Table 3 Recommendation of out-of-office blood pressure
From: Agreement regarding overcoming hypertension in the Asian Hypertension Society Network 2022
| Â | HBPM | ABPM |
|---|---|---|
ISH | • Out-of-OBP measurements are more reproducible than office measurements, more closely associated with hypertension-induced organ damage and the risk of CV events and identify the WCHT and MHT phenomena • Out-of-OBP measurement is often necessary for the accurate diagnosis of hypertension and for treatment decisions. In untreated or treated subjects with office BP classified as high-normal BP or grade 1 hypertension (130–159/85–99 mmHg), the BP level needs to be confirmed using HBPM or ABPM | |
AHA/ACC | • Out-of-OBP measurements are recommended to confirm the diagnosis of hypertension and for titration of BP-lowering medication, in conjunction with telehealth counseling or clinical interventions | |
ESC/ESH | • Out-of-OBP measurement with ABPM and/or HBPM, provided that these measurements are logistically and economically feasible • Out-of-OBP (i.e., ABPM or HBPM) is specifically recommended for a number of clinical indications, such as identifying WCHT and MHT, quantifying the effects of treatment, and identifying possible causes of side effects | |
HOPE-ASIA | – | – |
Asian regions | ||
China [25] | • HBPM can be used to evaluate antihypertensive efficacy and long-term BP variation for days, weeks, months or even years, and can help to enhance patient’s awareness of health participation, improve patient’s compliance and adherence to treatment, and is suitable for long-term BP monitoring of patients | • At present, the major clinical use of ABPM are: to diagnose WCHT, MHT and isolated nocturnal hypertension; to observe abnormal BP rhythm and variation; to evaluate the efficacy of antihypertensive therapy and BP control over all time periods (including morning and sleep) |
India | – | – |
Indonesia | • Establish a diagnosis of hypertension (detect white-coat hypertension and Mask hypertension). Monitor BPV, in hypertensive patients receiving treatment. Assess the effectiveness of treatment, dose adjustment, patient compliance | • Confirmation of patient with resistant hypertension, WCHT, OSA, Evaluate the effect of therapy on the 24-h BP profile |
Korea [27] | • Recommended for diagnosis of sustained HT, MHT and WCHT | |
Malaysia [28] | • A HBPM or ABPM should be done to exclude isolated office hypertension | |
Mongolia | – | – |
Pakistan | Refer to ISH guideline | |
Philippines [31] | In office and out-of-OBP recommendation using a digital device, Manual still recommended if digital device not available provided that person getting it is well trained. | |
Singapore [32] | • Younger patients • Those with target organ damage but without raised OBP | • Younger patients • Those with target organ damage but without raised OBP • Doubt of diagnosis of hypertension • Older, cognitively impaired, anxious or OSA patients, in whom HBPM might be unreliable or inappropriate |
Sri Lanka | – | – |
Taiwan [34] | • HBPM is recommended as the foundation for the diagnosis and grading of hypertension, and also for the treatment thresholds and targets | • ABPM parameters provide better information on cardio and cerebrovascular risk than office BP • ABPM should be considered in all patients with elevated BP, particularly those with unstable office or home BP, or whom are suspected to have white-coat or masked hypertension, or progressive hypertension-mediated organ damage |
Thailand [35] | • Out-of-OBP measurements, including HBPM or ABPM are also advocated to confirm the diagnosis of hypertension, identify WCHT or MHT, evaluate BP variation, and to assess antihypertensive treatment efficacy | |
Vietnam [36] | • HBPM is also an effective method used to evaluate treatment therapy efficacy, titrate antihypertensive therapy, and diagnose WCH, MHT, and hypertension in pregnancy. Meanwhile, HBPM results must be consulted by the physician, and must not be used by the patient to titrate the patient’s medication without permission from a physician | – |
Japan [37] | • The clinical availability, feasibility and diagnostic value of HBPM are highly appraised | • ABPM should be performed, if possible, as a complementary measure for hypertension diagnosis by home/OBP measurement |
