Emergence of Home Blood Pressure-Guided Management of Hypertension Based on Global Evidence

Recent guidelines for the management of hypertension from the 2018 European Society of Cardiology/European Society of Hypertension and the 2017 American College of Cardiology (ACC)/American Heart Association (AHA)1,2 have stressed the importance of out-of-office blood pressure (BP) measurement for hypertension management. There has been a similar emphasis on out-of-office BP monitoring for the management of hypertension in the United Kingdom, Canada, Japan, and other Asian countries.3–6 Ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM) are 2 well-validated approaches for measuring out-of-office BP. In the published literature, HBPM is a term that has commonly referred to the self-measurement of BP at home, although in some studies, HBPM has been used to describe a provider or research assistant measuring an individual’s BP in his/her home. ABPM and HBPM can identify white coat hypertension (diagnostic disagreement between office and out-of-office BP in untreated subjects) and white coat uncontrolled hypertension (diagnostic disagreement in treated subjects).1–8 Although ABPM has been the preferred method for out-of-office measurement, the 2017 ACC/AHA BP guideline considered HBPM to be a more practical approach in clinical practice than ABPM, particularly for individuals taking antihypertensive medication. The 2014 Japanese Society of Hypertension Guidelines for the Management of Hypertension proposed HBPM as the most effective and practical for guiding antihypertensive medication initiation and titration in clinical care, while waiting for intervention trials demonstrating better cardiovascular outcomes in patients managed based on out-of-office BP levels