Blood pressure measurement is a fundamental tool and method for assessing blood pressure levels, confirming the diagnosis of hypertension, and observing the effectiveness of treatment, and home blood pressure monitoring is one type of blood pressure measurement that is performed outside the office.
Home blood pressure monitoring has the advantage of being better tolerated, more accessible, and less costly.
However, a study showed that the self-measurement rate of blood pressure in elderly patients with hypertension in China was only 46.3%, probably due to the lack of knowledge and ability related to home blood pressure monitoring in the elderly population and the lack of health education by health care professionals.
In response to these questions, the relevant guidelines have given clearer answers.
1.What is home blood pressure monitoring and how should we do it?
(1) What is home blood pressure monitoring?
Home blood pressure monitoring is the measurement of blood pressure by the patient at home or with the help of family members, and is a supplement to office blood pressure and ambulatory blood pressure.
(2) Is there a point in doing home blood pressure monitoring?
Home blood pressure monitoring is useful in four ways: first, to improve the awareness of hypertension, second, to improve the accuracy of hypertension diagnosis, third, to improve the accuracy of the prognosis of hypertensive patients, and fourth, to improve the achievement rate of antihypertensive treatment.
Because the operation is performed at home and the number of measurements and days are unlimited, it provides a more accurate and comprehensive picture of a person’s blood pressure level in the state of daily life.
Similar to ambulatory blood pressure monitoring, home blood pressure monitoring can effectively identify “white coat hypertension” or “white coat uncontrolled hypertension” that is elevated only when the blood pressure is measured in the office, and “occult hypertension” that is elevated when the blood pressure is measured at home. “Occult hypertension” or “occult uncontrolled hypertension”.
In addition, home blood pressure monitoring allows hypertensive patients receiving antihypertensive therapy to be fully aware of their blood pressure levels, detect uncontrolled blood pressure in a timely manner, provide a basis for decision making to adjust antihypertensive treatment regimens, and bring blood pressure under control to target levels early.
(3) How does home blood pressure monitoring work?
The operation of home blood pressure monitoring is relatively easy to grasp, generally using an upper-arm blood pressure monitor, and the general conditions of measurement are generally similar to those in the office.
The blood pressure is measured after the patient has rested in a reclined chair for at least 5 minutes. For blood pressure measurement, the person should place the forearm on the side of the cuff on the table, with the midpoint of the upper arm of the cuff at the same level as the heart and both legs relaxed and on the ground.
Alternatively, the person can sit in a more comfortable position, such as a sofa, but care should be taken to ensure that the midpoint of the upper arm of the cuff is at the same level as the heart.
2.Specific home blood pressure monitoring program and diagnostic criteria for home blood pressure monitoring
(1) What do I need to know about the home blood pressure monitoring program?
When purchasing a blood pressure monitor or after purchasing it, you need to know in detail how to use the monitor. If needed, you can also seek help from the medical institution you visit to verify or calibrate the accuracy of the sphygmomanometer.
When purchasing a sphygmomanometer, it is also important to choose a cuff of the right size to match the circumference of the primary user’s upper arm.
The timing and frequency of testing also needs to be noted, with measurements taken 2-3 times a day in the morning and 3 times a day in the evening, 1 minute apart.
The blood pressure is measured in the morning one hour after waking up and before activities such as breakfast, taking antihypertensive medication, and morning exercise; in the evening after dinner and before going to bed; and the bladder needs to be emptied before each measurement.
Those who are first diagnosed, early in treatment or whose blood pressure has not yet reached the standard despite treatment should have their blood pressure measured for 5-7 consecutive days before the visit; when blood pressure is well controlled, measure at least 1 day per week.
Record blood pressure measurement values
In addition, to ensure the quality of home blood pressure monitoring, the time of waking up, going to bed, and the time of three meals as well as the time of taking medication should be recorded during blood pressure monitoring.
(2) What are the diagnostic criteria for home blood pressure monitoring?
Home blood pressure monitoring values allow for the diagnosis of hypertension and its status. For example, if the average home blood pressure is ≥135/85 mmHg, the diagnosis of hypertension can be confirmed or the blood pressure is not yet controlled.
It is also possible to assess early morning blood pressure versus evening blood pressure and to diagnose early morning hypertension versus evening hypertension based on whether the mean of early morning and evening blood pressure is ≥135/85 mmHg.
Sometimes it is also necessary to combine office blood pressure for the following judgments.
– When the office blood pressure is ≥140/90 mmHg and the home blood pressure is <135/85 mmHg, the diagnosis of "white coat hypertension" or "white coat uncontrolled hypertension" is made.
– When the office blood pressure is <140/90mmHg, but the home blood pressure is ≥135/85mmHg, it can be diagnosed as "occult hypertension" or "occult uncontrolled hypertension".
3, the indications for home blood pressure monitoring and the application of special populations
(1) What are the indications for home blood pressure monitoring?
Home blood pressure monitoring is not only for people with hypertension, but for everyone, including those who think their blood pressure is still in the normal range.
By regularly measuring blood pressure, elevated blood pressure can be detected in a timely manner, leading to timely diagnosis and treatment of hypertension and prevention of cardiovascular and cerebrovascular complications.
In addition, home blood pressure monitoring is also applicable in identifying white coat hypertension, occult hypertension and refractory hypertension, evaluating blood pressure fluctuations, assisting in the evaluation of antihypertensive efficacy, and predicting cardiovascular risk and prognosis.
(2) In what cases is home blood pressure monitoring not possible or not recommended?
For patients with certain arrhythmias such as atrial fibrillation and frequent premature beats, home blood pressure monitoring cannot accurately measure blood pressure.
Moreover, fluctuations in blood pressure itself may affect the patient’s mood and raise his or her blood pressure, creating a vicious cycle. Home blood pressure monitoring is not recommended for patients with mental anxiety and disorders or for patients who change their treatment regimen without authorization.
(3) Is home blood pressure monitoring suitable for some special groups?
In addition to the above, home blood pressure monitoring is also applicable to special populations such as end-stage renal disease, kidney transplantation, and hypertension in pregnancy.
– End-stage renal disease: Home blood pressure monitoring can detect changes or loss of blood pressure rhythm in maintenance dialysis patients. Studies have found that every 10 mmHg increase in diastolic blood pressure during dialysis in patients with end-stage renal disease can increase the risk of cardiovascular events by 2 times, and systolic blood pressure measured at home is an independent predictor of end-stage renal disease.
– Renal transplantation: The level of blood pressure after transplantation is an important determinant of the survival of the transplanted kidney. Home blood pressure monitoring (HBPM) is easy and inexpensive, provides a better response to the patient’s blood pressure, and plays an important role in preventing cardiovascular events in post-transplant patients.
Blood pressure monitoring at home in pregnant women
– Hypertension in pregnancy: Home blood pressure monitoring (HBPM) is particularly important for the early diagnosis and timely treatment of maternal disease. The comparison of current maternal blood pressure levels with basal blood pressure can be an important reference in the diagnosis of hypertension, and home blood pressure monitoring in early pregnancy provides an important basis for maternal basal blood pressure, so home blood pressure monitoring (HBPM) in early pregnancy should be taken seriously.
References
[1] Liu T T, Liao X Q, Pu L, et al. Quality evaluation and content analysis of clinical practice guidelines related to home blood pressure monitoring [J]. Nursing Research,2022,36(3):413-420.
[2]China Hypertension Alliance Committee on Home Blood Pressure Monitoring Guidelines.2019 China Home Blood Pressure Monitoring Guidelines[J]. Chinese Journal of Circulation,2019,34(7):635-639.