SOURCE: Shimbo D, et al. Studies comparing ambulatory blood pressure and home blood pressure on cardiovascular disease and mortality outcomes: A systematic review. J Am Soc Hypertens 2016;10:224-234.
For the last several decades, decisions about management of hypertension (HTN) have been based predominantly on blood pressure (BP) recorded in an office, commonly known as “office BP” (OBP). Randomized, interventional HTN trials based on OBP have confirmed important clinical benefits from treatment: reductions in myocardial infarction of about 25%, stroke of about 40%, and heart failure > 50%. Nonetheless, vocal supporters for 24-hour ambulatory blood pressure monitoring (ABPM) have pointed out that ABPM correlates significantly better with cardiovascular disease (CVD) outcomes than OBP, leading to the logical conclusion that treatments based on ABPM might also provide better CVD risk reduction.
The same arguments can be made for home BP monitoring (HBPM). Since both ABPM and HBPM provide the opportunity for many more BP readings than occasional OBP, it’s not surprising that either tool has better positive predictive value than OBP. Additionally, HBPM and ABPM definitions of HTN appear to be more accurate because they eliminate most white-coat HTN.
Shimbo et al performed a systematic review of ABPM and HBPM trials. While the authors were able to confirm that both ABPM and HBPM have stronger association with CVD than OBP, they were unable to determine whether one holds a distinct advantage over the other. Although clinical trials with ABPM seem to indicate a stronger association with CVD than observed in HBPM trials, trial data that include both methods of BP monitoring (ABPM and HBPM) in the same study population are few. Concordant with recent (2015) U.S. Preventive Services Task Force recommendations, clinicians should routinely use ABPM or HBPM prior to initiating treatment for HTN.
Clinicians should routinely use ambulatory blood pressure monitoring or home blood pressure monitoring prior to initiating treatment for hypertension.
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