Guidance on ambulatory blood pressure monitoring: A statement from the HOPE Asia Network

Hypertension is an important public health issue due to its association with a number of serious diseases, including cardiovascular disease and stroke. The importance of evaluating hypertension taking into account different blood pressure (BP) profiles and BP variability (BPV) is increasingly being recognized, and is particularly relevant in Asian populations given the specific features of hypertension in the region (including greater salt sensitivity and a high rate of nocturnal hypertension). Ambulatory BP monitoring (ABPM) is the gold standard for diagnosing hypertension and assessing 24‐hour BP and provides data on several important parameters that cannot be obtained using any other form of BP measurement. In addition, ABPM parameters provide better information on cardio‐ and cerebrovascular risk than office BP. ABPM should be used in all patients with elevated BP, particularly those with unstable office or home BP, or who are suspected to have white‐coat or masked hypertension. ABPM is also an important part of hypertension diagnosis and monitoring in high‐risk patients. ABPM needs to be performed using a validated device and good practice techniques, and has a role both in hypertension diagnosis and in monitoring the response to antihypertensive therapy to ensure strict BP control throughout the 24‐hour period. Use of ABPM in clinical practice may be limited by cost and accessibility, and practical education of physicians and patients is essential. The ABPM evidence and practice points in this document are based on the Hypertension Cardiovascular Outcome Prevention and Evidence (HOPE) Asia Network expert panel consensus recommendations for ABPM in Asia.     

Expert panel consensus recommendations for ambulatory blood pressure monitoring in Asia: The HOPE Asia Network

Hypertension is an important public health issue because of its association with a number of significant diseases and adverse outcomes. However, there are important ethnic differences in the pathogenesis and cardio‐/cerebrovascular consequences of hypertension. Given the large populations and rapidly aging demographic in Asian regions, optimal strategies to diagnose and manage hypertension are of high importance. Ambulatory blood pressure monitoring (ABPM) is an important out‐of‐office blood pressure (BP) measurement tool that should play a central role in hypertension detection and management. The use of ABPM is particularly important in Asia due to the specific features of hypertension in Asian patients, including a high prevalence of masked hypertension, disrupted BP variability with marked morning BP surge, and nocturnal hypertension. This HOPE Asia Network document summarizes region‐specific literature on the relationship between ABPM parameters and cardiovascular risk and target organ damage, providing a rationale for consensus‐based recommendations on the use of ABPM in Asia. The aim of these recommendations is to guide and improve clinical practice to facilitate optimal BP monitoring with the goal of optimizing patient management and expediting the efficient allocation of treatment and health care resources. This should contribute to the HOPE Asia Network mission of improving the management of hypertension and organ protection toward achieving “zero” cardiovascular events in Asia.     

The influence of age on blood pressure evaluation of hypertensive subjects

The aim of this study was to determine whether age influences the concordance between different methods of blood pressure (BP) measurement and ambulatory BP monitoring (ABPM) in hypertensive subjects. We studied two groups: I, individuals younger than 50 years (n = 57), and II, individuals aged 60 years or older (n = 55). They were submitted to the performance of one ABPM, office BP measurements, home BP monitoring (HBPM), and BP measurements at a public health center (PHCBP). Student's t-test, Fisher's test and Lin coefficient were calculated. For Group II, systolic and diastolic pressures measured by HBPM were higher than by day ABPM (p < 0.01). The concordance between day ABPM and the other methods was lower for Group II than for Group I. There was a good concordance between systolic day ABPM and office BP, and between systolic ABPM and PHCBP only for Group I (Lin coefficient = 0.71 and 0.73). Group II reported better sleep quality after ABPM (p < 0.05). Considering 24-h ABPM, 52.6% of Group I and 29% of Group II were controlled (p < 0.01). Concluding, there was worse concordance between different methods of BP measurements and day ABPM in the older group, which had lower hypertension control rate and better tolerance of ABPM.     

Rationale and design for the Asia BP@Home study on home blood pressure control status in 12 Asian countries and regions

Home blood pressure (BP) monitoring is endorsed in multiple guidelines as a valuable adjunct to office BP measurements for the diagnosis and management of hypertension. In many countries throughout Asia, physicians are yet to appreciate the significant contribution of BP variability to cardiovascular events. Furthermore, data from Japanese cohort studies have shown that there is a strong association between morning BP surge and cardiovascular events, suggesting that Asians in general may benefit from more effective control of morning BP. We designed the Asia BP@Home study to investigate the distribution of hypertension subtypes, including white‐coat hypertension, masked morning hypertension, and well‐controlled and uncontrolled hypertension. The study will also investigate the determinants of home BP control status evaluated by the same validated home BP monitoring device and the same standardized method of home BP measurement among 1600 or more medicated patients with hypertension from 12 countries/regions across Asia.     

The first study comparing a wearable watch‐type blood pressure monitor with a conventional ambulatory blood pressure monitor on in‐office and out‐of‐office settings

Wearable blood pressure (BP) monitoring devices which measure BP levels accurately both in and out of the office are valuable for hypertension management using digital technology. The authors have conducted the first comparison study of BPs measured by a recently developed wrist‐worn watch‐type oscillometric BP monitoring (WBPM) device, the “HeartGuide,” versus BPs measured by an ambulatory BP monitoring (ABPM) device, A&D TM‐2441, in the office (total of 4 readings alternately measured in the sitting position) and outside the office (30‐minutes interval measurements during daytime) in 50 consecutive patients (mean age 66.1 ± 10.8 years). The 2 BP monitoring devices were simultaneously worn on the same non‐dominant arm throughout the monitoring period. The mean difference (±SD) in systolic BPs (average of 2 readings) between WBPM and ABPM was 0.8 ± 12.8 mm Hg (P = .564) in the office and 3.2 ± 17.0 mm Hg (P < .001) outside the office. The proportion of differences that were within ±10 mm Hg was 58.7% in the office and 47.2% outside the office. In a mixed‐effects model analysis, the temporal trend in the difference between the out‐of‐office BPs measured by the two devices was not statistically significant. In conclusion, the difference between the WBPM and ABPM device was acceptable both in and out of the office.     

Evaluation of prehypertension and masked hypertension rate among clinically normotensive patients

Background: The present cross-sectional study was aimed to identify pre-hypertension and masked hypertension rate in clinically normotensive adults in relation to socio-demographic, clinical and laboratory parameters. Methods: A total of 161 clinically normotensive adults with office blood pressure (OBP) <140/90?mmHg without medication were included in this single-center cross-sectional study. OBP, home BP (HBP) recordings and ambulatory BP monitoring (ABPM) were used to identify rates of true normotensives, true pre-hypertensives and masked hypertensives. Data on sociodemographic and clinical characteristics were collected in each subject and evaluated with respect to true normotensive vs. pre-hypertensive patients with masked hypertension or true pre-hypertensive. Target organ damage (TOD) was evaluated in masked hypertensives based on laboratory investigation. Results: Masked hypertension was identified in 8.7% of clinically normotensives. Alcohol consumption was significantly more common in masked hypertension than in true pre-hypertension (28.6 vs. 0.0%, p?=?0.020) with risk ratio of 2.7 (95% CI 1.7–4.4). Patients with true pre-hypertension and masked hypertension had significantly higher values for body mass index, waist circumference, systolic and diastolic OBP and HBP (p?<?0.05 for each) compared to true normotensive subjects. ABPM revealed significantly higher values for day-time and night-time systolic and diastolic BP (p?=?0.002 for night-time diastolic BP, p?<?0.001 for others) in masked hypertension than true pre-hypertension. Conclusions: Given that the associations of pre-hypertension with TOD might be attributable to the high prevalence of insidious presentation of masked hypertension among pre-hypertensive individuals, ABPM seems helpful in early identification and management of masked hypertension in the pre-hypertensive population.     

Guidance on home blood pressure monitoring: A statement of the HOPE Asia Network

Hypertension is an important modifiable cardiovascular risk factor and a leading cause of death throughout Asia. Effective prevention and control of hypertension in the region remain a significant challenge despite the availability of several regional and international guidelines. Out‐of‐office measurement of blood pressure (BP), including home BP monitoring (HBPM), is an important hypertension management tool. Home BP is better than office BP for predicting cardiovascular risk and HBPM should be considered for all patients with office BP ≥ 130/85 mm Hg. It is important that HBPM is undertaken using a validated device and patients are educated about how to perform HBPM correctly. During antihypertensive therapy, monitoring of home BP control and variability is essential, especially in the morning. This is because HBPM can facilitate the choice of individualized optimal therapy. The evidence and practice points in this document are based on the Hypertension Cardiovascular Outcome Prevention and Evidence (HOPE) Asia Network expert panel consensus recommendations for HBPM in Asia.     

Ambulatory blood pressure monitoring over 24 h: A Latin American Society of Hypertension position paper—accessibility,clinical use and cost effectiveness of ABPM in Latin America in year 2020

Accurate office blood pressure measurement remains crucial in the diagnosis and management of hypertension worldwide, including Latin America (LA). Office blood pressure (OBP) measurement is still the leading technique in LA for screening and diagnosis of hypertension, monitoring of treatment, and long‐term follow‐up. Despite this, due to the increasing awareness of the limitations affecting OBP and to the accumulating evidence on the importance of ambulatory BP monitoring (ABPM), as a complement of OBP in the clinical approach to the hypertensive patient, a progressively greater attention has been paid worldwide to the information on daytime and nighttime BP patterns offered by 24‐h ABPM in the diagnostic, prognostic, and therapeutic management of hypertension. In LA countries, most of the Scientific Societies of Hypertension and/or Cardiology have issued guidelines for hypertension care, and most of them include a special section on ABPM. Also, full guidelines on ABPM are available. However, despite the available evidence on the advantages of ABPM for the diagnosis and management of hypertension in LA, availability of ABPM is often restricted to cities with large population, and access to this technology by lower‐income patients is sometimes limited by its excessive cost. The authors hope that this document might stimulate health authorities in each LA Country, as well as in other countries in the world, to regulate ABPM access and to widen the range of patients able to access the benefits of this technique.     

Prevalence and clinical correlates of ambulatory blood pressure phenotypes in a Saudi hypertensive population

International Guidelines recommend ambulatory blood pressure monitoring (ABPM) for the management of hypertension. ABPM phenotypes predict outcomes independent of office blood pressure (BP). The authors explored the prevalence and clinical correlates of ABPM phenotypes and relationship with office BP in Saudi patients (n = 428, mean age 53.5 ± 14.6, 55% male) referred to a Specialist Hypertension clinic in Riyadh, Saudi Arabia. ABPM phenotypes included sustained normotension (27%), masked hypertension, MHT(32%), sustained hypertension, SHT(52%), and white coat hypertension(2.6%). MHT was more prevalent using asleep than 24‐hours (26.4% vs 12.9%, P < .01) or awake BP (26.4% vs 8.5%, P < .001) and observed in 85% of pre‐hypertensive patients. Isolated nocturnal hypertension was more prevalent in MHT vs SHT (70% vs 30%, P < .001). Office BP overestimated control rates compared with ABPM (48% vs 12.9%, P < .001). Our study shows that one in three Saudi patients will be managed inappropriately if office BP alone was relied upon for management of hypertension.     

Uncontrolled hypertension in older patients: markers and associated factors to masked and white-coat effect

Background Hypertension is the main risk factor for cardiovascular diseases, affecting more than half the elderly population. It is essential to know if they have proper control of hypertension. The aim of this study was to identify the associated factors to masked uncontrolled hypertension and false uncontrolled hypertension in older patients. Methods Two-hundred seventy-three individuals (70.1 ± 6.7 years-old) had blood pressure (BP) measured at the office and by ambulatory BP monitoring (ABPM), with the definition of controlled group (C), individuals with high office BP and adequate ABPM, called white-coat effect group (WCE), uncontrolled (UC), and subjects with appropriate office BP and elevated ABPM denominated masked effect group (ME). Age, body mass index, diabetes, pulse pressure (PP) and BP dipping during sleep were evaluated (Kruskal-Wallis test and logistic regression models). Results Age was higher in UC than in C and ME (P < 0.01), and 24-h ABPM PP was lower in C (48 ± 7 mmHg) and WCE (51 ± 6 mmHg) than in UC (67 ± 12 mmHg) and ME (59 ± 8 mmHg) (P < 0.01). Sleep systolic BP dipping was lower in ME than in C (P = 0.03). Female gender was associated with a greater chance of being of ME group, which showed a higher PP and lower BP dipping during sleep. Conclusions In older individuals, office BP measurements did not allow the detection of associated factors that would permit to differentiate WCE from UC group and C from ME group. ABPM favored the identification of a higher PP and a lower BP dipping during sleep in the masked effect and uncontrolled groups.     

动态血压监测二级筛选诊断高血压的价值

选择上海人民出版社医务室管辖的７７０名职工中的１０８例高血压（确诊１０２例，临界６例）为对象，观察停服降压药２周以上后的２４ｈ动态血压（ＡＢＰ）参数。在１０１例（检测率９３．５％）受检患者中，ＡＢＰ各项参数均正常者占１９．８％，随年龄增大而减少，男性１５．２％，女性３６．４％（Ｐ＜０．０５）；各项参数均升高者占２５．７％，随年龄增大而增加，男性３０．４％，女性９．１％（Ｐ＜０．１）。高血压患病率根据随测血压的ＷＨＯ标准为１４．０％，按照ＡＢＰ参数则为１１．２％。结果提示动态血压监测可以作为高血压诊断的二级筛选手段，有助于识别＂诊所高血压＂和高危患者。     

Is resistant hypertension really resistant?

BACKGROUND: Managing resistant hypertension is difficult and mostly involves expensive testing seeking an underlying secondary cause. This study was undertaken to determine 1) the extent of the white-coat phenomenon in patients with resistant hypertension, and 2) whether 24-h ambulatory blood pressure (BP) monitoring (ABPM) or having BP recorded by a nurse instead of the referring doctor could clarify how many apparently resistant hypertensives actually have controlled BP. METHODS: This study involved 611 patients with BP > or = 140/90 mm Hg who were referred for 24-h ABPM by their specialist or general practitioner, including 277 patients who were taking no antihypertensives (group 1), 216 taking one or two antihypertensive drugs (group 2), and 118 taking at least three antihypertensives in combination (group 3). Each had BP recorded by one of two nurses before 24-h ABPM. Controlled BP was defined as awake ambulatory BP <135/85 mm Hg and the white-coat effect was the difference between the BP recorded by the referring doctor or nurse and the average awake ambulatory BP. RESULTS: Those with resistant hypertension (group 3) were older (61 years (12) v group 1: 46 years (14) and group 2: 56 (14) years; P < .001), but were of similar weight, height, and arm circumference to the other groups. Referral systolic, but not diastolic BP was higher in resistant hypertensives (mean 171/95 v 154/95 mm Hg and 164/94 mm Hg, respectively, P < .001 for systolic BP only). Twenty-eight percent of resistant hypertensives and 32% of those taking no antihypertensive drugs had normal awake ambulatory BP and the white-coat effect attributable to the referring doctor was always greater than that due to the nurse (range 16 to 26/12 to 14 mm Hg v 9 to 17/4 mm Hg, P < .001). Nurse recorded BP was highly sensitive (97%) in identifying awake hypertension but lacked specificity (57%) to replace ABPM. CONCLUSION: Our results show that approximately one in four patients with apparent resistant hypertension referred for ABPM have controlled BP and one-third of patients referred for initial evaluation of office or clinic hypertension have normal BP using ABPM, ie, white-coat hypertension. Twenty-four-hour ABPM appears an appropriate initial step before further investigating or treating patients with apparently resistant hypertension.     

家庭血压监测的临床应用

血压测量是诊断高血压病的基本手段,目前主要有三种方法评价血压：诊所偶测血压、动态血压监测和家庭血压监测。家庭血压监测方便、经济,已有大量数据表明：与诊所偶测血压相比,家庭血压监测是评估心血管疾病风险的一个更好的预测因子。同时它能改善高血压患者的治疗依从性,有利于血压控制,监测降压药物疗效,减少医疗费用。另外对鉴别白大衣高血压和隐性高血压也很有帮助。     

Blood pressure measurement: Should technique define targets?

Accurate assessment of blood pressure (BP) is the cornerstone of hypertension management. The objectives of this study were to quantify the effect of medical personnel presence during BP measurement by automated oscillometric BP (AOBP) and to compare resting office BP by AOBP to daytime average BP by 24‐h ambulatory BP monitoring (ABPM). This study is a prospective randomized cross‐over trial, conducted in a referral population. Patients underwent measurements of casual and resting office BP by AOBP. Resting BP was measured as either unattended (patient alone in the room during resting and measurements) or as partially attended (nurse present in the room during measurements) immediately prior to and after 24‐h ABPM. The primary outcome was the effect of unattended 5‐min rest preceding AOBP assessment as the difference between casual and resting BP measured by the Omron HEM 907XL. Ninety patients consented and 78 completed the study. The mean difference between the casual and Omron unattended systolic BP was 7.0 mm Hg (95% confidence interval [CI] 4.5, 9.5). There was no significant difference between partially attended and unattended resting office systolic BP. Resting office BP (attended and partially attended) underestimated daytime systolic BP load from 24‐h ABPM. The presence or absence of medical personnel does not impact casual office BP which is higher than resting office AOBP. The requirement for unattended rest may be dropped if logistically challenging. Casual and resting office BP readings by AOBP do not capture the complexity of information provided by the 24‐h ABPM.     

Ambulatory blood pressure monitoring and management of hypertension at a cardiac clinic in Kumasi Metropolis,Ghana

Ambulatory blood pressure monitoring (ABPM) is considered a good intervention strategy to avoid misdiagnosis of hypertension and allow for targeted treatment of patients with hypertension. This study sought to assess the contribution of ABPM to blood pressure (BP) control and antihypertensive therapy at a cardiac clinic in Ghana. Medical records of 97 patients, aged 18‐85 years (mean 55), were reviewed. Among patients with clinic BP (CBP) and ambulatory BP recorded on the same day, we assessed for the different hypertension phenotypes, CBP control 6 months following ABPM, and changes to antihypertensive therapy after review of the ABPM records in patients with controlled and uncontrolled ambulatory BP. From the clinic and ambulatory BP records measured at baseline, the proportion of patients with white‐coat uncontrolled hypertension (WUCH) was 19.5% (17/87) and those with masked uncontrolled hypertension (MUCH) was 16.1% (n = 14). A significant reduction in average systolic CBP in the overall cohort (−6.2 mm Hg, P < .01) and in the uncontrolled subgroup (−8.8 mm Hg, P < .001) at follow‐up was observed. After review of the ABPM records, 51.7% of the patients on treatment had changes made in their antihypertensive therapy. Antihypertensive therapy was deintensified or left unchanged in majority of the patients with WUCH and sustained controlled hypertension. In patients with MUCH and true uncontrolled hypertension (TUCH), therapy was intensified. In conclusion, ABPM improved clinical decision‐making for antihypertensive therapy and BP control. ABPM should therefore be used more often in hypertension and cardiac clinics in low/middle‐income countries for optimal care.     

Clinical predictors and impact of ambulatory blood pressure monitoring in pediatric hypertension referrals

Elevated blood pressure (BP) is rising in children. Significant proportions of children have reactive hypertension or masked hypertension, making ambulatory BP monitoring (ABPM) a valuable tool, although with potential economic implications. In youth referred for elevated BP, we sought clinic BP combinations that obviated the need for ABPM and to specify the economic role of ABPM. In a retrospective pediatric referral cohort (N = 170), we examine clinic systolic BP (SBP) predictors of components of ABPM hypertension and their combination. In economic analyses, we compared effectiveness and charges of three diagnostic pathways: (1) clinic BP alone; (2) abnormal clinic BP prompting ABPM; or (3) universal ABPM. ABPM hypertension occurred in 55 (32.4%) and reactive hypertension in 37 (21.8%), average automated (β = 0.208; 95% confidence interval, 0.027, 0.389; P = .03) and maximum auscultatory clinic SBP (β = 0.160; 95% confidence interval 0.022, 0.299; P = .02) were associated with ABPM SBP mean, but none predicted SBP load. No clinic SBP combination was associated with ABPM hypertension. Universal ABPM accrued the lowest average charge per hypertensive youth identified ($10,948). We did not identify a clinic SBP combination that predicted ABPM hypertension in youth referred for elevated BP. Universal ABPM, in this context, may be the most economically and clinically efficient diagnostic strategy.     

Comparison of randomization techniques for clinical trials with data from the HOMERUS-trial

Background. Several methods of randomization are available to create comparable intervention groups in a study. In the HOMERUS-trial, we compared the minimization procedure with a stratified and a non-stratified method of randomization in order to test which one is most appropriate for use in clinical hypertension trials. A second objective of this article was to describe the baseline characteristics of the HOMERUS-trial. Methods. The HOMERUS population consisted of 459 mild-to-moderate hypertensive subjects (54% males) with a mean age of 55 years. These patients were prospectively randomized with the minimization method to either the office pressure (OP) group, where antihypertensive treatment was based on office blood pressure (BP) values, or to the self-pressure (SP) group, where treatment was based on self-measured BP values. Minimization was compared with two other randomization methods, which were performed post-hoc: (i) non-stratified randomization with four permuted blocks, and (ii) stratified randomization with four permuted blocks and 16 strata. In addition, several factors that could influence outcome were investigated for their effect on BP by 24-h ambulatory blood pressure monitoring (ABPM). Results. Minimization and stratified randomization did not lead to significant differences in 24-h ABPM values between the two treatment groups. Non-stratified randomization resulted in a significant difference in 24-h diastolic ABPM between the groups. Factors that caused significant differences in 24-h ABPM values were: region, centre of patient recruitment, age, gender, microalbuminuria, left ventricular hypertrophy and obesity. Conclusion. Minimization and stratified randomization are appropriate methods for use in clinical trials. Many outcome factors should be taken into account for their potential influence on BP levels. Recommendation. Due to the large number of potential outcome factors that can influence BP levels, minimization should be the preferred method for use in clinical hypertension trials, as it has the potential to randomize more outcome factors than stratified randomization.     

Ambulatory blood pressure monitoring in clinical practice

Being one of the most widely prevalent diseases throughout the world, hypertension has emerged as one of the leading causes of global premature morbidity and mortality. Hence, blood pressure (BP) measurements are essential for physicians in the diagnosis and management of hypertension. Current American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend initiating antihypertensive medications on the basis of office BP readings. However, office BP readings provide a snapshot evaluation of the patient's BP, which might not reflect patient's true BP, with the possibility of being falsely elevated or falsely low. Recently, there is ample evidence to show that ambulatory blood pressure monitoring (ABPM) is a better predictor of major cardiovascular events than BP measurements at clinic settings. ABPM helps in reducing the number of possible false readings, along with the added benefit of understanding the dynamic variability of BP. This article will focus on the significance of ambulatory BP, its advantages and limitations compared with the standard office BP measurement and a brief outlook on its use and interpretation to diagnose and treat hypertension.     

Dialysis unit blood pressure two hours after hemodialysis is useful for predicting home blood pressure and ambulatory blood pressure in maintenance hemodialysis patients

This study aimed to determine which BP measurement obtained in the HD unit correlated best with home BP and ambulatory BP monitoring (ABPM). We retrospectively analyzed data from 40 patients that received maintenance HD who had available home BP and ABPM data. Dialysis unit BPs were the averages of pre-, 2hr- (2 h after starting HD), and post-HD BP during a 9-month study. Home BP was defined as the average of morning and evening home BPs. Dialysis unit BP and home BP were compared over the 9-month study period. ABPM was performed once for 24 h in the absence of dialysis during the final 2 weeks of the study period and was compared to the 2-week dialysis unit BP and home BP. There was a significant difference between dialysis unit systolic blood pressure (SBP) and home SBP over the 9-month period. No significant difference was observed between the 2hr-HD SBP and home SBP. When analyzing 2 weeks of dialysis unit BP and home BP, including ABPM, SBPs were significantly different (dialysis unit BP > home BP > ABPM; P = 0.009). Consistent with the 9-month study period, no significant difference was observed between 2hr-HD SBP and home SBP (P = 0.809). The difference between 2hr-HD SBP and ambulatory SBP was not significant (P = 0.113). In conclusion, the 2hr-HD SBP might be useful for predicting home BP and ABPM in HD patients.     

Recommendations for home blood pressure monitoring in Latin American countries: A Latin American Society of Hypertension position paper

Out‐of‐office blood pressure (BP) monitoring appears to be a very useful approach to hypertension management insofar it allows to obtain multiple measurements in the usual environment of each individual, allows the detection of hypertension phenotypes, such as white‐coat and masked hypertension, and appears to have superior prognostic value than the conventional office BP measurements. Out‐of‐office BP can be obtained through either home or ambulatory monitoring, which provide complementary and not identical information. Home BP monitoring yields BP values self‐measured in subjects' usual living environment; it is an essential method for the evaluation of almost all untreated and treated subjects with suspected or diagnosed hypertension, best if combined with telemonitoring facilities, also allowing long‐term monitoring. There is also increasing evidence that home BP monitoring improves long‐term hypertension control rates by improving patients' adherence to prescribed treatment. In Latin American Countries, it is widely available, being relatively inexpensive, and well accepted by patients. Current US, Canadian, Japanese, and European guidelines recommend out‐of‐office BP monitoring to confirm and refine the diagnosis of hypertension.