Home blood pressure monitoring for hypertension diagnosis by current recommendations: a long way to go

Out-of-office blood pressure (BP) monitoring (eg, home BP monitoring [HBPM] or ambulatory BP monitoring) to confirm a diagnosis of hypertension before treatment initiation after initial office screening is recommended by the United States Preventive Services Task Force and 2017 American College of Cardiology and American Heart Association (ACC/AHA) BP guidelines.1,2 One tool that may be used to help identify those in need of confirmatory BP monitoring is the Predicting Out-of-Office BP (PROOF-BP) algorithm, which uses office BP measurements and clinical characteristics to predict a patient’s out-of-office BP.3 Though many providers report recommending out-of-office BP monitoring to patients, the baseline frequency of its use for specific indications, such as confirming a diagnosis of hypertension, is not known.4 Further, barriers relevant to the accessibility and affordability of out-of-office BP monitoring have led to concerns that there may be disparities in the uptake of hypertension screening recommendations.5 This analysis examined how historical use of HBPM aligns with current out-of-office BP monitoring recommendations for hypertensive US adults without a previous hypertension diagnosis, and how HBPM use varies by patient characteristics.