Home blood pressure monitoring in hypertension

Hypertension is highly prevalent in the general population and represents a major risk factor for cardiovascular disease. The early identification of hypertension and the achievement of tight blood pressure (BP) control is thus a mainstay of cardiovascular prevention. Although routine BP measurements obtained in the clinic/office setting continue to be the basis for the diagnosis and management of hypertension, they are unable to provide a representative measure of patients' actual BP burden, leading to misclassification of hypertension and being thus imperfect indicators of BP control. Recently available methodologies for home BP monitoring have been proposed as viable solutions for a better assessment and management of hypertension when combined with conventional office BP measurements. The availability of automated devices for BP measurement at home, the increasing awareness of the importance of regular BP monitoring, and the recognition of the benefits of clinical implementation of home BP monitoring by international hypertension management guidelines, have led to a wide diffusion of this technique. In spite of this, home BP monitoring in clinical practice is not always properly used, in part because of the limited information so far available from properly designed, randomized, controlled trials, which has prevented formally graded recommendations to be issued. The purpose of this chapter is to provide a critical review of the current evidence comparing the prognostic value of home BP monitoring with that of office BP monitoring as well as the advantages of home BP monitoring for the diagnostic and therapeutic approach to hypertension. Additionally, key methodological aspects are highlighted, which should be considered to better exploit the potential clinical benefits of home BP monitoring