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Perspectives

Blood pressure monitoring: addressing the controversy about targets and methods

Colin Machado, John Amerena

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Abstract

Accurate blood pressure monitoring is essential to managing hypertension, but moving targets and the choice of different measurement methods complicate this area of care. Recent Australian hypertension guidelines have only added to contention.

Key Points

  • Most patients diagnosed with hypertension are started on treatment by their GP.
  • The main modalities available for diagnosing hypertension and monitoring its control are clinic blood pressure measurement, 24-hour ambulatory blood pressure monitoring and home blood pressure monitoring, each with their own benefits and limitations.
  • An Australian consensus statement has recommended 24-hour ambulatory blood pressure and/or home blood pressure monitoring as tools for diagnosing hypertension if blood pressure measured in the clinic is more than 140/90 mmHg, as have the British Hypertension Society/NICE guidelines.
  • Incorporating 24-hour ambulatory blood pressure monitoring and/or home-based blood pressure monitoring in a complementary fashion as dictated by individual situations may improve compliance, help achieve targets and more effectively empower patients.
  • Target blood pressure levels are contentious and recommendations vary according to international guidelines.
  • At present the recommendation set out by the National Heart Foundation of Australia is to aim for blood pressure targets of less than 140/90 mmHg for all patients, and even lower (systolic pressure <120 mmHg) in selected high-risk patients, but the authors of this article question the wisdom of this latter recommendation.

    Picture credit: © Richard Wareham Fotografie/SPL

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