Ambulatory and Home Blood Pressure Monitoring

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What is out-of-office blood pressure monitoring?

Out-of-office blood pressure (BP) monitoring is the assessment of BP outside of the clinic setting using either ambulatory BP monitoring (ABPM) or self-monitoring of BP at home, also known as home BP monitoring (HBPM).

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Why is out-of-office BP monitoring performed?

Out-of-office BP monitoring is performed to confirm the diagnosis of hypertension and to assist with titration of antihypertensive medications. Out-of-office BP monitoring is particularly useful for identifying discrepancies between BPs measured in versus outside of the clinic, including masked and white coat hypertension ( Fig. 2.1 ).

Masked hypertension (MH) and masked uncontrolled hypertension (MUCH) :

• Defined as normal clinic BP with elevated out-of-office BP

  • MH occurs in patients not yet on antihypertensive therapy

  • MUCH occurs in patients on antihypertensive therapy

• Associated with similarly elevated cardiovascular risk as sustained hypertension

• Most common in men, individuals of African descent, individuals with chronic kidney disease, and individuals with obstructive sleep apnea

• Consider screening patients with:

  • Evidence of target organ damage disproportionate to their degree of BP control in the clinic

  • Clinic BPs less than 10 mm Hg below their goal

  • Labile clinic BPs

White coat hypertension (WCH) and white coat effect (WCE) :

• Defined as elevated clinic BP with normal out-of-office BP

  • WCH occurs in patients not yet on antihypertensive therapy

  • WCE occurs in patients on antihypertensive therapy

• WCH is associated with:

  • Elevated cardiovascular risk that is lower in magnitude than sustained hypertension

  • High risk of transitioning to sustained hypertension

• WCE is not associated with elevated cardiovascular risk

• Most common in women, children, older adults, and patients with apparent treatment resistant hypertension

• Consider screening in patients with:

  • Apparent treatment resistant hypertension

  • Treated hypertension and symptoms of low BPs outside of the office

  • Labile clinic BPs

  • Newly elevated clinic BPs

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What is ABPM?

ABPM is a noninvasive method of out-of-office BP monitoring in which BPs are measured repeatedly over a 24- to 48-hour period, during routine daily activities and sleep, using a fully automated device.

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