Recent guidelines have emphasized the use of home blood pressure monitoring (HBPM) for the diagnosis and the treatment of hypertension [1, 2]. In Asia, there is a strong emphasis on the use of HBPM and the Japanese society of hypertension and the Taiwan hypertension society went as far as to recommend HBPM as the out of office BP monitoring of choice for the management of hypertension [2,3,4]. However, despite the emphasis of HBPM in the recent guidelines, its utilization in the real world is still not up to par. In the Asia HBPM survey 2020, a survey of 7945 physicians from 11 countries in Asia, only 50.3% of physicians highly recognized HBPM [5]. Although nearly all physicians (95.9%) reportedly recommended HBPM to their patients, only less than 50% of their patients actually measured home BP(HBP). Among physicians who recommended HBPM, only 22.4% of the physicians were able to define the correct threshold value for HBP diagnostic threshold [5]. In the latest paper by Lin et al., the authors surveyed a total of 779 physicians in Taiwan with regards to the utilization of HBPM [6]. According to the survey, less than half (45.6%) of patients measured their own home blood pressures. Among the physicians who recommend HBPM to their patients, only 15.5% correctly identified the correct diagnostic threshold for HBPM. Also, the physicians’ knowledge of the standard method of measurement of HBPM was substandard [6]. Despite the presence of numerous guidelines, 57.3% of physicians surveyed suggested that lack of guidelines for HBMP is a barrier for recognition of HBMP [6]. The data clearly shows that the hypertension societies in Asia need to do a better job to educate not only the patients, but educate the physicians to reduce the gap between the ideal world of the guidelines and the real world. Additionally, a unified guideline regarding home BP thresholds maybe necessary for the Asian population, as various guidelines present differing recommendations. For example, the Taiwanese guideline suggests a threshold of 130/80 mmHg for diagnosis of hypertension and 130/80 mmHg for treatment target of home BP. In contrast, the Japanese guideline suggests a threshold of 135/85 mmHg for diagnosis but BP threshold of 125/75 mmHg for treatment target in adults younger than 75 [2, 4]. The varying cutoff values for evaluating BP control status across regions can lead to challenges for physicians in consistently applying home BP thresholds [2, 4].

The BP control rate is still not ideal among Asian countries and has plateaued [7]. To get the needle moving in the right direction, more efforts to educate the primary physicians should be the single most important mission of each and every hypertension societies of Asia. One major barrier is that the guidelines are too long and complicated, making it a daunting task for physicians to tackle. One way to overcome this would be to disseminate a simplified version of the guideline, such as the simplified clinical practice guideline developed by the ESH in 2024, and disseminate them by using various social media platforms [8]. Development and dissemination of simplified versions of guidelines for the patients would also be important for increasing the use of HBPM. These efforts would be a step in the right direction of narrowing the large gap that exists between the ideal world and the reality that is the suboptimal use of HBPM.