Home and Ambulatory Blood Pressure Measurements Are Essential Tools in Managing Hypertension 

Michael A. Weber, MDDivision of Cardiovascular MedicineState University of New York, Downstate Medical Center

The ABPM Device

www.bmj.com/cgi/reprint/322/7285/531.pdf

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Reproducibility of the Circadian Pattern (Drayer JIM, Weber MA. Am J Med 1982; 493-9, 1982)

Time of Day

Average DBP (mm Hg)

Average SBP (mm Hg)

First 24-hr StudySecond 24-hr Study (n = 56)

24-h Ambulatory Systolic Blood Pressure is a better predictor of clinical outcomes than Office Blood Pressure: USPSTF

USPHS: https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/high‐blood‐pressure‐in‐adults‐screening#fig2

Weber, MA ACP Presentation April, 2018

HR Risk for CVD by ABPM adjusted for office BP

Diagnostic Categories of Blood Pressure

Normal:  BP normal in office and at home or elsewhere

Sustained Hypertension:  BP high in office, high elsewhere

White coat hypertension:  High in office, normal elsewhere

Masked hypertension:  BP normal in office, high elsewhere*

* Major CV event rates as high as with sustained hypertension

Prevalence of normal BP, hypertension, white coat hypertension and masked hypertension at 2 office visits 1 week apart as modified by self‐measured BP averaged between the visits in 18,918 previously undiagnosed  Indian primary care patients     (Kaul U. et al. J Hypertens 2020; 1262‐1270)

A small, inexpensive and validated Home BP Monitor (can also be used in the clinic)

Home Blood Pressure Measurements

• Useful for identifying normal BP/ hypertension/ white coat hypertension/ masked hypertension

• Helpful in improving patients adherence to treatment

Improved Drug Taking After 3 Months of Home BP Measurements in Hypertensive Patients                       (Jo SH et al. JCH 2019; Vol 20 [In press])

Effects on Office BP of 3 months Home BP Monitoring in Patients Seen in General Hospitals (GH) 0r Local Clinics (LC)(Jo SH et al. JCH 2019; Vol 20, in press)

Is Nighttime BP the Best predictor of CV Events?

A wrist‐cuff device that measures nighttime blood pressures at pre‐set intervals without noise and only minimal awareness

Out-of-Office and Self-Monitoring of BP

COR LOE Recommendation for Out-of-Office and Self-Monitoring of BP

I ASR

Out-of-office BP measurements are recommended to confirm the diagnosis of hypertension and for titration of BP-lowering medication, in conjunction with telehealth counseling or clinical interventions

SR indicates systematic review

Note: Diagnostic office BP should be average of >2 carefully performed readings, performed on each of >2 separate visits

ABPM Highly Recommended in Pediatric Practice by American Pediatrics Association Guidelines

Graphical Abstract

Am J Hypertens, hpab095, https://doi.org/10.1093/ajh/hpab095

Will new technologies make diagnosing and treating hypertension largely an out‐of‐office procedure?

Categories of Hypertension Using Home BP Monitoring in a Japanese Cohort  (Fujiwama T et al. JAMA Cardiol 2018; 3:583‐590)

Adjusted 5-Year Risk of CV Death According to Clinic and Ambulatory BP

Adjusted for other covariates.

Dolan E et al. Hypertension. 2005;46:1-6.

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J Hum Hypertens . 2019 Sep 4. doi: 10.1038/s41371‐019‐0243‐6. O

Total Mortality CV Events

Adjusted for cohort, sex, age, body mass index, smoking and drinking, cholesterol, history of CV disease, diabetes mellitus, AH treatment, and 24-hour SBP.

Boggia J et al. Lancet. 2007;370:1219-1229.

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IDACO Total Mortality and CV Events by Category of the Night:Day Ratio of SBPTotal Mortality and CV Events by Category of the Night:Day Ratio of SBP

Framingham Heart Study: Characteristics of Heart rate QuartilesHo JE et al. J Am Heart Assoc 2020 doi: 10.1161/JAHA.113.000668

Patient Adherence and BP Control: Effects of 3 Months of Home BP Monitoring

• 7751 patients, 3827 from hospital practices and 3924 from local practices

• BP carefully measured by clinicians immediately before and after the 3 month period

• Patients told to measure BP within 10 minutes of awakening and just before going to bed

• Patients told their BP targets: < 140/90 mmHg if no CV history, < 130/80 mmHg if positive CV history

• All patients provided with Omron BP devices

Jo SH et al. JCH 2019;Vol 20, in press.

Framingham: Quartiles of Heart Rate and Incidence of CV Disease and Heart FailureHo JE et al. J Am Heart Assoc 2020  doi: 10.1161/JAHA.113.000668