Rationale for Ambulatory and Home Blood Pressure Monitoring Thresholds in the 2017 American College of Cardiology/American Heart Association Guideline
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Several studies found that at lower OBP levels the difference with corresponding HBP values becomes much lower.
“Several studies found that at lower OBP levels the difference with corresponding HBP values becomes much lower [38,144]”
From Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension (2021) · cites this paper as [144]
The ‘Selection of thresholds values’ section says the guideline matched home-blood-pressure thresholds to several office-blood-pressure levels using published studies. But the passages available in our copy do not say that the office–home difference becomes smaller at lower office pressures; searches for that trend and the corresponding threshold values did not establish it. (LLM, conf=0.70)
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Cites
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“In the early 1990s, BP thresholds for ABPM were identified based on populations distributions—a method called the distribution-based approach.(9,10) For example, in 1 study, BP above the 95th percentile or 2 SDs above the mean was identified as being significantly elevated and a BP between 1 and 2 SDs above the mean w…”
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“ABPM and HBPM also can be used to identify white coat hypertension and masked hypertension.(8) Therefore, the ACC/AHA writing committee sought to identify ABPM and HBPM threshold levels associated with the office BP levels that were selected for BP classification.”
BackgroundMethodSelf-citationReference Values for Self-recorded Blood Pressure: A Meta-analysis of Summary Data
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“In another study, the percentage of participants with an office SBP/DBP ≥140/90 mm Hg was identified, and ABPM SBP and DBP values with a similar percentage of participants above these levels were identified and used as the upper limit of normotension.(11) The ABPM thresholds used to define elevated or high BP with the…”
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“†Kikuya et al.20 ‡Because no data using the outcomes-based approach were identified for these BP values, the values were determined from a study using the regression-based approach (Head et al17).”
MethodStaessen, J. A., Thijs, L., Ohkubo, T., Kikuya, M., Richart, T., Boggia, J., Adiyaman, A., Dechering, D. G., Kuznetsova, T., Thien, T., et al. (2008) · Blood Pressure Monitoring · doi:10.1097/mbp.0b013e3283108f93 · Cited by 56 · cited 1× · see citing works
“The ABPM thresholds used to define elevated or high BP with the distribution-based approach varied markedly across populations.(10,12,13) This likely reflects the enrollment of populations with different characteristics, including the proportion taking antihypertensive medication and office BP levels.”
Methodde la Sierra, A., Vinyoles, E., Banegas, J., Segura, J., Gorostidi, M., de la Cruz, J. D., & Ruilope, L. (2017) · Journal of Hypertension · doi:10.1097/hjh.0000000000001493 · Cited by 54 · see citing works
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“This approach may seem counterintuitive because the association of BP with Numbers in the table are SBP and DBP and are presented in mm Hg. Blank cells indicate office BP levels for which thresholds on ABPM were not reported.”
BackgroundMethodInfluentialSelf-citationChanging relationship among clinic, home, and ambulatory blood pressure with increasing age.
Stergiou, G., Ntineri, A., Kollias, A., Destounis, A., Nasothimiou, E., & Roussias, L. G. (2015) · Journal of the American Society of Hypertension : JASH · doi:10.1016/j.jash.2015.04.002 · Cited by 43 · see citing works
Reference values for ambulatory blood pressure: a population study.
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“The ABPM thresholds used to define elevated or high BP with the distribution-based approach varied markedly across populations.(10,12,13) This likely reflects the enrollment of populations with different characteristics, including the proportion taking antihypertensive medication and office BP levels.”
MethodNtineri, A., Stergiou, G., Thijs, L., Asayama, K., Boggia, J., Boubouchairopoulou, N., Hozawa, A., Imai, Y., Johansson, J., Jula, A., et al. (2016) · Hypertension Research · doi:10.1038/hr.2016.32 · Cited by 20 · see citing works
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3 of the 39 references couldn’t be matched to a known paper.
Research works printed but not linked: 2
- [1]Whelton PK, Carey RM, Aronow WS, 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. J Am Coll Cardiol. 2017; 71: e127– e248. 29146535
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Cheung, A. K., Chang, T. I., Cushman, W. C., Furth, S. L., Hou, F. F., Ix, J. H., Knoll, G. A., Muntner, P., Pecoits-Filho, R., Sarnak, M. J., et al. (2021) · Kidney International · doi:10.1016/j.kint.2020.11.003 · Cited by 1,452 · see citing works
Self-citationShimbo, D., Artinian, N. T., Basile, J. N., Krakoff, L. R., Margolis, K. L., Rakotz, M. K., Wozniak, G., & On behalf of the American Heart Association and the American Medical Association (2020) · Circulation · doi:10.1161/cir.0000000000000803 · Cited by 389 · see citing works
Jones, D. W., Ferdinand, K. C., Taler, S. J., Johnson, H. M., Shimbo, D., Abdalla, M., Altieri, M. M., Bansal, N., Bello, N. A., Bress, A. P., et al. (2025) · JACC · doi:10.1016/j.jacc.2025.05.007 · Cited by 280 · see citing works
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Self-citationAmbulatory Blood Pressure Monitoring to Diagnose and Manage Hypertension
Huang, Q.-F., Yang, W.-Y., Asayama, K., Zhang, Z.-Y., Thijs, L., Li, Y., O'Brien, E., & Staessen, J. (2021) · HYPERTENSION · doi:10.1161/hypertensionaha.120.14591 · Cited by 129 · see citing works
Agrawal, A., & Wenger, N. (2020) · Current Hypertension Reports · doi:10.1007/s11906-020-01070-0 · Cited by 115 · see citing works
Emergence of Home Blood Pressure-Guided Management of Hypertension Based on Global Evidence
Kario, K., Shimbo, D., Hoshide, S., Wang, J.-G., Asayama, K., Ohkubo, T., Imai, Y., McManus, R. J., Kollias, A., Niiranen, T. J., et al. (2019) · Hypertension · doi:10.1161/hypertensionaha.119.12630 · Cited by 82 · see citing works
“The 2017 ACC/AHA BP Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults2 suggested lower BP thresholds (ie, office BP goal of 130/80 mm Hg) with the aim of preventing organ damage and CVD events.44 At lower BP levels, the differences between office and home or daytime a…”
MethodInfluentialSelf-citationManagement of Hypertension in Pregnancy
Magee, L., & von Dadelszen, P. (2021) · Maternal-Fetal Medicine · doi:10.1097/fm9.0000000000000095 · Cited by 78 · see citing works
Cepeda, M., Pham, P., & Shimbo, D. (2023) · Hypertension Research · doi:10.1038/s41440-022-01137-2 · Cited by 51 · see citing works
Wu, M., Zhu, Z., Wan, R., & Xu, J. (2024) · Environmental Pollution · doi:10.1016/j.envpol.2024.123615 · Cited by 49 · see citing works
Implementing Home Blood Pressure Monitoring into Clinical Practice
Liyanage-Don, N. A., Fung, D., Phillips, E., & Kronish, I. (2019) · Current Hypertension Reports · doi:10.1007/s11906-019-0916-0 · Cited by 47 · see citing works
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Self-citationToward personalized management of chronic hypertension in pregnancy
Magee, L., Khalil, A., Kametas, N., & von Dadelszen, P. (2020) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2020.07.026 · Cited by 36 · see citing works
“gy FEBRUARY 2022 between diagnoses and adverse outcomes, convenience, antihypertensive compliance, and BP control.(36) Therefore, women with chronic hypertension may have used HBPMpreconceptionally; the coronavirus disease 2019 pandemic has broadened pregnancy HBPM implementation.”
Khan, N. A., Stergiou, G., Omboni, S., Kario, K., Renna, N. F., Chapman, N., McManus, R., Williams, B., Parati, G., Konradi, A., et al. (2022) · Journal of Hypertension · doi:10.1097/hjh.0000000000003205 · Cited by 34 · see citing works
Mechanisms and pharmacotherapy of hypertension associated with type 2 diabetes
Kamalumpundi, V., Shams, E., Tucker, C., Cheng, L., Peterson, J., Thangavel, S., Ofori, O., & Correia, M. (2022) · Biochemical Pharmacology · doi:10.1016/j.bcp.2022.115304 · Cited by 27 · see citing works
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Diagnostic Performance of Office versus Ambulatory Blood Pressure in Kidney Transplant Recipients
Korogiannou, M., Sarafidis, P., Theodorakopoulou, M. P., Alexandrou, M., Xagas, E., Boletis, I. N., & Marinaki, S. (2021) · American Journal of Nephrology · doi:10.1159/000517358 · Cited by 22 · see citing works
White Coat Hypertension & Cardiovascular Outcomes
Townsend, R. R., & Cohen, J. B. (2024) · Current Hypertension Reports · doi:10.1007/s11906-024-01309-0 · Cited by 15 · see citing works
“…has WCH since his in-office values are higher than the currently recommended threshold value of 130 mmHg systolic [1], and his daytime ambulatory systolic pressure is lower than the current recommended ambulatory daytime threshold value of 130 mmHg in the absence of antihypertensive medication [2].”
BackgroundThomas, S. J., Johnson, D. A., Guo, N., Abdalla, M., Booth, J., Spruill, T., Jackson, C. L., Yano, Y., Sims, M., Calhoun, D., et al. (2020) · American Journal of Hypertension · doi:10.1093/ajh/hpaa088 · Cited by 15 · see citing works
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“The first approach was to use the daytime systolic/diastolic BP thresholds recommended by the 2017 American College of Cardiology/American Heart Association high BP guideline that corresponds to the office systolic/diastolic BP of 120/80 mm Hg in the intensive strategy group (daytime systolic/diastolic BP of 120/80 mm…”
MethodSelf-citationBlood Pressure in Young Adults and Cardiovascular Disease Later in Life.
Yano, Y. (2021) · American Journal of Hypertension · doi:10.1093/ajh/hpab005 · Cited by 14 · see citing works
Nuckols, V. R., Stroud, A. K., Armstrong, M. K., Brandt, D., Santillan, M., Santillan, D., & Pierce, G. (2022) · Pregnancy Hypertension · doi:10.1016/j.preghy.2022.05.003 · Cited by 13 · see citing works
Towards wearable blood pressure measurement systems from biosignals: a review
Şentürk, Ü., Polat, K., & Yücedag, I. (2019) · Turkish J. Electr. Eng. Comput. Sci. · doi:10.3906/elk-1812-121 · Cited by 13
“Nowadays, transducers are used to measure blood pressure in the arteries, and the blood pressure information with the transducer can be converted into electrical signals and monitored on monitors [22, 23].”
MethodRuilope, L., Ruiz-Hurtado, G., Barderas, M., de la Cruz, J. D., Lucía, A., de la Sierra, A., Gorostidi, M., Vinyoles, E., Segura, J., Solis, J., et al. (2019) · HYPERTENSION · doi:10.1161/hypertensionaha.119.12921 · Cited by 13 · see citing works
Self-citationGreen, B., Anderson, M., Ehrlich, K., Hall, Y., Hansell, L., Hsu, C. W., Joseph, D., Margolis, K., McClure, J. B., Munson, S. A., et al. (2022) · Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2022.02.210318 · Cited by 12 · see citing works
“28 Aligning quality performance metrics with guidelines (and including the differences between clinic and out-of-of fi ce BP measurements) 29 could lead to improved knowledge by health professionals of recommended clinic BP, HBPM, and ABPM diagnostic and treatment thresholds and improved clinical…”
BackgroundAubert, C., Sussman, J. B., Hofer, T., Cushman, W., Ha, J.-K., & Li, M. (2021) · Annals of Internal Medicine · doi:10.7326/m21-1456 · Cited by 12 · see citing works
“” Are they referring only to ambulatory measurements, or did they include home measurements? If both ambulatory and home measurements were used for data assessment, individuals' BP might have been evaluated inappropriately because of the difference between these types of measurements (2).”
BackgroundMethodInfluentialPeeters, L. E. J., van Oortmerssen, J. A. E., Derks, L. H., den Hertog, H., Fonville, S., Verboon, C., Rietdijk, W. J. R., Boersma, E. H., Koudstaal, P. J., van den Meiracker, A. H., et al. (2022) · Blood Pressure · doi:10.1080/08037051.2021.2013115 · Cited by 12 · see citing works
bp: Blood pressure analysis in RPreprint
Schwenck, J., Punjabi, N., & Gaynanova, I. (2022) · medRxiv · doi:10.1101/2022.05.12.22274995 · Cited by 8 · see citing works
Filippone, E., Foy, A. J., & Naccarelli, G. (2022) · American Journal of Medicine · doi:10.1016/j.amjmed.2022.05.007 · Cited by 7 · see citing works
Home Blood Pressure Monitoring And Nocturia In Adults
Lazar, J., Posner, A., Akbar, K., Tologonova, G., Monaghan, T. F., Murray, C., Weiss, J., Everaert, K., DeBacker, T., Helzner, E., et al. (2022) · Journal of community health · doi:10.1007/s10900-022-01171-8 · Cited by 6 · see citing works
Kario, K., Tomitani, N., Hoshide, S., Nishizawa, M., Yoshida, T., Kabutoya, T., Fujiwara, T., & Mizuno, H. (2023) · Journal of the American Heart Association : Cardiovascular and Cerebrovascular Disease · doi:10.1161/jaha.123.030992 · Cited by 4 · see citing works
“21 However, some limitations of the current analysis need to be acknowledged.”
BackgroundMethodResultInfluentialGreenwood-Hickman, M., Zhou, J., Cook, A. J., Mettert, K. D., Green, B., McClure, J. B., Arterburn, D. E., Florez-Acevedo, S., & Rosenberg, D. (2022) · Gerontology and Geriatric Medicine · doi:10.1177/23337214221096007 · Cited by 4 · see citing works
“This suggests our observed higher BP in the post-COVID sample may be an underestimation (de Gaudemaris et al., 1994; Muntner et al., 2019).”
BackgroundResultAutomated Office BP Monitor Measurements: What Is The Secret Sauce?
Green, B. B. (2024) · American Journal of Hypertension · doi:10.1093/ajh/hpae148 · Cited by 1 · see citing works
Hernández-Aceituno, A., Sánchez-Martínez, M., López-García, E., Guallar-Castillón, P., Cruz, J., Ortolá, R., Graciani, A., García-Esquinas, E., García-Puig, J., Rodríguez-Artalejo, F., et al. (2021) · REC: CardioClinics · doi:10.1016/j.rccl.2021.07.003 · Cited by 1 · see citing works
2026 International Society of Hypertension Global Hypertension Practice Guidelines.
Stergiou, G., Kario, K., Aristizábal, D., Beheiry, H., Cho, M., Colombari, D., Itoh, H., Jafar, T., Jones, E. S. W., Li, Y., et al. (2026) · Journal of Hypertension · doi:10.1097/hjh.0000000000004451
Self-citationAchieved home systolic blood pressure and cardiovascular risk in older hypertensive patients
Ji, Y.-F., Peng, X.-Y., Bai, J., Song, Q.-R., & Cai, J. (2026) · Hypertension Research · doi:10.1038/s41440-026-02787-2
“…community-based cohorts has raised questions about whether the conventional HBPM threshold of 135/ 85 mmHg may be too high for cardiovascular risk strati fi - cation, with several studies suggesting that home BP values closer to 130/80 mmHg may better correspond to lower-risk BP levels [13 – 15].”
Arterial blood pressure waveform reconstruction estimation from PPG using TCN–BiLSTM
Loumissi, H., Barra, A., Messaoudi, N., & Medromi, H. (2026) · American Heart Journal Plus Cardiology Research and Practice · doi:10.1016/j.ahjo.2026.100837
Lou, J., Cui, R., Yan, M., Chen, Z., Mao, S., Chen, J., Lu, T., & Qian, H.-F. (2026) · Emerging Contaminants · doi:10.1016/j.emcon.2026.100709
Santo, K., Martins, E., Silva, G., Guimarães, P. O., Tavares, C. A., Brainer, J., Monfardini, F., Nieri, J., Assis, S. R. L., Felício, J., et al. (2026) · American Heart Journal · doi:10.1016/j.ahj.2026.107545
Self-citationAbdalla, M., Poudel, B., Sakhuja, S., Fernandez-Sedano, B., David, M., Shurovi, S., Butler, M., Hardy, S. T., Jackson, C. L., Johnson, D. A., et al. (2026) · Journal of Hypertension · doi:10.1097/hjh.0000000000004314
“Among participants not taking and taking antihypertensive medication, mean awake”
Self-citationVilela-Martin, J. F., Minari, T. P., Vieira-da-Silva, M. A., Fernandes, L. A. B., de Almeida, M. A., Lopes, V. D. S., de Oliveira, K. A., Uyemura, J. R. R., Moreno, H., Yugar‐Toledo, J. C., et al. (2025) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2025.1640622
Liu, Z.-Y., Liu, M., Wei, D., Yuan, J., Liu, M., Zhao, W., & Fang, Y.-J. (2025) · Neurological Research · doi:10.1080/01616412.2025.2581851
“Hypertension was defined based on the latest ACC/AHA guidelines, which classify stage 1 hypertension as a systolic blood pressure (SBP) > 130 mmHg and/or a diastolic blood pressure (DBP) > 80 mmHg [31].”
Out-of-office blood pressure monitoring in defining and confirming true resistant hypertension
Kollias, A., Kyriakoulis, K., & Stergiou, G. (2025) · Hypertension Research · doi:10.1038/s41440-025-02097-z
“In this respect 2 factors should be taken into account: First, inadequate BP control in treated hypertensive patients corresponds to values above the of fi ce BP threshold of 130/80 mmHg [1] which is the same for daytime ambulatory and home BP [2].”
The utility of home blood pressure load in predicting average self-measured blood pressure
Hinderliter, A. L., Lin, F.-C., Yang, Y., Viera, L., Olsson, E., Voora, R. A., & Viera, A. (2024) · Journal of Hypertension · doi:10.1097/hjh.0000000000003776
Mean‐ing Beyond Office Blood Pressure
Ogungbe, O., Rose, E., & Juraschek, S. (2023) · Journal of the American Heart Association : Cardiovascular and Cerebrovascular Disease · doi:10.1161/jaha.123.032576
Rather, J. I., Sofi, K., Wani, M., Wani, M., Rasheed, R., Bhat, M. A., & Wani, I. (2023) · Saudi Journal of Kidney Diseases and Transplantation · doi:10.4103/sjkdt.sjkdt_256_23
- Authors
- Muntner, P., Carey, R. M., Jamerson, K., Wright, J. T., & Whelton, P. K.
- Affiliations
- University of Alabama at Birmingham (US)
- University of Virginia (US)
- University of Michigan (US)
- Case Western Reserve University (US)
- Tulane University (US)
- Venue
- Hypertension
- Published
- 2019-01
- Volume
- 73
- Issue
- 1
- Pages
- 33-38
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- PMC
- PMC6392041
- OpenAlex
- W2904399022
- Cited by
- 62
- References
- 39
- Citations by year
- 2026: 6 · 2025: 11 · 2024: 7 · 2023: 6 · 2022: 14 · 2021: 7 · 2020: 6 · 2019: 5
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- American Heart Association
- National Heart, Lung, and Blood Institute (P01HL074940, R01HL128189)
- National Institute of General Medical Sciences (P20GM109036)
- National Institute of Diabetes and Digestive and Kidney Diseases (U01DK061028)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Keywords
- ambulatory blood pressure monitoring, home blood pressure monitoring, blood pressure thresholds, hypertension diagnosis, 2017 ACC/AHA guidelines, blood pressure targets
- MeSH terms
- American Heart Association, Cardiology, Humans, Hypertension, United States, Practice Guidelines as Topic, Blood Pressure Monitoring, Ambulatory
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