Measure Description: Percentage of patients who had a diagnosis of ACC/AHA stage 2 HBP for whom HBPM is recommended and HBPM data are documented in the patient record
Numerator	Documentation of home BP readings in the medical record
Denominator	All patients 18–85 y of age who had a diagnosis of ACC/AHA stage 2 HBP who had at least 1 outpatient encounter with a diagnosis of HBP during the first 6 mo of the measurement year or any time before the measurement period
Denominator Exclusions	End-stage renal disease, kidney transplantation, pregnancy, BP readings taken during an inpatient stay
Denominator Exceptions	Documentation of a patient reason (eg, economic issues, refusal, cognitive deficits)
Measurement Period	12 mo/measurement year
Sources of Data	Paper medical record/prospective data collection flow sheet, Qualified Electronic Health Record, QCDR, electronic administrative data (claims), expanded (multiple source) administrative data, electronically or telephonically transmitted BP readings
Attribution	Healthcare provider (healthcare provider, physician group practice, accountable care organization, clinically integrated network, health plan, integrated delivery system)
Care Setting	Outpatient (office, clinic, home, or ambulatory)
Rationale
HBPM or self-monitoring of BP refers to the regular measurement of BP by an individual at home or elsewhere outside the clinic setting. Home-based measurement has been found to be a better predictor of cardiovascular risk than clinic-based measurement. Evidence also suggests that home-based BP measurement in combination interventions with telemedicine with nurse- or pharmacist-led care may be effective for improving hypertension management.
Procedures for Use of HBPM4
Patient training should occur under medical supervision, including:
• Information about hypertension
• Selection of equipment
• Acknowledgment that individual BP readings may vary substantially
• Interpretation of results
Devices:
• Verify use of automated validated devices. Use of auscultatory devices (mercury, aneroid, or other) is not generally useful for HBPM because patients rarely master the technique required for measurement of BP with auscultatory devices.
• Monitors with provision for storage of readings in memory are preferred.
• Verify use of appropriate cuff size to fit the arm.
• Verify that left/right inter-arm differences are insignificant. If differences are significant, instruct patient to measure BPs in the arm with higher readings.
Instructions on HBPM procedures:
• Remain still:
- Avoid smoking, caffeinated beverages, or exercise within 30 min before BP measurements.
- Ensure ≥5 min of quiet rest before BP measurements.
• Sit correctly:
- Sit with back straight and supported (on a straight-backed dining chair, for example, rather than a sofa).
- Sit with feet flat on the floor and legs uncrossed.
- Keep arm supported on a flat surface (such as a table), with the upper arm at heart level.
• Bottom of the cuff should be placed directly above the antecubital fossa (bend of the elbow).
• Take multiple readings:
- Take at least 2 readings 1 min apart in morning before taking medications and in evening before supper. Optimally, measure and record BP daily. Ideally, obtain weekly BP readings beginning 2 wk after a change in the treatment regimen and during the week before a clinic visit.
• Record all readings accurately:
- Monitors with built-in memory should be brought to all clinic appointments.
- BP should be based on an average of readings on ≥2 occasions for clinical decision making.
Clinical Recommendation
2017 Hypertension Clinical Practice Guidelines4
1. Out-of-office BP measurements are recommended to confirm the diagnosis of hypertension and for titration of BP-lowering medication, in conjunction with telehealth counseling or clinical interventions.47–50 (Class 1, Level of Evidence: ASR)

ACC indicates American College of Cardiology; AHA, American Heart Association; BP, blood pressure; HBP, high blood pressure; HBPM, home blood pressure monitoring; and QCDR, Qualified Clinical Data Registry.