Department of Family and Community Medicine, University of Missouri, Columbia patilso@health.missouri.edu
The authors reported no potential conflict of interest relevant to this article.
This project was supported by grant number R01HS023328 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.
In yet another study, home BP and ambulatory BP measurements were identical when the same dual-mode device was used to measure both ambulatory and home BP.10
2. What are the diagnostic and treatment targets for home BP monitoring?
Treat patients if home BP is ≥130/80 mm Hg and categorize patients as normotensive if home BP is <125/76 mm Hg (SOR C). Monitor patients who are in between.
A 2017 joint statement from the American College of Cardiology/American Heart Association (ACC/AHA) Task Force states that the target BP for HBPM should be <130/80 mm Hg.11 The Joint National Commission (JNC) 8 issued BP goals of <140/90 mm Hg for adults <60 years of age and those with diabetes and/or chronic kidney disease, and a goal of <150/90 mm Hg for adults ≥60 years of age with no diabetes or chronic kidney disease,12 but much debate has recently surrounded these guidelines. JNC 8 does not provide a separate BP goal for HBPM.
Although based solely on evidence (and not patient-oriented outcomes), a home BP threshold of ≥135/85 mm Hg for the diagnosis and treatment of hypertension has been supported by the European Society of Hypertension consensus guidelines,13 results of a longitudinal study,14 meta-analyses of published studies, and a meta-analysis using individual subject data.15
Support for a home BP measurement of <125/76 mm Hg as normal is limited to a single cross-sectional study of 48 patients with 2 elevated office BP readings where the threshold of 125/76 mm Hg on home BP was shown to exclude 80% of patients diagnosed with hypertension by ambulatory readings.16 If home BP measurements are >125/76 mm Hgbut <135/85 mm Hg, 24-hour ambulatory BP monitoring is recommended to assess hypertension control.17
3. Does home BP monitoring improve hypertension control?
Yes, in the short term, but not in the long term (SOR C).
A meta-analysis of 13 comparative studies looking at HBPM alone vs usual care showed a small, but statistically significant, benefit of achieving target BP at 6 months with a relative risk ratio (RRR) of 1.3 (95% confidence interval [CI], 1.00-1.68; I2=77%).18 However, the pooled effects from 3 studies that measured the benefit of achieving a predefined BP target at the 12-month follow-up mark were not significant in this review (RRR=1.18; 95% CI, 0.95-1.46, I2=86%).18 The pooled effect from 19 studies from the same review showed that there was a statistically significant weighted mean difference of -3.9 mm Hg in systolic BP and a weighted mean difference of -2.4 mm Hg in diastolic BP at 6 months; however, the changes were no longer significant at the 12-month follow-up mark.18
Continue to: More than half of the studies included...
