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Dr. Vikas Singh
Taking readingsWith its inflatable bladder centred on the anterior surface of arm (most cuffs have an indication of proper placement) and the lower edge of the cuff approximately 2–3 cm above the bend of the elbow, reading should be taken. Morning measurement before drug intake and evening reading before meal is preferred. Two measurements should be taken per occasion (1–2 min apart) (21). Results should be immediately reported in a specific logbook or stored in device memory.In rare cases of significant (>10 mm Hg) and consistent BP difference between arms, the patient should be advised to use the arm with higher BP values for HBPM.How to proceed with the data obtained?Morning and evening blood pressure should be measured for atleast 5 days and ideally 7. In each sitting, a minimum of 2 readings should be taken 1-2 minutes apart. Measurements of the first monitoring day are usually higher and unstable and are excluded. This is because of the anxiety induced from using the technique but the patient generally tends to settle over the next day.The average of a series of measurements taken as described should be used for the clinical decisions based on HBPM readings. The users should be informed that BP may vary between measurements and be instructed not to be alarmed by high or low BP measured on a single occasion, unless an important elevation or reduction persists or is associated with symptoms of clinical relevance (for example, dyspnoea, chest pain).For follow-up patients: less frequent measurements (for example, once or twice per week) could be regularly performed aimed at reinforcing compliance, although isolated readings should never be used for diagnostic purposes. Overuse of the method and self-modification of treatment on the basis of HBPM should be avoided (22). Casual, isolated home measurements can be very misleading and should not by themselves constitute the basis for clinical decisions (23).InterpretationAverage systolic home BP >135 mm Hg and/or diastolic>85 mm Hg indicates elevated BP. The levels of ‘normal’ and "optimal" home BP are still under investigation, provisionally suggested values being <130/80 mm Hg for normal home BP (24). In high-risk subjects (for example, those with diabetes or chronic kidney disease) lower home BP values should probably be achieved but the targets have not yet been defined.In most patients, there is a concordance in the blood pressure values measured at home or in the hospital settings; making it easy to categorize them as normotensives or hypertensives. However, cases of discrepancies between office and home (or ambulatory) BP measurements are not uncommon in both untreated and treated subjects.
Patient training, knowledge of devices and cuffs and mode remain important considerations; if used casually, home blood pressure monitoring may cause unnecessary anxiety and unwarranted medications. Home BP monitoring offers advantages over clinic BP measurements provided the calibration, validation process, readings, data processing and interpretation are performed as described and that its indications and pre-requisites are met. Home BP monitoring should form a part of management of all hypertensive patients.
1 - 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 . Parati G, Stergiou GS, Asmar R, Bilo G, de Leeuw P,Imai Y et al. J Hypertens 2008;26: 1505–1526.2 - Call to action on use and reimbursement for home blood pressure monitoring: a joint scientific statement from the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association. Pickering TG, Miller NH, Ogedegbe G, Krakoff LR, Artinian NT et al. Hypertension ;2008;52: 10–29.3 - Self monitoring of blood pressure at home. Working Group on Blood Pressure Monitoring of the European Society of Hypertension. Stergiou G, Mengden T, Padfield PL, Parati G,O’Brien E. Br Med J 2004; 329: 870–871.4 - European Society of Hypertension Recommendations for Conventional, Ambulatory and Home Blood Pressure Measurement. O’Brien E, Asmar R, Beilin L, Imai Y, Mancia G, Mengden T, on behalf of the European Society of Hypertension Working Group on Blood Pressure Monitoringet al. J Hypertens2003;21: 821–848.5 - 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. ESH-ESC Guidelines Committee. J Hypertens 2003;21: 1011–1053.6 - Guidelines for the use of self-blood pressure monitoring: a summary of the first international consensus conference. Asmar R, Zanchetti A. J Hypertens 2000;18:493–5087 - European Society of Hypertension International Protocol revision 2010 for the validation of blood pressure measuring devices in adults. Eoin O’Brien, Neil Atkins et al..on behalf of the Working Group on Blood Pressure Monitoring of the European Society of Hypertension; Blood Pressure Monitoring 2010, 15:23–388 - Self measured and ambulatory blood pressure in assessing the white coat phenomenon. Parati G, Stergiou G. JHypertens2003;21: 677–682.9 - White coat effect detected using self-monitoring of blood pressure at home: comparison with ambulatory blood pressure. Stergiou GS, Zourbaki AS, Skeva II, Mountokalakis TD.Am J Hypertens1998;11: 820–82710 - Cardiovascular prognosis of ‘masked hypertension’ detected by blood pressure self-measurement in elderly treated hypertensive patients. Bobrie G, Chatellier G, Genes N, Clerson P, Vaur L, Vaisse Bet al. JAMA 2004;291: 1342–1349.11 - Home blood pressure monitoring. Current knowledge and directions for future research Reims H, Fossum E, Kjeldsen SE, Julius S. Blood Press2001;10:281–28712 - Ambulatory blood pressure is superior to clinic blood pressure in predicting treatment-induced regression of left ventricular hypertrophy. Mancia G, Zanchetti A, Agabiti-Rosei E, Benemio G, De Cesaris R, Fogari R,et al. Circulation1997;95:1464– 147013 - Home blood pressure as a predictor of future blood pressure stability in borderline hypertension. Nesbitt SD, Amerena JV, Grant E, Jamerson KA, Lu H, Weder A,et al. The Tecumseh study.Am J Hypertens1997; 10:1270–128014 - Predictive power of screening blood pressure, ambulatory blood pressure and blood pressure measured at home for overall and cardiovascular mortality: a prospective observation in a cohort from Ohasama, northern Japan. Imai Y, Ohkubo T, Sakuma M, Tsuji II, Satoh H, Nagai K,et al.Blood Press Monit 1996;1:251–254.15 - Home blood pressure measurement has a stronger predictive power for mortality than does screening blood pressure measurement: a population-based observation in Ohasama, Japan. Ohkubo T, Imai Y, Tsuji I, Nagai K, Kato J, Kikuchi N,et al.J Hypertens1998;16:971–975.16 - Predictive value of home blood pressure measurement in relation to stroke morbidity: a population-based pilot study in Ohasama Japan Sakuma M, Imai Y, Tsuji I, Nagai K, Ohkubo T, Watanabe N,et al. Hypertens Res1997;20:167–174..17 - Day-by-day variability of blood pressure and heart rate at home as a novel predictor of prognosis: the Ohasama Study. Kikuya M, Ohkubo T, Metoki H, Asayama K, Hara A, Obara Tet al. Hypertension2008; 52: 1045–1050.18 - Clinical relevance of day-by-day blood pressure and heart rate variability. New information from home self-measurements. hyper.ahajournals.org/content/52/6/1006.full.pdf Parati G, Bilo G..Hypertension 2008;52:1006–1008.19 - Home blood pressure telemonitoring improves hypertension control in general practice. The TeleBPCare Study. Parati G, Omboni S, Albini F, Piantoni L, Giuliano A, Della Rosa F, on behalf of the TeleBPCare Study Group et al. J Hypertens2009;27: 198–20320- Devices for blood pressure measurement. Dabl Educational Trust. December 2008.21 - Self blood pressure measurement at home: how many times? Parati G, Stergiou GS. J Hypertens2004;22: 1075–107922 - Reliability of reporting self-measured blood pressure values by hypertensive patients. Mengden T, Hernandez Medina RM, Beltran B, Alvarez E, Kraft K, Vetter H. Am J Hypertens1998;11: 1413–1417.23 - Reporting bias in self-measurement of blood pressure. Myers M.Blood Press Monit2001;6: 181–18324 - International protocol for validation of blood pressure measuring devices in adults. O’Brien E, Pickering T, Asmar R, Myers M, Parati G, Staessen J, on behalf of the Working Group on Blood Pressure Monitoring of the European Society of Hypertensionet al. Blood Press Monit2002;7: 3–17.
Dr Vikas Singh MBBS (Honors); Gold Medalist MD (Medicine) DM (Cardiology)Working as a consultant Intervention Cardiologist at the Paras HMRI Hospital, Patna (India)Author's disclosures: None declared.
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