Role of Ambulatory and Home Blood Pressure Monitoring in Clinical Practice: A Narrative Review

Abstract

Hypertension, a common risk factor for cardiovascular disease, is usually diagnosed and treated based on blood pressure readings obtained in the clinic setting. Blood pressure may differ considerably when measured inside versus outside of the clinic setting. Over the past several decades, evidence has accumulated on the following 2 approaches for measuring blood pressure outside of the clinic: ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM). Both of these methods have a stronger association with cardiovascular disease outcomes than clinic blood pressure measurement. Controversy exists about whether ABPM or HBPM is superior for estimating risk for cardiovascular disease and under what circumstances these methods should be used in clinical practice for assessing blood pressure outside of the clinic. This review describes ABPM and HBPM procedures, the blood pressure phenotypic measurements that can be ascertained, and the evidence that supports the use of each approach to measuring blood pressure outside of the clinic. It also describes barriers to the successful implementation of ABPM and HBPM in clinical practice, proposes core competencies for the conduct of these procedures, and highlights important areas for future research.

Figure 1

Blood pressure data from an untreated healthy individual who underwent clinic blood pressure assessment immediately followed by 24-hour ABPM (upper panel). HBPM was then performed for 18 days (lower panel). The points for clinic blood pressure represent the average of 3 readings. The points on HBPM represent the average of 2 morning or 2 evening readings. Average clinic blood pressure, daytime (awake), nighttime (sleep), 24-hour blood pressure, and home blood pressure are shown in the figure. On ABPM (upper panel), blood pressure falls to its lowest level during at night, followed by a surge in the morning hours coinciding with waking up. Because blood pressure readings on HBPM (lower panel) are obtained at fixed times during the day, and are measured at rest, the variability of blood pressure over time is less than what is observed on ABPM. Unlike ABPM, HBPM cannot measure blood pressure readings during sleep. Abbreviations: ABPM = ambulatory blood pressure monitoring. BP = blood pressure. DBP = diastolic blood pressure. HBPM = home blood pressure monitoring. SBP = systolic blood pressure.