Table 1. Consensus recommendations on HBP monitoring in diagnosis and management of arterial hypertension.

Recommendations	COR	LOE
The role of HBP monitoring in the diagnosis and management of hypertension
1. HBP is one form of out-of-office BP; and is, if measured appropriately, able to be used for diagnostic confirmation of OBP, identification of hypertension phenotypes, guidance of anti-hypertensive treatment, and improvement of hypertension control.	I	B
Methods to perform HBP monitoring correctly
2. HBP is obtained at home, preferably using automated oscillometric upper-arm sphygmomanometer, which should be validatedand regularly calibrated (at least every 12 months). The device is better equipped with capabilities of automatic data recording and/or auto-transmission.	I	C
3. Cuff selection: following manufacturer’s instructions (cuff bladder width and length are at least 40% and 80% of arm circumference, respectively).	I	B
Before measurement:
30 min: avoid vigorous exercise and caffeine-containing drink; empty bladder
5 min: sitting rest at a chair with back support and feet flat on the ground (not leg dangling or crossing)
On measurement: upper arm, the one with higher averaged SBP reading, supported at the level of heart.
Methods to obtain reliable HBP estimates
4. As for hypertension diagnosis or HBP-guided antihypertensive management, HBP should be measured according to the “722” principle. That is, HBP should be measured for “7” (at least 4) consecutive days, in the morning (taken within 1 hour after awakening, but before taking food and medication) and the evening (within 1 hour before bedtime) (“2” occasions), and with ≥ “2” (≥ 3, if atrial fibrillation is present) BP readings, 1-min apart, on each occasion. Morning and evening HBP estimates are the averages of all morning and evening BP readings, respectively, except those obtained on the first day.	I	B
5. The 722 principle should be applied in the confirmation of hypertension diagnosis and 2 weeks after adjustment of antihypertensive medications. In uncontrolled hypertensive patients, HBP monitoring should be performed following the 722 principle at least monthly. In well-controlled hypertensive patients, HBP monitoring could be performed following the 722 principle at least every 3 months. At least one measurement (duplicate readings, at least one minute apart, on one occasion) per week is a suitable alternative follow-up strategy for stable hypertensive patients.	IIa	C
Methods to diagnose and identify hypertension phenotypes
6. Hypertension could be diagnosed if HBP estimate is ≥ 135/85 mmHg, whose corresponding OBP is ≥ 140/90 mmHg.	I	B
7. HBP monitoring is adequate to identify sustained hypertension, white-coat hypertension, and masked hypertension, which could be confirmed by ABP monitoring if necessary.	I	C
Methods to implement HBP-guided initiation and titration of antihypertensive treatment
8. Hypertension is regarded as well-controlled if both morning and evening HBP are < 135/85 mmHg (obtained based on the “722” principle).	IIa	C
9. Patients with HMOD or at high risk for cardiovascular disease should be controlled at the level of HBP estimate of < 130/80 mmHg, whose corresponding OBP is < 130/80 mmHg.	IIa	B
10. HBP-based hypertension management strategies including bedtime dosing (for uncontrolled morning hypertension), shifting to drugs with longer-acting antihypertensive effect (for uncontrolled evening hypertension), and adding another antihypertensive drug (for uncontrolled morning and evening hypertension) should be considered.	IIa	B
11. Given that high home BP variability is associated with increased cardiovascular risk, adjustment of antihypertensive medications (with longer duration of actions or balanced 24-hour coverage) to lower home BP variability might be considered.	IIb	B
12. HBP monitoring is recommended to identify orthostatic hypotension, postprandial hypotension, and hypotension events during antihypertensive treatment.	IIa	C
Methods to improve hypertension control with HBP monitoring
13. HBP monitoring could improve hypertension control, especially when combined with active interventions (such as team-based interventions or telemonitoring).	IIa	B
14. Implementation of HBP monitoring in clinical practice could be facilitated by increasing awareness of physicians and patients in “SERVE” ways, and insurance reimbursement.	IIa	C

ABP, ambulatory blood pressure; BP, blood pressure; COR, class of recommendation; HBP, home blood pressure; HMOD, hypertension-mediated organ damage; LOE, level of evidence; OBP, office blood pressure.