II. Indications

  1. Hypertension Diagnosis Confirmation
    1. Recommended since 2015 in ACC/AHA Hypertension diagnosis guidelines
  2. More accurate Blood Pressure monitoring in Hypertension
    1. Validated Home Blood Pressure Monitoring is a key Hypertension quality measure
    2. Lowest systolic and diastolic Blood Pressure readings from a single date may be recorded in health record
    3. Obtain 3-7 day log before clinic visits (in person or Telemedicine)
    4. Obtain 3-7 day log after medication changes
  3. White-Coat Hypertension
    1. Home recorded Blood Pressures are typically lower than in-office Blood Pressure readings for most patients
  4. Refractory Hypertension
  5. Antihypertensive Compliance
  6. Masked Hypertension
    1. Increased Blood Pressure at home when compared with office Blood Pressure recordings

III. Types: Home monitors

  1. Automatic arm cuffs monitors
    1. Home arm cuffs are most accurate, and recommended
    2. Kiosks (e.g. in pharmacies) are not recommended (typically not validated, calibrated or allow for proper position)
  2. Manual arm monitors
  3. Wrist monitors
    1. Most convenient but least accurate
    2. Not recommended unless large arm is unable to fit in arm cuff
    3. If wrist cuffs must be used, during measurement, keep the wrist still at heart level
    4. Sensor must be positioned directly over the radial artery
  4. Avoid finger cuffs
    1. Most inaccurate of all devices

IV. Preparations: Blood Pressure Monitors

  1. U.S. Blood Pressure Validated Devices
    1. https://www.validatebp.org/
  2. General
    1. Arm cuffs are preferred for most consistent accuracy (see above)
  3. Recommended Arm Cuffs for home use (DABL Educational Trust)
    1. http://www.dableducational.org/sphygmomanometers/devices_2_sbpm.html#ArmTable
  4. Cost
    1. Automatic arm cuffs monitors typically cost $70-100 in the United States
    2. Some insurers cover Blood Pressure cuffs if patient caries Hypertension diagnosis

V. Preparations: Calibration and Fitting

  1. Patient should bring Blood Pressure cuff to clinic annually to check against a manual Blood Pressure
  2. See BP Examination for determining cuff size
  3. Measure arm circumference at midpoint of upper arm
    1. Cuff Bladder width should be 37-50% of arm circumference
    2. Cuff Bladder length should be 75-100% of arm circumference

VI. Technique

  1. Rest for 5 minutes before checking Blood Pressure
    1. Empty a full Urinary Bladder before checking Blood Pressure
    2. Avoid checking Blood Pressure within 30 minutes of Exercise, Caffeine or Tobacco
  2. Patient positioning
    1. Keep arm supported on flat surface at heart level
    2. Sit with back supported and feet flat on floor
  3. Position the cuff
    1. Apply Blood Pressure cuff tautly to bare arm, just above the antecubital fossa (elbow crease)
    2. Center of Blood Pressure cuff (manufacturer insignia) should be positioned over brachial artery
  4. Take 2-3 readings, each at 1 minute apart

VII. Protocol: Blood Pressure Logs

  1. Pre-visit Blood Pressure monitoring (and after medication changes)
    1. Log Blood Pressures morning and night for 3-7 days (7 days is preferred)
    2. Obtain two measurements at least one minute apart twice daily
  2. Periodic Monitoring between visits
    1. Repeat Blood Pressure check weekly (or repeat a one week log every 6-12 months)
    2. Return to more intensive monitoring before and during antihypertensive management changes
  3. Reviewing Logs
    1. Many reviewers discard day 1 Blood Pressure readings (higher than other days in 3-7 day log)

VIII. Efficacy

IX. References

  1. (2014) Consumer Reports, accessed online 2/11/2015
  2. (2008) Presc Lett 15(3):14
  3. (2015) Presc Lett 22(2):11-2
  4. Weinfeld (2021) Am Fam Physician 104(3): 237-43 [PubMed]

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