Home Blood Pressure Measurements Will or Will Not Replace 24-Hour Ambulatory Blood Pressure Measurement
To the Editor:
I am pleased that the protagonists in this controversy largely negate the question posed in the title by agreeing that the techniques are complementary rather than one being an alternative for the other, with Verdecchia et al acknowledging that, “Home BP [blood pressure] and 24-hour ABP [ambulatory BP] should be possibly considered as complimentary techniques, to be used with the precise aim of exploiting the best that each technique can provide,”1 and Parati et al stating that, “The current position is that HBPM [home BP monitoring] and ABPM [ABP monitoring] should coexist and be used as complimentary tools, providing different information on a subject’s BP status.”2
I would like to draw attention to 2 aspects of the debate, which were not considered. First, HBPM is a demanding procedure for patients. To obtain a measurement approximating to mean daytime ABPM for clinical decision making, the subject must make 2 measurements in the morning and evening on 7 consecutive days, discard the first day of measurement, and average the measurements of the last 6 days.3 At the end of this demanding routine, the subject has no indication of nighttime BP, which is now recognized as being the most sensitive predictor of outcome.4 Is this routine for obtaining 1 facet of the 24-hour profile preferable to 1 day of ABPM with the given advantages conferred by that technique? Unfortunately, the misconception prevails that an occasional HBPM will give equivalency to ABPM, which is clearly not the case, and such measurements may be every bit as misleading as the inaccurate technique of conventional BP measurement.
The expense of ABPM is acknowledged by both sides as a disadvantage, but the means of making ABPM less expensive was not addressed. The cost of devices is reducing quite significantly and could be favorably influenced by reimbursement incentives by healthcare providers. Of equal importance is the presentation and reporting of ABPM data. I have been developing the dabl ABPM system over many years, not only to standardize the presentation of ABPM data on a comprehensive 1-page report but also to provide a computer-generated report interpreting the data and thereby removing the considerable expense of requiring a doctor to make a report.5 These developments will greatly facilitate the use of ABPM in clinical practice.
In keeping with the helpful analyses and opinions expressed in these “controversy” articles, I join my colleagues in their efforts to propagate out-of-office measurements so as to improve the control of hypertension, which we all admit is deplorable throughout the world.
Verdecchia P, Angeli F, Mazzotta G, Gentile G, Reboldi G. Home blood pressure measurements will not replace 24-hour ambulatory blood pressure monitoring. Hypertension. 2009; 54: e130.
Parati G, Omboni S, Bilo G. Why is out-of-office blood pressure measurement needed? Home blood measurements will increasingly replace ambulatory blood pressure monitoring in the diagnosis and management of hypertension. Hypertension. 2009; 54: 181–187.
Parati G, Stergiou GS, Asmar R, Bilo G, de Leeuw P, Imai Y, Kario K, Lurbe E, Manolis A, Mengden T, O'Brien E, Ohkubo T, Padfield P, Palatini P, Pickering T, Redon J, Revera M, Ruilope LM, Shennan A, Staessen JA, Tisler A, Waeber B, Zanchetti A, Mancia G; for the ESH Working Group on Blood Pressure Monitoring. European Society of Hypertension guidelines for blood pressure monitoring at home: a summary report of the Second International Consensus Conference on Home Blood Pressure Monitoring. J Hypertens. 2008; 26: 1505–1530.
Dolan E, Stanton A, Thijs L, Hinedi K, Atkins N, McClory S, Den Hond E, McCormack P, Staessen JA, O'Brien E. Superiority of ambulatory over clinic blood pressure measurement in predicting mortality: the Dublin Outcome Study. Hypertension. 2005; 46: 156–161.
O'Brien E. Ambulatory blood pressure measurement: the case for implementation in primary care. Hypertension. 2008; 51: 1435–1441.