Advantages | Limitations | |
Office BP measurement | Cornerstone in the approach to hypertension diagnosis and management for over a century Easily available Related to outcome in large epidemiological and intervention studies | Intrinsic inaccuracy of the auscultatory technique (mainly for diastolic BP and in specific populations) Observer's bias and digit preference Only isolated measurement allowed Interference by white coat effect Inability to account for physiological BP variability No information on nocturnal BP |
Home BP monitoring | A number of measurements during the day and also over several days, weeks or months are possible; assessment of treatment effects at different times of the day and over extended periods No alarm reaction to BP measurement Good reproducibility Good prognostic value Relatively low cost Patient friendliness (in semiautomatic devices) Involvement of patient in hypertension management Possibility of digital storage, printout, PC download or tele-transmission of BP values (in some devices/systems) Improvement of patients' compliance to treatment Improvement of hypertension control rates | Need of patient training (short for automated devices) Possible use of inaccurate devices Measurement errors Limited reliability of BP values reported by patients Induction of anxiety resulting in excessive monitoring Treatment changes made by patients on the basis of casual home measurements without doctor's guidance Normality thresholds and therapeutic targets still debated Lack of night recordings |
24-ABPM | No observer bias and digit preference Large number of BP values available over 24 h in daily life particularly in true ambulatory conditions No alerting reaction to BP automated measurements (no white coat effect) Higher reproducibility of 24 h average BP No placebo effect Allows assessment of 24 h, daytime, night-time and hourly BP values Allows assessment of BP variability (although limited with discontinuous BP monitoring) Allows assessment of day to night BP changes (dippers, nondippers and extreme dippers); better if performed over repeated recordings 24 h average BP more closely related to target-organ damage of hypertension Superior prognostic value of 24 h, daytime or night-time average BP Allows assessment of effectiveness and time distribution of BP control by treatment over 24 h, also through mathematical indices (trough/peak ratio and smoothness index) | Possible inaccuracy of automated BP readings Interference with patient's daily activities Quality of sleep affected to a greater or lesser degree Limited reproducibility of hourly BP values Reference “normal” ambulatory BP values still under debate Need for more evidence on prognostic value of different ABPM parameters High costs |
Beat-by-beat BP monitoring | Possibility to accurately assess beat-by-beat BP variability | Invasive methods: poorly suited to a clinical setting Noninvasive methods: possible inaccuracies due to pulse wave distortion in peripheral arteries, limited availability because of relatively high cost, need of expert operators |
ABPM: ambulatory BP monitoring.