0.81–0.92), and 94.6% (0.87–0.99), respectively. In contrast, self-reported BP control, antihypertensive treatment, availability of primary care, and preoperative pain scores demonstrated poor agreement with elevated HBP. Elevated preoperative CBP is highly predictive of longitudinally elevated HBP. BP measurement during presurgical assessment may provide a way to improve longitudinal detection and treatment of hypertension.     

Adding Hydrochlorothiazide to Olmesartan/Amlodipine Increases Efficacy in Patients With Inadequate Blood Pressure Control on Dual‐Combination Therapy

This randomized, parallel‐group study in patients inadequately controlled on olmesartan medoxomil/amlodipine (OLM/AML) 40/10 mg assessed the effects of adding hydrochlorothiazide (HCTZ) 12.5 mg and 25 mg, using seated blood pressure (SeBP) measurements and ambulatory blood pressure (BP) monitoring. Enrolled patients were screened and tapered off of therapy if required. All patients received OLM/AML 40/10 mg and those with mean seated BP (SeBP) ≥140/90 mm Hg after 8 weeks (n=808) were randomized (1:1:1) to continue with OLM/AML 40/10 mg or receive OLM/AML/HCTZ 40/10/12.5 or 40/10/25 mg for a further 8 weeks. The primary endpoint was the change in seated diastolic BP (SeDBP) from the start to the end of the randomized treatment period. The addition of HCTZ 25 mg significantly reduced SeDBP (?2.8 mm Hg; P<.0001), lowered seated systolic BP (SeSBP) and ambulatory DBP and SBP, and improved BP goal rates. In patients uncontrolled on OLM/AML 40/10 mg, adding HCTZ led to further BP reductions, particularly in ambulatory BP.     

Ambulatory or Home Measurement of Blood Pressure?

Ambulatory blood pressure monitoring (ABPM) and home blood pressure (HBPM) monitoring have been shown to be superior to conventional measurement of blood pressure in terms of reproducibility, relationship to the impact of high blood pressure on target organs, and the prediction of cardiovascular events. Nevertheless, these 2 techniques have yet to find their place in the diagnosis of hypertension and during evaluation of the efficacy of antihypertensive treatment. Although these 2 methods do not give identical results in approximately 20% of cases, their diagnostic performance and prognostic value are quite comparable. Although ABPM remains a valuable tool in clinical research, its utilization in routine clinical practice is limited by cost and availability. HBPM is increasingly employed for informed and well-managed patients, and it can help to improve control of the patient's blood pressure. Physicians involved in the management of hypertensive patients should be aware of its value in order to assist patients in their care.