Home blood pressure monitoring

Home blood pressure monitoring

Home blood pressure monitoring is cheaper than ambulatory BP monitoring and avoids white coat hypertension. Equipment should be validated prior to use as errors may be there in some equipment. Hypertension is the most common preventable cause of cardiovascular disease [1] and home self monitoring can go a long way in improving the control.

Home monitoring helps in identifying white coat hypertension (hypertension in clinic, not at home), hypertension with white coat effect (higher clinic blood pressure) and masked hypertension (clinic pressure lower). A recent study from Thailand used telehealth assisted home BP monitoring as a nationwide pilot project [2]. It was a multicentric study involving 1184 patients diagnosed to have hypertension based on clinic recordings. Almost one fourth of them were found to have a white coat effect. Half of the treated patients, especially the older males, were found to have uncontrolled hypertension, requiring more intensive treatment.

Incorrect positioning of the blood pressure cuff can be the cause of erroneous reading. To counteract this, the use of a wide range cuff (Omron IntelliWrap) with oscillometric measurement has been employed [3]. It was noted that incorrect placement of oscillometric cuff had not significant effect on the accuracy of measurements with difference from the correct position being less than 1.5 mm Hg. This may be of benefit in home monitoring where the user may not be adequately trained in the usage of the measuring device.

References

1. George J, MacDonald T. Eur Cardiol. 2015 Dec;10(2):95-101.
2. Montrivade S, Chattranukulchai P, Siwamogsatham S, Vorasettakarnkij Y, Naeowong W, Boonchayaanant P, Sakulsupsiri A, Ariyachaipanich A, Lertsuwunseri V, Rungpradubvong V, Satitthummanid S, Puwanant S, Prechawat S, Srimahachota S, Chaipromprasit J, Buddhari W, Boonyaratavej S, Sitthisook S, Buranakitjaroen P, Sukonthasarn A, Sangwatanaroj S. Int J Hypertens. 2020 Apr 9;2020:3261408. 
3. Bilo G, Sala O, Perego C, Faini A, Gao L, Głuszewska A, Ochoa JE, Pellegrini D, Lonati LM, Parati G. Impact of cuff positioning on blood pressure measurement accuracy: may a specially designed cuff make a difference? Hypertens Res. 2017 Jun;40(6):573-580.