Clinical applications for out-of-office blood pressure monitoring

Abstract

Hypertension is one of the most common chronic diseases as well as the leading risk factor for cardiovascular disease (CVD). Efficient screening and accurate blood pressure (BP) monitoring are the basic methods of detection and management. However, with developments in electronic technology, BP measurement and monitoring are no longer limited to the physician's office. Epidemiological and clinical studies have documented strong evidence for the efficacy of out-of-office BP monitoring in multiple fields for managing hypertension and CVD. This review discusses applications for out-of-office BP monitoring, including home blood pressure monitoring (HBPM) and ambulatory blood pressure monitoring (ABPM), based on recent epidemiological data and clinical studies regarding the following factors: the detection of abnormal BP phenotypes, namely, white coat hypertension and masked hypertension; stronger ability to determine the prognosis for target organ damage and mortality; better BP control; screening for hypotension; and unique approaches to identifying circadian BP patterns and BP variability.

Keywords: ambulatory blood pressure monitoring; blood pressure; home blood pressure monitoring; hypertension; masked hypertension; white coat hypertension.

Figure 1.

Classification of BP subtypes by combination of clinic office BP and out-of-office BP. *The diagnostic threshold in the United States based on the 2017 ACC/AHA guideline. ABPM, ambulatory blood pressure measurement; ACC/AHA, American College of Cardiology/American Heart Association; BP, blood pressure; HBPM, home blood pressure measurement.

Figure 2.

Proposed clinical procedure for application of out-of-office BP monitoring. BP, blood pressure; BPV, blood pressure variability; CVD, cardiovascular disease; MH, masked hypertension; NT, normotension; SH, sustained hypertension; WCH, white coat hypertension.