Why measure Blood Pressure at home?

The advantages of home blood pressure measurement are that it may provide numerous values on different days in a setting closer to daily life conditions than the doctor's surgery. It may also favourably affect patients perceptions of their "hypertension" problems and improve adherence to treatment. It may therefore be a valuable tool for checking the effectiveness of treatment.

'White Coat' Hypertension

• In some patients, surgery taken blood pressure is persistently elevated whereas day time blood pressure outside the surgery environment is not.
• This condition is widely known as 'white coat hypertension'
• It is likely that only a small fraction of the hypertensive population exhibits white coat hypertension.

Aim of treatment

Lowering raised blood pressure decreases the frequency of stroke, coronary events, heart failure, and renal failure. Antihypertensive therapy reflects the recommendations of the doctor

British Hypertension Society (Guidelines for management of hypertension: report of the third working party of the British Hypertension Society. J Hum Hypertens 1999; 13: 569-92).

Thresholds and targets for treatment

The following thresholds for treatment are recommended:

• Accelerated (malignant) hypertension (with papilloedema or fundal haemorrhages and exudates) or impending cardiovascular complications, admit for immediate treatment;
• Where the initial blood pressure is systolic >=220 mmHg or diastolic >=120 mmHg, treat immediately;
• Where the initial blood pressure is systolic 200-219 mmHg or diastolic 110-119mmHg, confirm over 1-2 weeks then treat if these values are sustained;
• Where the initial blood pressure is systolic 160-199mmHg or diastolic 100-109mmHg, and the patient has cardiovascular complications, end-organ damage (e.g. left ventricular hypertrophy, renal impairment) or diabetes mellitus (type 1 or 2), confirm over 3-4 weeks then treat if these values are sustained;
• Where the initial blood pressure is systolic 160-199mmHg or diastolic 100-109mmHg, but no cardiovascular complications, end-organ damage or diabetes, advise lifestyle changes, reassess weekly initially and treat if these values are sustained on repeat measurements over 4-12 weeks;
• Where the initial blood pressure is systolic 140-159mmHg or diastolic 90-99mmHg and the patient has cardiovascular complications, end-organ damage or diabetes, confirm within 4-12 weeks and treat if these values are sustained;
• Where the initial blood pressure is systolic 140-159mmHg or diastolic 90-99mmHg and no cardiovascular complications, end-organ damage or diabetes, advise lifestyle changes and reassess monthly; if mild hypertension persists, treat if coronary heart disease risk is >=15% over 10 years.