Out-of-office blood pressure improves risk stratification in normotension and prehypertension people.

This review addresses to what extent out-of-office blood pressure, the ambulatory blood pressure monitoring and the self-measured home blood pressure, refines conventional blood pressure-based risk stratification across increasing blood pressure categories, in particular individuals assumed to be associated with no or only mildly increased risk. Compared with sustained normotension, individuals with prehypertension as well as masked hypertension tend to be developed to true hypertension. Ambulatory blood pressure measurement refines risk stratification among prehypertensive people. Home blood pressure is more useful for the prediction of cerebrovascular diseases than conventional blood pressure, by replacing information from conventional to home blood pressure in risk stratification system. Furthermore, the two participant-level meta-analyses demonstrated that the out-of-office blood pressure substantially refines risk stratification in normotension and prehypertension, particularly among participants with masked hypertension. Properly organized randomized clinical trials are required to demonstrate that identification and treatment of masked hypertension, compared with the current standard care based on conventional pressure, lead to the reduction of cardiovascular diseases in population and are cost-effective.