2020 Consensus Statement of the Taiwan Hypertension Society and the Taiwan Society of Cardiology on Home Blood Pressure Monitoring for the Management of Arterial Hypertension

Abstract

To facilitate the applications of home blood pressure (HBP) monitoring in clinical settings, the Taiwan Hypertension Society and the Taiwan Society of Cardiology jointly put forward the Consensus Statement on HBP monitoring according to up-to-date scientific evidence by convening a series of expert meetings and compiling opinions from the members of these two societies. In this Consensus Statement as well as recent international guidelines for management of arterial hypertension, HBP monitoring has been implemented in diagnostic confirmation of hypertension, identification of hypertension phenotypes, guidance of anti-hypertensive treatment, and detection of hypotensive events. HBP should be obtained by repetitive measurements based on the " 722 " principle, which is referred to duplicate blood pressure readings taken per occasion, twice daily, over seven consecutive days. The " 722" principle of HBP monitoring should be applied in clinical settings, including confirmation of hypertension diagnosis, 2 weeks after adjustment of antihypertensive medications, and at least every 3 months in well-controlled hypertensive patients. A good reproducibility of HBP monitoring could be achieved by individuals carefully following the instructions before and during HBP measurement, by using validated BP devices with an upper arm cuff. Corresponding to office BP thresholds of 140/90 and 130/80 mmHg, the thresholds (or targets) of HBP are 135/85 and 130/80 mmHg, respectively. HBP-based hypertension management strategies including bedtime dosing (for uncontrolled morning hypertension), shifting to drugs with longer-acting antihypertensive effect (for uncontrolled evening hypertension), and adding another antihypertensive drug (for uncontrolled morning and evening hypertension) should be considered. Only with the support from medical caregivers, paramedical team, or tele- monitoring, HBP monitoring could reliably improve the control of hypertension.

Keywords: Antihypertensive; Blood pressure; Home; Hypertension.

Figure 1

Schematic representations of integrating home blood pressure monitoring with office and ambulatory blood pressure monitoring in management of hypertension for antihypertensive treatment-naïve individuals. ABPM, ambulatory blood pressure monitoring; BP, blood pressure; HBP, home blood pressure; HMOD, hypertension-mediated organ damage; HTN, hypertension; OBP, office blood pressure; OD, organ damage. The recommended flowchart of diagnosis and management of hypertension for treatment-naïve patients with office BP of ≥ 140/90 mmHg (A) or with office BP of < 140/90 mmHg (B). Averaged HBP is derived according the “722” principle.

Figure 2

Schematic representations of integrating home blood pressure monitoring with office and ambulatory blood pressure monitoring in management of hypertension for hypertensive patients treated with antihypertensive medications. ABPM, ambulatory blood pressure monitoring; BP, blood pressure; CCB, calcium channel blocker; HBP, home blood pressure; HMOD, hypertension-mediated organ damage; HTN, hypertension; OBP, office blood pressure; OD, organ damage. The recommended flowchart of management of hypertension for medically treated hypertensive patients with on-treatment office BP of ≥ 140/90 mmHg (A) or with on-treatment office BP of < 140/90 mmHg (B). HBP includes morning and evening BP, of which both should be below HBP targets (< 135/80 mmHg, in general; < 130/80 mmHg, if at high risk).