Table 2.

Major Hypertension Guidelines on BP Measurement Techniques and Targets

BP Technique	ACC/AHA 201717	ESC/ESH 2016 and 201816,18	KDIGO 202114
Office BP	Emphasis on standard office BP measurement protocols by validated BP measurement devices (Manual or automated) {COR- 1, LOE- EO} Standardized protocol and instructions for office BP measurement provided in the guideline	Office BP measurement is preferred by either, auscultatory, oscillometric semi-automatic, or automatic sphygmomanometers following validated protocols Office BP to be measured in both arms. A pressure difference of 15 mmHg may indicate significant cardiovascular risk {LOE – IA}	Recommend standardized office BP measurement compared to routine office BP measurement. No preference for manual versus automated, attended versus unattended {LOE- IB} The standard protocol to be followed as adopted from AHA 2017 guidelines Automated office BP measurement may be preferred (Practice Point)
24-hour ambulatory BP	Recommended for confirming the diagnosis of HTN, titration of antihypertensive along with counselling or clinical interventions {COR- 1, LOE - A} ABPM may predict long term CVD outcomes Useful for diagnosing/titrating medications in patients with masked or white coat HTN {COR – IIa, IIb}	Recommended as an alternative to office BP when economically or logistically feasible {LOE – IC} Recommended to detect white coat hypertension or masked hypertension, quantifying effects of treatment or side-effects {LOE- IA} A better predictor of hypertension mediated organ damage, coronary events, and stroke	May be used to complement office BP for management of high BP. {LOE – IIB}
Home BP	Recommended for confirming the diagnosis of HTN, titration of antihypertensive along with counseling or clinical interventions {COR- 1, LOE - A} Useful for diagnosing/titrating medications in patients with masked or white coat HTN {COR – IIa, IIb} Instructions for Home BP monitoring have been given in the guidelines	Recommended as an alternative to office BP when economically or logistically feasible {LOE – IC} Recommended to detect white coat hypertension or masked hypertension, quantifying effects of treatment or side-effects {LOE- IA} HBPM may better predict left ventricular hypertrophy and cardiovascular outcomes compared to office BP	May be used to complement office BP for management of high BP. {LOE – IIB}
Specific recommendations/comments in CKD	CKD ± proteinuria Target BP - <130/80mmHg	CKD ± proteinuria Target BP- <130–39/70–79 mmHg	CKD ± proteinuria, ± Diabetes, ± old age Target BP-SBP<120 mmHg High prevalence of white coat effect and masked uncontrolled HTN in CKD which may need out-of-office BP readings. However, no major RCTs comparing clinical outcomes targeting or higher BP based on out of office BP measurements
Specific recommendations/comments in the HD population	Nil	Nil	Nil
Specific recommendations/comments in kidney transplant recipients	Use of standardized office BP to achieve target BP (< 130 /80 mm Hg)	Nil	Practice point – Use of standardized office BP to achieve target BP (< 130 /80 mm Hg) Out-of-office BP may be used as complementary modalities
Specific recommendations in the pediatric CKD population	Nil	A target MAP of <50th percentile for pediatric CKD with proteinuria >0.5g/g (protein creatinine ratio). For non-proteinuric pediatric CKD patients, a more liberal target of <75th percentile is recommended (ESH 2016)	24-hour ABPM is preferred to measure for MAP targets of <50th percentile When ABPM is not available, manual auscultatory office BP is obtained in a protocol-driven standardized method for a target of SBP <90th percentile for age, sex, and height of normal children Practice point- Use of ABPM once a year and standardized office BP once in 3–6 months to achieve BP targets if standardized

Abbreviations: COR, class of recommendation; LOE, level of evidence; ACC/AHA, 2017, American College of Cardiology/American Heart Association 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults; ESC/ESH, European Society of Cardiology and the European Society of Hypertension Guidelines for the Management of Arterial Hypertension; KDIGO, 2021 Kidney Disease: Improving Global Outcomes Clinical Practice Guideline for the management of Blood Pressure in Chronic Kidney Disease; CKD, chronic kidney disease; RCT, randomized control trial; MAP, mean arterial pressure; HBPM, home BP monitoring; ABPM, ambulatory BP monitoring.