Arq. Bras. Cardiol. 2021; 116(3): 501-503
What are the Optimal Reference Values for Home Blood Pressure Monitoring?
Audes D. M. Feitosa
, Marco A. Mota-Gomes
, Fernando Nobre
, Decio Mion Jr.
, Annelise M.G. Paiva
, Fábio Argenta
, Weimar K.S. Barroso
, Roberto D. Miranda
, Eduardo C. D. Barbosa
, Andréa A. Brandão
, Thiago S.V. Jardim
, Paulo C.B.V. Jardim
, Wilson Nadruz
Introduction
The diagnosis of hypertension usually relies on office blood pressure (BP) measures. However, this approach might underestimate or overestimate the true prevalence of hypertension due to the presence of alternative BP phenotypes, such as masked hypertension and white-coat hypertension. In this regard, current hypertension guidelines have recommended the evaluation of out-of-office BP by ambulatory BP monitoring (ABPM) or home blood pressure monitoring (HBPM), when these techniques are available, to confirm the diagnosis and to provide a more adequate management of hypertension.–
HBPM reference values used to define hypertension have been more consistently suggested since the end of 1990s. In 1998, results of a meta-analysis including data from 17 studies and 5,422 untreated participants suggested that elevated HBPM values should be ≥ 137/89 mmHg or ≥ 135/86 mmHg based on analysis of means + 2 standard deviations or ninety-fifth percentiles, respectively. In 1999, the analysis of the ninety-fifth percentiles of HBPM values from 2,401 normotensive individuals at the office estimated that elevated HBPM values were ≥ 137/85 mmHg. Furthermore, the evaluation of 1,913 individuals (69% not treated with antihypertensive medications) from the Ohasama Study showed that HBPM values ≥ 137/84 mmHg were associated with greater risk of death after 5 years of follow-up. Subsequent hypertension guidelines rounded the reference values suggested by these latter studies and recommended that abnormal HBPM measures should be considered when ≥ 135/85 mmHg., HBPM thresholds of 135/85 mmHg were then incorporated into clinical practice, and they have been used to define abnormal HBPM values by hypertension guidelines from various societies,, including the Seventh Brazilian Hypertension Guidelines published in 2016 and the Sixth Brazilian Guidelines of ABPM and Fourth Brazilian Guidelines of HBPM published in 2018.
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