The case for home monitoring in hypertension

Although the assessment of cardiovascular risk in individual patients takes into account a range of risk factors, the diagnosis and management of hypertension (high blood pressure) is largely determined by a single numerical value, albeit that often several readings are taken over time. Given the critical impact of a decision to embark on lifelong drug therapy, the importance of ensuring that a blood pressure (BP) record is both accurate and representative is clear. However, there is good evidence that the variability of BP is such that even if measurement is of the highest quality, it can be difficult to say with confidence whether a patient is above or below a treatment threshold. This commentary argues that current BP measurement is inadequate to make the clinical decisions that are necessary and that multiple readings are required to deliver an acceptable degree of accuracy for safe decision-making. This is impractical in a doctor's surgery, and the only realistic long-term strategy is to involve the patient in measuring his or her own BP in their own environment. Evidence is presented that such a strategy is better able to predict risk, is cost-effective for diagnosing hypertension, can improve BP control and is thus better able to protect individuals in the future. In this commentary, I explain why doctors and other healthcare professionals should increase their familiarity with the technology, be aware of its strengths and limitations and work with patients as they become more empowered in the management of their chronic condition, hypertension.