Monitoring of Treatment for Arterial Hypertension–The Role of Office, Home, and 24 h Ambulatory Blood Pressure Measurement.

BACKGROUND: The treatment of arterial hypertension can be monitored by office blood pressure (office BP), home blood pressure (home BP), or 24 hours ambulatory blood pressure (ABPM). In this review, we present current recommendations from Germany and from international guidelines as well as the findings of the main studies on the use of these methods to guide treatment.
METHODS: This review is based on pertinent publications retrieved by a selective search in PubMed up to and including March 2020. Special attention was paid to guidelines and position papers.
RESULTS: The guidelines offer heterogeneous recommendations for treatment monitoring. Home BP is the most reproducible method, with test-retest correlation coefficients of 0.91/0.86 (systolic/diastolic), in comparison to office BP (0.77/0.76). Two meta-analyses revealed better blood pressure control with home measurement than with usual care (systolic, -3.2 to -8.9 mmHg). A meta-analysis of randomized controlled trials also suggests that home measurement promotes adherence. In the randomized and controlled TASMINH4 trial, the home BP group with telemetric surveillance achieved better blood pressure control than the group with treatment titration based on office BP (systolic -4.7 [CI: -7; -2.4] mmHg, diastolic -1.3 [-2.5; 0.02] mmHg). With ABPM, patients frequently reported moderate to severe discomfort, limiting its practical applicability.
CONCLUSION: Blood pressure measurement at home is recommended for treatment monitoring, using validated, automatic upper arm devices with data storage and trend analysis. Changes of treatment should be based on average values (28 home measurements) from seven days (two morning and two evening measurements per day). Office BP is mainly used for for screening purposes. There have not yet been any randomized trials comparing the three measuring methods in terms of hard cardiovascular endpoints.