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CLINICAL STATEMENTS AND GUIDELINES Circulation. 2025;152:e114–e218. DOI: 10.1161/CIR.0000000000001356 September 16, 2025 e129 measurement of BP using ABPM or HBPM, which is also known as self-measurement of BP at home, can provide valuable information beyond office BP for the confirmation and management of hypertension. Both ABPM and HBPM provide BP estimates that are based on a greater number of BP measurements than are obtained in the office setting, enhancing the accuracy and precision for detecting a patient’s true and usual BP levels. ABPM typically involves wearing a fully automated device, usually over a period of 24 hours, with out-of-office BP readings obtained at rela tively frequent intervals during the daytime (ie, 15-30 minutes) and less frequent intervals at nighttime (ie, 30-60 minutes). ABPM can: 1) provide estimates of mean BP over the entire monitoring period, and sepa rately during daytime and nighttime; 2) determine the daytime-to-nighttime BP ratio to identify the extent of nocturnal “dipping”; 3) identify the early-morning BP surge pattern; 4) estimate BP variability; and 5) al low for recognition of hypotension. HBPM involves the patient measuring their BP at home using an oscillo metric device over days to weeks, which can provide estimates of mean BP over the entire monitoring pe riod and separately during daytime and evening, and determine daytime-to-evening BP variability or BP variability across days. 3.1.4 ABPM and HBPM Recommendations for ABPM and HBPM Referenced studies that support the recommendations are summarized in the Evidence Table. COR LOE Recommendations 1 A 1 In adults with suspected hypertension, out-of- office BP measurements by either ABPM or HBPM are recommended to confirm the diagnosis of hypertension.1,2 1 A 2 In adults who are taking antihypertensive medication, HBPM is recommended for monitoring the titration of BP-lowering medication, along with cointerventions such as patient education, telehealth counseling, and clinical interventions.2–6 Synopsis High-quality out-of-office BP measurements can be ob tained using either ABPM or HBPM. ABPM has been the de facto reference standard for out-of-office BP monitor ing as there are more data linking ABPM to CVD events compared with HBPM.1,2 However, there are scarce data on whether ABPM or HBPM is superior for CVD risk prediction.7,8 Additional data support the use of HBPM for longitudinal titration of antihypertensive medications. Among adults taking antihypertensive medication, com pared with usual care, HBPM use improves office BP control when used in conjunction with other interventions to lower BP.2,3,6,9 Further, HBPM is often a more practi cal approach in clinical practice than ABPM and may be more reproducible and accessible, supporting its use for longitudinal management and titration of BP-lowering medication.10,11 Recommended procedures for the col lection of HBPM data are provided in Figure 4. It is im portant to ensure that the out-of-office BP measurement device has been validated with a rigorous, standardized protocol and the appropriate size cuff is used.12 A guide to the relationship between HBPM and ABPM readings and corresponding readings obtained in the office is pre sented in Table 7. These thresholds are provided as a guide but should be interpreted with caution because the data are primarily from European, Australian, and Asian populations, with few data available for establishing ap propriate thresholds for US populations.13,14 Further, the data are derived primarily from observational studies.15 Recommendation-Specific Supportive Text 1 Out-of-office BP monitoring with either ABPM or HBPM provides valuable and distinct information compared with office BP for confirming the diagno sis of hypertension. Systematic reviews conducted for the US Preventive Services Task Force reported that ABPM more strongly predicts long-term CVD outcomes than office BP.1,2 Evidence suggests that HBPM more strongly predicts CVD outcomes than office BP2,8,16 and may be more reproducible than ABPM.11 Although ABPM provides distinctive infor mation on nighttime BP, HBPM is often more practi cal than ABPM in clinical practice.12 See Section 3.2 (“Patient Diagnosis”) for additional details of diagnos tic classification. ABPM thresholds corresponding to office BP levels are provided in Table 7. 2. High-quality evidence supports the use of HBPM in combination with cointerventions, such as patient education, telehealth (Section 5.4, “Plan of Care for Hypertension”), and medication titration using pre specified algorithms, for the longitudinal management of BP. Meta-analyses of RCTs have identified modest reductions in office SBP and DBP at 6 months and 1 year with the use of HBPM on its own without cointer ventions, as compared with usual care.2,3,6,9 More clini cally meaningful reductions in office SBP and DBP and improved BP control at 6 months and 1 year were noted when HBPM was used in conjunction with coin terventions, compared with usual care. These studies indicate the importance of combining HBPM with cointerventions to make meaningful improvements in office BP control rates. HBPM thresholds corre sponding to office BP levels are provided in Table 7. More recent RCTs showed no BP-lowering benefit of HBPM when enhanced only by using a smartphone application (eg, providing reminders to measure BP and with the ability to store and transmit BP) versus HBPM alone in adults with uncontrolled BP.5 These studies reinforce the importance of combining HBPM with interventions to make meaningful advances in BP control rates. Additional studies are required to determine the optimal approach to implement health Downloaded from http://ahajournals.org by on October 7, 2026