The high level of misdiagnosis of hypertension that occurs with casual clinic measurement of blood pressure has led to most guidelines recommending out-of-office measurements. However, the choice between 24-hour ambulatory blood pressure monitoring, which is costly but robust, and patient self-monitoring at home, which is cheaper and more convenient, remains a difficult one.
- Inaccuracies in casual clinic blood pressure (BP) measurements and subsequent misdiagnosis of hypertension make out-of-office BP assessment highly recommended for the diagnosis and management of hypertension.
- Out-of-office techniques involve either 24-hour assessment with an automated ambulatory BP monitoring (ABPM) device or a simpler patient-managed self-measurement protocol using a home BP monitoring (HBPM) device.
- ABPM is the gold standard as it is the most robust method for diagnosing ‘white-coat’ or masked hypertension and it takes nocturnal BP measurements, which are the best predictors of future cardiovascular events, but it is more expensive than HBPM.
- HBPM performed during the morning and evening across several days is cheaper and more convenient, making it the method preferred by patients and thereby increasing patient adherence.
- The threshold for diagnosing hypertension using either the daytime ABPM reading or HBPM readings is 135/85 mmHg.
- Both techniques have considerable cost–benefit and recommendations must include their use in conjunction with routine clinic BP assessment.
- ABPM is recommended initially for the correct diagnosis and assessment of the 24-hour BP profile, with HBPM used in the longer term for the maintenance phase of treatment or monitoring.
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