Clinical Review

Blood pressure self monitoring: questions and answers from a national conference

BMJ 2008; 337 doi: http://dx.doi.org/10.1136/bmj.a2732 (Published 22 December 2008) Cite this as: BMJ 2008;337:a2732
  1. Richard J McManus, clinical senior lecturer1,
  2. Paul Glasziou, professor2,
  3. Andrew Hayen, senior lecturer3,
  4. Jonathan Mant, professor 4,
  5. Paul Padfield, professor5,
  6. John Potter, professor 6,
  7. Emma P Bray, research fellow1,
  8. David Mant, professor 2
  1. 1Primary Care Clinical Sciences, University of Birmingham, Edgbaston Birmingham B15 2TT
  2. 2Department of Primary Health Care, University of Oxford, Headington, Oxford OX3 7LF
  3. 3Screening and Test Evaluation Program, School of Public Health, University of Sydney, NSW 2006 Australia
  4. 4General Practice and Primary Care Research Unit, Institute of Public Health, University of Cambridge, Cambridge CB2 0SR
  5. 5Department of Medical Sciences, University of Edinburgh, Edinburgh EH4 2XU
  6. 6Faculty of Health, University of East Anglia, Norwich NR4 7TJ
  1. Correspondence to: R J McManus r.j.mcmanus{at}bham.ac.uk

    Summary points

    • Self monitoring of blood pressure is useful in the diagnosis and management of hypertension

    • Multiple measurements of blood pressure allow a better estimation of “true” blood pressure

    • Systematic reviews show that blood pressure is lower when self monitored

    • Self monitored blood pressure correlates better with risk of stroke than office readings

    • Patient education and clinically validated sphygmomanometers are prerequisites for effective self monitoring

    Self measurement of blood pressure was introduced in the 1930s and is now practised by almost 10% of the general population of the United Kingdom.1 2 Because blood pressure monitors are now readily available and cheap (as little as £10; $15; €11.8), self monitoring is likely to increase—in the United States and Europe up to two thirds of people with hypertension self monitor.3 At present we have insufficient evidence to make use of multiple blood pressure readings generated from home monitoring in clinical care. This review—which is based on available evidence from randomised trials, systematic reviews, and expert consensus—discusses the clinical importance of self measurement of blood pressure in establishing the diagnosis of hypertension, in subsequent titration of drugs, and in longer term monitoring.

    Sources and selection criteria

    We extracted key studies from a Medline search for randomised controlled trials and systematic reviews to the end of 2007. These were supplemented by data from the personal references of study group members. After an open conference in early July 2008, at which the main data from the literature were presented, the group held a writing day to distil what was known and unknown for a series of questions for self monitoring of hypertension.

    What is self monitoring of blood pressure?

    Self monitoring of blood pressure is when a person (or carer) measures their own blood pressure outside the clinic—at home, in the workplace, or elsewhere.4 Self monitoring allows multiple measurements and therefore provides a more precise …

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