Why Is Out-of-Office Blood Pressure Measurement Needed?

Over the last decades, 2 main techniques for measuring blood pressure (BP) out of the physician’s office have gained increasing importance in the clinical approach to arterial hypertension, both being supported by recent international hypertension management guidelines.1,2 These techniques are home BP monitoring (HBPM) and 24-hour ambulatory BP monitoring (ABPM). Their diffusion in clinical practice has been favored by a number of factors, including on one side technical progress and wider availability of accurate HBPM and ABPM devices and on the other side the increasing awareness of the limitations of office BP (Table 1).3,4 Office BP is in fact characterized by a random error affecting casual BP readings and by a systematic error related to the patient’s alerting reaction to the measurement procedure and setting, known as “white coat effect.”1,3 Both ABPM and HBPM are devoid of these limitations and, thus, provide more stable and reproducible information on BP values,5 which is also of greater prognostic relevance6–21 (Table 2). Furthermore, office BP readings are unable to collect information on BP during a subject’s usual activities and over a long period of time,22 an important limitation in everyday management of hypertensive subjects that can be overcome by out-of-office BP monitoring. View this table: Table 1. Comparison of Main Features of 3 Main Methods of BP Measurement View this table: Table 2. Home BP Measurements and Outcome ABPM was initially confined to specialized hypertension centers because of its relatively high cost, but over the years its availability has steadily increased. HBPM, on the other hand, has been used rather reluctantly by physicians in routine management of hypertensive patients. Although its potential usefulness in clinical practice was acknowledged many years ago,23 its application has been limited until the end of last century by the need to use auscultatory measurements, an approach …