European Society of Hypertension guidelines for blood pressure monitoring at home: a summary report of the Second International Consensus Conference on Home Blood Pressure Monitoring

About 10% to 30% of subjects attending clinics due to high blood pressure have white coat hypertension.

“About 10%-30% of subjects attending clinics due to high BP have white coat hypertension”

Out-of-office blood pressure measurements are more closely associated with hypertension-induced organ damage and the risk of cardiovascular events than office measurements.

“more closely associated with hypertension-induced organ damage and the risk of cardiovascular events”

About 10% to 15% of subjects attending clinics due to high blood pressure have masked hypertension.

“and 10%-15% have masked hypertension.”

Other blood pressure monitoring device components in addition to the electronic transducer, such as tubing, connections and cuffs, may deteriorate and may affect accuracy, emphasizing the need for regular maintenance.

“However, other BP monitoring device components in addition to the electronic transducer, such as tubing, connections and cuffs, may deteriorate (air leaks, etc.), and may affect accuracy, which emphasizes the need of regular maintenance.”

Using a larger cuff, or overcuffing, is common in children and leads to blood pressure underestimation.

“whereas using a larger cuff (overcuffing) is common in children and leads to BP underestimation [4,90,98,99].”

Using a small bladder, or undercuffing, is common in obese adults and leads to overestimation of blood pressure.

“Using a small bladder (undercuffing) is common in obese adults and leads to overestimation of BP”

Out-of-office blood pressure measurements are more reproducible than office measurements.

“Out-of-office BP measurements (by patients at home or with 24-hour ambulatory blood pressure monitoring [ABPM]) are more reproducible than office measurements,”

Subjects with white coat hypertension are at intermediate cardiovascular risk between normotensives and sustained hypertensives.

“White coat hypertension: These subjects are at intermediate cardiovascular risk between normotensives and sustained hypertensives.”

The use of office and out-of-office blood pressure measurements identifies individuals with white coat hypertension and those with masked hypertension.

“The use of office and out-of-office (home or ambulatory) BP measurements identifies individuals with white coat hypertension, who have elevated BP only in the office (nonelevated ambulatory or home BP), and those with masked hypertension, who have nonelevated BP in the office but elevated BP out of the office (ambulatory or home). 1,2,17-21,25-27”

Out-of-office blood pressure measurements identify the white coat and masked hypertension phenomena.

“and identify the white coat and masked hypertension phenomena (see below).”

Patients with masked hypertension are at similar risk of cardiovascular events as sustained hypertensives.

“Masked hypertension: These patients are at similar risk of cardiovascular events as sustained hypertensives.”

The clinical application and accuracy of HBPM may be limited by conditions related to the individual, the procedure, the oscillometric technique, or cuff-related issues.

“the clinical application and the accuracy of HBPM may be limited by certain conditions related either to the individual [63–66], to the procedure itself [4,67], to the oscillometric technique for BP measurement or to cuff-related issues [4,65,68–74].”

There is some inconsistency in the recommendations by scientific societies on the issue of miscuffing.

“However, there is some inconsistency in the recommendations by scientific societies on the issue of miscuffing [1,4,90,98–100].”

In the 2008 ESH HBPM recommendations, a threshold for hypertension diagnosis with systolic/diastolic HBP of 135/85 mmHg was proposed, based on a review of evidence including two meta-analyses.

“In the 2008 ESH HBPM recommendations, a threshold for hypertension diagnosis with systolic/diastolic HBP of 135/85 mmHg was proposed [4], based on the review of evidence including two meta-analyses [139,140]”

Current guidelines recommend HBPM as a method for the evaluation of BP in untreated individuals with suspected hypertension and for monitoring long-term BP control in treated hypertensive patients.

“Consequently, current guidelines recommend also HBPM as a method for the evaluation of BP in untreated individuals with suspected hypertension and, more so, for monitoring the long-term BP control in treated hypertensive patients [4,169]”

Compared with the last 2008-2010 Position Papers, the number of articles published in the field of HBPM in the last decade has been on considerable rise.

“Compared with the last 2008–2010 Position Papers [4], the number of articles published in the field of HBPM in the last decade has been on considerable rise”

A smartphone application from the European Society of Hypertension (ESH CARE app) has been validated and continuously updated.

“A smartphone application from the European Society of Hypertension (ESH CARE app) has been validated and continuously updated.”