Home blood pressure monitoring: advantages and limitations.

Home blood pressure monitoring is a useful tool for clinical management of patients with hypertension. Its major advantages are the ease with which the techniques can be learned, reproducibility of values, sensitivity of measurement and availability of normotensive data. In spite of the ability to tell whether a subject has normal or abnormal values, because of the lack of prospective mortality/morbidity data, home blood pressure monitoring cannot be used to decide whether treatment is indicated. The treatment decision must be based on repeated clinic blood pressure readings. After that the home blood pressure monitoring can be used to exclude individuals who are at risk for side effects due to low out-of-office blood pressure readings and to precisely monitor the blood pressure response to therapy. Home blood pressure monitoring is frequently used to find subjects with 'white-coat' hypertension. In our study of borderline hypertension in Tecumseh, white-coat hypertension is present in 7.1% of the whole population and in 58% of all subjects with elevated blood pressures in the clinic. Subjects with white-coat hypertension in Tecumseh appear to be at an increased risk for coronary heart disease: they show repeated elevated clinic readings throughout their life time, their parents have higher blood pressure, their high-density lipoprotein is decreased and insulin, cholesterol and triglycerides are elevated. Whereas subjects with white-coat hypertension should not be treated with antihypertensive agents, they must be followed and managed through non-pharmacologic means.