In the past three decades, the prevalence of hypertension in China has shown a significant upward trend, and the resulting cardiovascular and cerebrovascular diseases have increased significantly. Through the unremitting efforts of medical workers in recent years, coupled with the continuous expansion of medical insurance coverage at all levels of government, the management of hypertension in China has improved significantly, and the control rate has increased significantly. However, because the number of patients is still increasing, the overall control rate of hypertension is still at a relatively low level, and most hypertensive patients have not yet had their blood pressure effectively controlled. The main reason for this is that blood pressure is usually not measured or rarely measured, regardless of whether or not they have hypertension; therefore, the rate of hypertension awareness is low, and patients taking antihypertensive medications have poor treatment compliance or poor quality of management.
Home blood pressure monitoring is an important tool to improve blood pressure measurement. If every family member could measure blood pressure regularly at home and perform home blood pressure monitoring, the awareness and control rate of hypertension would be significantly increased. Home blood pressure monitoring is usually done by the person who is being measured, or with the assistance of a family member, etc. Because the measurement is done in a familiar home environment, the “white coat effect” of “office blood pressure measurement” can be avoided; home blood pressure monitoring can also be used to Home blood pressure monitoring can also be used to assess long-term changes in blood pressure or the effectiveness of antihypertensive therapy over days, weeks, months, or years. Therefore, it has become an indispensable method of blood pressure measurement.
I. Home blood pressure monitoring is an important method of measuring blood pressure outside the office
The distinctive feature of home blood pressure monitoring (HBPM) is that a large number of blood pressure measurements can be obtained outside the hospital, which may be closer to the patient’s blood pressure level in daily life, and can improve the management of high hypertension in several aspects.
1. Home blood pressure monitoring can improve the rate of hypertension awareness. Not only hypertensive patients, but also people with normal blood pressure need to have regular home blood pressure monitoring. A family, if you have a blood pressure monitor, and regular blood pressure monitoring, will be able to timely detection of elevated blood pressure, timely diagnosis and treatment of hypertension, can more effectively control blood pressure, more effective prevention of cardiovascular and cerebrovascular complications.
2, home blood pressure monitoring can improve the accuracy of hypertension diagnosis. Home blood pressure monitoring can partially replace the function of ambulatory blood pressure monitoring, help to detect and diagnose “white coat hypertension” and “occult hypertension”, so as to give “white coat hypertension” and “occult hypertension It can help to detect and diagnose “white coat hypertension” and “occult hypertension”, and thus give more appropriate treatment to patients with “white coat hypertension” and “occult hypertension”.
3, home blood pressure monitoring can improve the quality of antihypertensive treatment and achieve the standard rate. Through home blood pressure monitoring, patients can more fully understand their blood pressure levels, communicate more effectively with their treating physicians about their blood pressure control, find the causes of uncontrolled or low blood pressure, make effective lifestyle interventions, or adjust the usage and dosage of antihypertensive drugs, thus reducing long-term variability in blood pressure.
4, home blood pressure monitoring also helps to improve the assessment and prediction of cardiovascular and cerebrovascular complications risk. Home blood pressure monitoring, compared with in-office blood pressure, has significant advantages in predicting the incidence of cardiovascular and cerebrovascular complications and mortality. The risk of cardiovascular and cerebrovascular complications in hypertensive patients can be more accurately assessed by home blood pressure monitoring.
Home blood pressure monitoring and ambulatory blood pressure monitoring complement each other and are not substitutes for each other
Ambulatory blood pressure monitoring and home blood pressure monitoring are in good agreement with each other, but they are very different, so they are not substitutes for each other, but have a strong complementary nature.
Ambulatory blood pressure monitoring can avoid the error of the measurer; it can avoid the “white coat phenomenon” and diagnose “white coat hypertension”; it can obtain more blood pressure readings in one day and night, and obtain the average blood pressure value of 24 hours, day and night; it can measure the blood pressure during activity, sleep, etc. It can measure blood pressure in special states and detect “occult hypertension”, including “nocturnal hypertension”; it can observe the circadian rhythm of blood pressure and determine whether blood pressure drops at night; it can measure morning peak blood pressure; and it can measure blood pressure variability throughout the day. The disadvantages are that the direct cost of measurement is large, the monitoring time is long, it is usually difficult to repeat several times, and the long-term changes in blood pressure cannot be observed.
The direct cost of home blood pressure monitoring is smaller; it can monitor blood pressure for a longer period of time and measure the variation of blood pressure from day to day; it can improve the motivation of patients to manage their blood pressure and help improve the control rate of hypertension and the quality of antihypertensive treatment; it can detect elevated blood pressure in time and help improve the awareness rate; some automatic electronic blood pressure monitors can also determine whether patients have arrhythmias. In addition, it can also be used as an alternative to ambulatory blood pressure monitoring in some aspects, for example, it can also avoid the “white coat phenomenon” and diagnose “white coat hypertension”. The disadvantage is that sometimes it is difficult to guarantee the quality of blood pressure measurement, or the records are not accurate and complete; it may lead to patient anxiety, or change the antihypertensive treatment plan at will.
Three, home blood pressure monitoring methods
The Chinese Expert Consensus on Home Blood Pressure Monitoring recommends that an upper-arm fully automatic electronic blood pressure monitor that has been independently clinically validated in accordance with international standards should be selected. The current validation programs mainly include the European Society of Hypertension (ESH) international validation program, the British Hypertension Society (BHS) program or the American Association for the Advancement of Medical Devices (AAMI) program. Traditional mercury column sphygmomanometers are not recommended for home blood pressure monitoring because of the use of the heavy metal mercury. Barometer sphygmomanometers, in addition to requiring training in measurement, are not easy to read accurately and are also not recommended.
Whether it is used to diagnose hypertension or to evaluate the efficacy of antihypertensive therapy, home blood pressure monitoring must be performed in a standardized manner. Taking into account the recommendations of national guidelines and the lifestyles of Chinese residents, the “Chinese Expert Consensus on Home Blood Pressure Monitoring” recommends that for home blood pressure monitoring, two to three readings should be taken each day in the morning (after waking up) and in the evening (before going to bed), with a 1-minute interval between measurements. Measurements should be taken for 5 to 7 consecutive days. Clinical judgment and assessment is made based on the mean value of all measurements for 5 to 7 days.
Usually, blood pressure is higher in the early morning and lower at night. If, ideally, a person’s higher blood pressure for the day can be measured early in the morning and the lower blood pressure for the day can be measured at night, a complete picture of the day’s blood pressure can be obtained. Therefore, when measuring blood pressure early in the morning, factors that may lead to lower blood pressure should be excluded as much as possible; while when measuring blood pressure at night, factors that may lead to higher blood pressure should be excluded as much as possible. Usually, early morning blood pressure measurements should be taken within an hour of waking up and should precede the administration of antihypertensive medications. Eating can sometimes significantly affect blood pressure; therefore, blood pressure should be measured before breakfast whenever possible. Given that sitting blood pressure is usually measured in domestic hospitals, home blood pressure monitoring should also be performed in the sitting position whenever possible. The bladder should be emptied before the blood pressure is taken. Compared with early morning blood pressure measurement, the conditions for evening blood pressure measurement are more difficult to control. It is recommended that blood pressure be measured after dinner, after bathing, and before going to bed after taking medication.
IV. Clinical significance of home blood pressure monitoring
Home blood pressure monitoring undoubtedly has many advantages compared to office blood pressure. Even compared with ambulatory blood pressure monitoring, it also has its irreplaceable value and role. However, compared with office blood pressure and ambulatory blood pressure, home blood pressure has not yet been able to play a full role in the clinical management of hypertension. In addition to the lack of standardization of home blood pressure monitoring, one of the most important reasons is that the recording, storage and analysis of the measurement results have not been fully computerized.
If home blood pressure monitoring can be standardized and the results can be transmitted wirelessly to a cloud computing platform, recorded and stored, then analyzed and processed for clinical assessment. It can be used to diagnose hypertension and detect “white coat hypertension” and “occult hypertension”; it can be used to evaluate the effect of antihypertensive treatment and monitor the effect of antihypertensive treatment continuously for a long time. The Chinese Expert Consensus on Home Blood Pressure Monitoring recommends that hypertension can be diagnosed if the home blood pressure is ≥135/85 mm Hg; if the home blood pressure is <130/80 mm Hg, the blood pressure can be considered normal; if the home blood pressure is 130-134/80-84 mm Hg, ambulatory blood pressure monitoring is recommended.
V. Summary
Home blood pressure monitoring has an irreplaceable role in the management of hypertension; therefore, unless there are certain circumstances that prevent or make home blood pressure monitoring inappropriate, patients with hypertension should have home blood pressure monitoring, and those with normal blood pressure should also have their blood pressure measured at least once a year. With the introduction of various fully automated electronic blood pressure monitors into the home, home blood pressure monitoring has gradually become the main method for hypertensive patients to observe the effectiveness of antihypertensive therapy. With the development and improvement of big data technologies such as Internet, wireless communication and cloud platform, home blood pressure monitoring will play an increasingly important role in the clinical management of hypertension.