p.23 抽出テキスト

5.2.5 Comparison of home and ambulatory blood

pressure monitoring There is overlap between home and ambulatory monitoring in terms of differentiating between hypertensive phenotypes. However, around 15% of people will have diagnostic disagreement, of whom approximately 50% will represent clinically significant differences of >5 mmHg.67 The advantages and disadvantages of home and ambulatory monitoring are outlined in Table 6.

5.3 What is the best method for

measuring blood pressure to diagnose hypertension? 5.3.1. Blood pressure measurement for hypertension screening Opportunistic screening is typically performed using office BP measurement and is key in detecting possible hypertension. However, a single screening office BP alone does not typically have sufficient diagnostic test performance to establish a diagnosis, especially for BP values close to diagnostic thresholds. Therefore, a single screening office BP requires some form of repeat BP assessment to confirm a diagnosis (preferably out-of-office or repeat office if out-of-office is not available). Relatedly, the BP threshold for acting on a screening office BP by conducting repeat BP assessments should also be lower than the office BP threshold used for diagnosing hypertension. This latter consideration is particularly relevant in the presence of increased CVD risk or markers of HMOD. Also of note, populations where masked hypertension is more prevalent include men, those who smoke, those with excessive alcohol intake, or those with diabetes or obesity.68,69 While a screening office BP of >160/100 mmHg is almost always consistent with a diagnosis of hypertension, a small proportion of patients will have extreme white-coat effects that motivate prompt repeat BP assessment.68

Hypertension screening approaches are discussed further in Section 7.1.

5.3.2 Blood pressure measurement for diagnosing

hypertension After detecting high BP in the office, subsequent BP measurement for diagnosing hypertension depends on the clinical circumstances. Office BP has lower specificity than ABPM for detecting hypertension, so diagnosis based on office BP alone is less desirable unless resources do not allow out-of-office measurements.70 For screening BP of 160–179 mmHg systolic or 100–109 mmHg diastolic, prompt confirmation (within 1 month) using either office or out-of-office methods is recommended, as delays in treatment are associated with increased CVD event rates.71 For BP of ≥180/110 mmHg, assessment for hypertensive emergency is recommended. In the setting of hypertensive emergency, immediately commencing BP-lowering treatment is recommended, otherwise, prompt confirmation (preferably within a week) can be considered prior to commencing treatment (Sections 7 and 10). For screening BP of 140–159/90–99 mmHg, out-of-office BP should be measured to confirm the diagnosis.72 When treatment of elevated BP is being considered (e.g. 120–139/70–89 mmHg) for individuals with high risk CVD conditions or sufficiently high 10-year predicted CVD risk, out-of-office BP measurement is recommended, both to confirm BP and to assess for masked hypertension. Out-of-office measurements may also be helpful for individuals with office BP of 130–139/85–89 mmHg to diagnose masked hypertension. Further details on the diagnostic evaluation of hypertension are provided in Section 7.2.

5.4 What is the best method for

measuring blood pressure for long-term management of hypertension? While repeat office measurement of BP remains the commonest approach to long-term management of hypertension, several lines of investigation support augmenting office BP measurements with out-of-office assessment.

5.4.1 Home monitoring

There are over 50 trials of different self-monitoring-based interventions.73 Self-monitoring is associated with lower mean systolic BP at 12 months [−3.2 mmHg; 95% confidence interval (CI) −4.9 to −1.6 mmHg].74 Furthermore, there are known benefits of telemonitoring, digital interventions, and mobile health in managing BP.75–78 Self-monitoring is also likely to be cost-effective.79 Unfortunately, in clinical practice, some patients may not provide reliable information on their home BP, and both their device and measurement technique need to be checked.

5.4.2 Ambulatory monitoring

ABPM provides a reference BP measurement but repeat ABPM testing is sometimes not practical due to resource constraints and, uncommonly, low patient acceptability.80 There is a paucity of data on treatment guided by ABPM vs. that of office or HBPM measurements. A trial of treatment guided by HBPM vs. clinic and ambulatory monitoring found equivalence in BP control and HMOD.81 Other studies reported a non-significant trend to worse BP control with ambulatory vs. office BP monitoring, though the ambulatory group also received fewer

Table 6 Comparison of ambulatory and home blood pressure monitoring Ambulatory monitoring Advantages • Can identify white-coat and masked hypertension • Measurement in real-life settings and during usual activities • Stronger prognostic evidence • Night-time readings • Abundant information from a single investigation, including short-term

diurnal BP variability • Additional BP phenotyping (e.g. nocturnal dipping status) Disadvantages • Relatively expensive and sometimes limited availability • Can be uncomfortable and affect sleep Home monitoring Advantages • Identify white-coat and masked hypertension • Cheap and widely available • Measurement at home, which may be more relaxed than at doctor’s office • Patient engagement in BP measurement and telemedicine potential • Easily repeated and used over longer periods to assess day-to-day BP variability Disadvantages • Only static BP at rest is typically available • Potential for measurement error due to improper measurement technique or unvalidated or poorly calibrated device • Nocturnal readings not usually possible © ESC 2024

BP, blood pressure. Downloaded from academic.oup.com/eurheartj/article/45/38/3912/7741010 by guest on 07 October 2026