George S. Stergiou - Home Blood Pressure Monitoring

The aim of this series is to provide informative updates on both the knowledge and the clinical management of a disease that, if uncontrolled, can very seriously damage the human body and is still among the leading causes of death worldwide. Although hypertension is associated mainly with cardiovascular, endocrine, and renal disorders, it is highly relevant to a wide range of medical specialties and fields from family medicine to physiology, genetics, and pharmacology. The topics addressed by volumes in the series Updates inHypertension and Cardiovascular Protection have been selected for their broad significance and will be of interest to all who are involved with this disease, whether residents, fellows, practitioners, or researchers.

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Self-monitoring of blood pressure at home is widely used by patients with hypertension in several countries [1]. Indeed, the clinical application of home blood pressure monitoring by patients has preceded the publication of strong research evidence from outcome studies, which are necessary to support its clinical utility in the management of hypertension [2]. Thus, despite its wide availability, scientific organizations around the world have initially hesitated to endorse the use of home blood pressure monitoring for decision-making in hypertension in clinical practice. However, in the last 20 years, the publication of several outcome studies reporting the superiority of home blood pressure monitoring compared to the conventional office measurements has now supported a major role of home monitoring in hypertension management [16].

Home blood pressure monitoring has unique advantages for clinical practice, particularly for repeated and long-term use, as it is widely available in most countries, is well accepted by hypertensive patients, and has relatively low cost [1, 36]. Thus, although ambulatory blood pressure monitoring, which is the alternative method for out-of-office blood pressure evaluation, is regarded as the gold standard method for hypertension diagnosis as it has stronger research evidence and additional unique advantages [5, 6], a pragmatic approach for most scientific societies and healthcare organizations is to promote home blood pressure monitoring as much as ambulatory monitoring, aiming to increase the number of people having their blood pressure status confirmed by out-of-office readings. When home blood pressure monitoring is applied according to the current recommendations [36], it can play a primary role for treatment initiation and titration in subjects with suspected or treated hypertension [7, 8]. These advantages strongly call for reimbursement of home blood pressure monitoring by healthcare systems, as done for glucose monitors in patients with diabetes [9].

The 2017 American College of Cardiology/American Heart Association guidelines for hypertension [5] and the 2018 guidelines by the European Society of Cardiology/European Society of Hypertension [6] highlighted the primary role of home blood pressure monitoring as well as of ambulatory monitoring in the diagnosis and management of hypertension. These statements on both sides of the Atlantic have started a new era in hypertension management by endorsing out-of-office blood pressure measurement as mandatory for most diagnostic and treatment decisions.