-Apart from the awareness that home readings of 140/90 mm Hg reflect inadequate BP control, this paper calls our attention to the importance of out-of-office monitoring. Just as we recognize the foolishness of adjusting medications for diabetes based on a single blood glucose concentration, titrating anti-hypertensives in response to a lone office reading is equally ill-advised.
-To this end,
I find self-monitoring invaluable. It is not only inexpensive but can be carried out as frequently as required (e.g. after medication adjustment, post-hospitalization). Because
24-hour ABPM is not yet widely available,
home monitoring can identify those patients who would realize the most benefit from this modality.
-As is the case in the clinic, incorrect technique remains a considerable obstacle to accurate home measurement. However, because patients provide 20-25 measurements over several days, regression to the mean allows for a clear trend to emerge.
-Study Shortcomings: The authors included treated hypertensives, a difficult confounder to adjust for. The study was conducted outside of North America so African-Americans were not included.
-Despite the above criticisms, the BP thresholds
generated are largely in accordance with those in clinical guidelines.
-Disclosures: I have no conflicts to declare.