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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.
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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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