Home BP monitoring

Home blood pressure is now recommended by NICE as an option for use in the diagnosis of hypertension (1).

If blood pressure measured in the clinic is 140/90 mmHg or higher:

• take a second measurement during the consultation
  • if the second measurement is substantially different from the first, take a third measurement. Record the lower of the last two measurements as the clinic blood pressure

If the clinic blood pressure is 140/90 mmHg or higher, offer ambulatory blood pressure monitoring (ABPM) to confirm the diagnosis of hypertension. If a person is unable to tolerate ABPM, home blood pressure monitoring (HBPM) is a suitable alternative to confirm the diagnosis of hypertension

If the person has severe hypertension, consider starting antihypertensive drug treatment immediately, without waiting for the results of ABPM or HBPM

Home blood pressure monitoring

• When using home blood pressure monitoring (HBPM) to confirm a diagnosis of hypertension, ensure that:
  • for each blood pressure recording, two consecutive measurements are taken, at least 1 minute apart and with the person seated and
  • blood pressure is recorded twice daily, ideally in the morning and evening
  • blood pressure recording continues for at least 4 days, ideally for 7 days
  • discard the measurements taken on the first day and use the average value of all the remaining measurements to confirm a diagnosis of hypertension

Notes:

• Classification of hypertension
  • stage 1 hypertension
    • clinic blood pressure is 140/90 mmHg or higher AND
      • subsequently Ambulatory blood pressure monitoring (ABPM) daytime average OR Home blood pressure monitoring (HBPM) average blood pressure is 135/85 mmHg or higher
  • stage 2 hypertension
  • clinic blood pressure is 160/100 mmHg or higher AND
    • subsequently ABPM daytime average or HBPM average blood pressure is 150/95 mmHg higher
  • severe hypertension
  • clinic systolic blood pressure is 180 mmHg or higher or clinic diastolic blood pressure is 110 mmHg or higher
    
    
• Possible indications for ambulatory blood pressure monitoring (ABPM) were outlined in previous BHS guidance (2):
  
  
  • if there is unusual variability of clinic blood pressure measurements
  • if there are symptoms suggestive of hypotension
  • to aid the diagnosis of 'white coat hypertension'
  • informing equivocal treatment decisions
  • evaluation of nocturnal hypertension
  • evaluation of drug resistant hypertension
  • determining the efficacy of drug treatment over 24 hours
  • diagnosis and treatment of hypertension in pregnancy
    

Reference:

• (1) NICE (November 2016).Management of hypertension in adults in primary care.