Hypertension is the most frequently diagnosed condition during outpatient office visits in the United States.¹ According to the 2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults, approximately 45.6% of American adults are living with high blood pressure.² Among those diagnosed, 46% do not have their condition under adequate control.³
One effective method for confirming a hypertension diagnosis and managing it outside of a clinical setting is home blood pressure monitoring. This approach assists patients in achieving their target blood pressure levels through consistent and accurate tracking.
Benefits of Managing Hypertension at Home
Monitoring blood pressure at home offers numerous advantages. It allows physicians to obtain readings from the patient’s typical living environment, where measurements are often lower compared to those recorded in clinical settings.⁴ Averaging blood pressure readings throughout the day presents a more accurate picture of a patient’s true BP status than a single in-office measurement. This can help prevent the misclassification of hypertension, which may be influenced by factors such as the white-coat effect, clinician technique, equipment differences, the patient’s health status, or recent physical activities.⁵
Additionally, home monitoring provides valuable insights into how patients respond to medication, enabling healthcare providers to make timely adjustments to treatment plans. This, in turn, can improve adherence to therapy and enhance progress toward achieving established BP targets.
Compared to ambulatory blood pressure monitoring, home monitoring is often more practical due to its convenience, affordability, and wider accessibility.⁶ Unlike the ambulatory method, home monitoring does not require staff training, continuous 24-hour use, or restrict the patient’s physical activities.
Choosing the Right Home Blood Pressure Monitor
A wide selection of home blood pressure monitors is available for consumer purchase. When selecting a monitor, patients should consider the following factors:
- Trusted by medical professionals: Choose a device recommended by healthcare providers for dependable blood pressure management.
- Accuracy: The American Heart Association recommends using an automatic upper-arm monitor. Wrist and finger monitors are discouraged due to their tendency to produce less accurate readings.⁷
- Proper cuff sizing: An ill-fitting cuff, particularly one that is too small, is a common source of inaccurate readings.
- Comfort: Look for a device that provides fast, comfortable readings, ideally within 30 seconds.
- Smart connectivity: Devices with Bluetooth® or other smart features allow users to share their results with healthcare professionals or caregivers easily.
For example, Hillrom offers a clinician-connected home monitor that helps patients take readings at home and wirelessly transmit the data to their physicians, enhancing communication and progress tracking.
Ensuring Accurate Measurements at Home
Accurate home blood pressure monitoring depends on proper technique. In fact, 82% of physicians agree that most patients do not follow the correct procedures when measuring their blood pressure at home.⁸ Before recommending this method, it’s important to ensure the patient is educated on the appropriate technique:
- Bare arm: Roll up your sleeve and place the cuff directly on the skin of your upper arm.
- Correct cuff placement: The cuff should fit snugly, with space for no more than two fingers. The tubing should align with the center of your forearm, and the bottom edge of the cuff should be roughly one inch (two finger-widths) above your elbow.
- Supportive seating: Sit upright in a chair with back support. Keep your legs uncrossed and both feet flat on the floor.
- Arm positioning: Rest your arm on a table or other surface so the cuff is level with your heart.
- Rest beforehand: Sit quietly for at least five minutes before taking a reading.
- Remain still: Do not move your arms during the measurement cycle.
Patients should take at least two readings one minute apart, both in the morning and in the evening before dinner.⁴ Ideally, this should be done weekly—especially for two weeks following any change in treatment, and again the week before a scheduled appointment.⁴
It is equally important that patients record their blood pressure readings accurately. This can be done using a monitor with built-in memory or manually logging the numbers along with the date and time.⁹ These readings should be shared electronically with the healthcare provider or brought to the next appointment. For clinical decision-making, physicians typically consider the average of readings taken across two or more separate occasions.⁴
To ensure consistency and accuracy, patients should always use the same validated home monitor for every reading.⁴
Limitations of Home-Based Hypertension Management
Despite its many advantages, home blood pressure monitoring has some limitations. Accurate and useful data relies heavily on the patient’s effort and consistency—this includes following correct procedures, recording and sharing results, and maintaining open communication with their physician. Furthermore, because this method only captures BP during waking hours, it may miss fluctuations that occur during sleep.
Key Takeaway
Home blood pressure monitoring is a valuable tool for both diagnosing and managing hypertension. By capturing blood pressure readings in the patient’s usual environment and reflecting their response to treatment, it provides healthcare providers with essential information that supports more personalized and effective care.
Reference:
1. Cherry DK, Woodwell DA. National Ambulatory Medical Care Survey: 2000 Summary. Advance Data. 2002;328. PR.
2. American Heart Association. Heart Disease and Stroke Statistics 2018. https://www.heart.org/-/media/data-import/downloadables/heart-disease-and-stroke-statistics-2018—at-a-glance-ucm_498848.pdf. Accessed September 17, 2018.
3. Home Blood Pressure Monitor Motion Tolerance Clinical Study, August 2016.
4. 2017 Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults.
5. Pickering TG, et al; American Heart Association; American Society of Hypertension; Preventative Cardiovascular Nurses Association. Call to action on use and reimbursement for home blood pressure monitoring: a joint scientific statement from the American Heart Association, American Society of Hypertension, and Preventative Cardiovascular Nurses Association. Hypertension. 2008 Jul:52(1):10-29.
6. Verberk WJ, et al. The optimal scheme of self blood pressure measurement as determined from ambulatory blood pressure recordings. J Hypertens. 2006 Aug;24(8):1541-8.
7. American Heart Association and American Stroke Association. 2017 Heart Disease and Stroke Statistics Update.
8. Green B et al. Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control. JAMA 2008;299(24):2857-2867.
9. National Heart, Lung, and Blood Institute. High Blood Pressure. https://www.nhlbi.nih.gov/health-topics/high-blood-pressure. Accessed September 17, 2018.
10. National Institutes of Health. National Heart, Lung, and Blood Institute. JNC 7 Express. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.