Feature Article

Ambulatory versus home self-monitoring of blood pressure: why both serve important roles

Geoffrey A. Head, Yusuke Sata



The high level of misdiagnosis of hypertension that occurs with casual clinic measurement of blood pressure has led to most guidelines recommending out-of-office measurements. However, the choice between 24-hour ambulatory blood pressure monitoring, which is costly but robust, and patient self-monitoring at home, which is cheaper and more convenient, remains a difficult one. 

Key Points

  • Inaccuracies in casual clinic blood pressure (BP) measurements and subsequent misdiagnosis of hypertension make out-of-office BP assessment highly recommended for the diagnosis and management of hypertension. 

  • Out-of-office techniques involve either 24-hour assessment with an automated ambulatory BP monitoring (ABPM) device or a simpler patient-managed self-measurement protocol using a home BP monitoring (HBPM) device.

  • ABPM is the gold standard as it is the most robust method for diagnosing ‘white-coat’ or masked hypertension and it takes nocturnal BP measurements, which are the best predictors of future cardiovascular events, but it is more expensive than HBPM. 

  • HBPM performed during the morning and evening across several days is cheaper and more convenient, making it the method preferred by patients and thereby increasing patient adherence.

  • The threshold for diagnosing hypertension using either the daytime ABPM reading or HBPM readings is 135/85 mmHg.
  • Both techniques have considerable cost–benefit and recommendations must include their use in conjunction with routine clinic BP assessment.

  • ABPM is recommended initially for the correct diagnosis and assessment of the 24-hour BP profile, with HBPM used in the longer term for the maintenance phase of treatment or monitoring.

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