TABLE 1.
Main changes between 2008/2010 and 2021 HBPM position papers
| Topic | 2008/2010 | 2021 |
| Cuff size | Different cuff sizes are recommended for patients with different arm circumferences | Cuff choice should consider patient's arm size but should also be based on the instructions by the manufacturer, based on evidence from validation studies. The use of wide-range cuffs with automated devices may be particularly useful |
| Clinical validation protocols | Several validation protocols are recommended (BHS, AAMI, ESH International Protocol) | The 2018 Universal Standard AAMI/ESH/ISO is recommended for all new validation studies |
| Cuffless devices | (not mentioned) | Now available, they should undergo thorough clinical validation (appropriate validation protocol by AAMI/ESH/ISO under preparation) before being recommended for performing HBPM |
| Information on validated devices | DABL | STRIDE BP, www.stridebp.org |
| BIHS | BIHS, www.bihsoc.org/bp-monitors | |
| VDL | US BP VDL, www.validatebp.org | |
| Hypertension Canada | Hypertension Canada, www.hypertension.ca/bpdevices | |
| Deutsche Hochdruckliga | Deutsche Hochdruckliga, www.hochdruckliga.de/betroffene/blutdruckmessgeraete-mit-pruefsiegel | |
| JSH | JSH, www.jpnsh.jp/com_ac_wg1.html | |
| MEDAVAL | ||
| Preferred devices | (not mentioned) | Preferred HBPM devices (www.stridebp.org) now specified as:: upper arm cuff devices with at least one STRIDE BP approved validation study published in the last 10 years and using a recent protocol (AAMI/ESH/ISO 2018; ANSI/AAMI/ISO 2013 or 2009; ESH-IP 2010); being in use for less than 4 years [13]; and equipped with storage/connectivity facilities for objective reporting of readings |
| Monitoring schedule and interpretation | 3--7 days monitoring schedule, with BP values measured on the first monitoring day to be discarded | 3--7 days monitoring schedule, with 2 measures taken in the morning and evening. Discarding the first day may have an effect on a 3-day schedule, but appears to have minimal impact with more monitoring days |
| Diagnostic thresholds | Threshold for hypertension at least 135/85 mmHg for SBP/DBP less than 130/80 mmHg normal HBP | The threshold for ESC/ESH hypertension diagnosis is 135/85 mmHg (corresponding to 140/90 mmHg of clinic BP in the ESC--ESH hypertension guidelines). HBP of 130/80 mmHg may correspond to 130/80 mmHg clinic BP threshold for grade I hypertension used in ACC/AHA guidelines |
| Therapeutic targets | No recommendations | Systolic HBP between 125 and 135 mmHg for most people. Diastolic HBP between 70 and 80 mmHg as a reasonable goal. In the frail very elderly, slightly higher systolic HBP might be the preferred target (suggested in the 140–150 mmHg range but more evidence is needed), while avoiding excessive reductions of diastolic HBP. |
| Children | Few suggestions regarding when and how frequently HBPM should be measured in children | Preliminary evidence supports use of a HBPM schedule similar to that recommended for adults |
| Pregnancy | HBPM should be performed with the woman seated or lying on her side at a 45° angle | The sitting position appears to be appropriate for HBPM during pregnancy. The same 3--7 days monitoring schedule recommended. Concerning BP threshsolds: in unselected women HBP = clinic BP [14] |
| Chronic kidney disease on dialysis (ESKD) | No recommended schedule | HBP should be measured twice daily, at bedtime and on waking up, after the midweek dialysis for 4 days |
| Arrhythmias | In patients with frequent or persistent arrhythmias, HBPM should not be used as the sole diagnostic tool | With HBPM, automated devices should be preferred to auscultatory devices and used even in the presence of atrial fibrillation (AF) (with controlled ventricular rate) triplicate measurements could be useful because of increased beat-to-beat variability. In the case of uncontrolled tachyarrhythmias automated devices may provide inaccurate readings (a debated issue) [15] AF detecting algorithm during automated HBPM might be useful for early detection of asymptomatic AF in elderly individuals with hypertension |
| Nocturnal HBPM | Lack of night recordings as a limitation of HBPM | With technological development of devices, nocturnal HBPM is feasible and appears to be a promising alternative to ABPM for the evaluation of sleep BP |
| Home BP variability | Not mentioned | Home BP variability is an independent outcome predictor but the current evidence is insufficient to support its application in clinical practice |
AAMI, Association for the Advancement of Medical Instrumentation; ACC, American College of Cardiology; AHA, American Heart Association; BHS, British Hypertension Society; ESC, European Society of Cardiology; ESH, European Society of Hypertension; HBPM, home blood pressure monitoring.