Response to Home Blood Pressure Measurements Will or Will Not Replace 24-Hour Ambulatory Blood Pressure Measurement
We have read with interest the letter by O'Brien1 contributing to the debate on the respective role of home blood pressure (BP; HBP) monitoring (HBPM) and ambulatory BP (ABP) monitoring (ABPM) in the clinical management of hypertensive patients.2,3 We largely agree with O'Brien’s1 observations, although with a slightly different perspective.
First, we agree that isolated HBP measurements are of limited clinical value. Indeed, only the average of repeated HBP readings carries diagnostic and prognostic information, which may be partly comparable to that provided by 24-hour ABPM,4 with most outcome studies being based on structured HBPM schedules including a consistent number of measurements. The recent European guidelines on HBPM recommend that HBP data from ≥3 (and ideally 7) days of measurements performed twice daily should be used, disregarding the values obtained on the first day.4 This task does not appear to be particularly demanding for patients, and it could be made even easier by supplying them with a structured logbook, where HBP values collected during the week preceding each physician’s visit can be stored, or by using automated BP measuring devices equipped with specific software tools able to follow the HBPM schedule recommended by recent guidelines4 and providing the average value of the HBPM week after discarding the initial day. It has to be acknowledged that many patients perform HBPM without doctor’s guidance, often measuring their HBP much too frequently. The recent European Society of Hypertension and American Heart Association recommendations on HBPM4,5 strongly advise HBPM to be performed always under a physician’s supervision, and the currently recommended schedule indeed represents a simplification of the HBPM habits often self-implemented by patients, rather than a “demanding routine.”
We also share the view that the availability of ABPM should be increasing with its cost being less prohibitive, a point clearly emphasized at the end of our article.3 A wider availability of ABPM might allow this diagnostic tool to become a more frequent companion to the HBPM implementation in daily practice, complementing the information that it provides. Indeed, whereas HBPM allows BP to be measured over a relative long time span, ABPM provides unique assessment of the 24-hour ABP profile, including nighttime and morning BP and BP variability.
Finally, we acknowledge the possible usefulness of software tools supporting adequate ABPM reporting. Indeed, although international hypertension guidelines recognize the diagnostic and prognostic values of average ABP, only vague reference is made to other potentially relevant information provided by analysis of 24-hour ABP profiles. Clear and evidence-based indications on which clinically relevant features of 24-hour ABP should be included in the final report thus have to be provided by national and international scientific societies, and software tools able to make this information easily available to physicians would be welcome.
G.P. has received lecture honoraria from Omron Healthcare and Microlife. G.B. has received lecture honoraria from Docleader Srl.
O'Brien E. Home blood pressure measurements will or will not replace 24-hour ambulatory blood pressure measurement. Hypertension. 2009; 54: e128.
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: 188–195.
Parati G, Omboni S, Bilo G. Why is out-of-office blood pressure measurement needed? Home blood monitoring will increasingly replace ambulatory blood pressure 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.