Thirty years of research on diagnostic and therapeutic thresholds for the self-measured blood pressure at home.
OBJECTIVE
The goal of this review study is to summarize 30 years of research on cut-off limits for the self-measured blood pressure.


METHODS
We reviewed two meta-analyses, several prospective outcome studies in populations and hypertensive patients, studies in pregnant women, three clinical trials and the thresholds proposed in earlier and current hypertension guidelines.


RESULTS
In line with existing guidelines, prospective studies support that levels of the self-measured blood pressure at home of greater than or equal to 135 mmHg systolic or greater than or equal to 85 mmHg diastolic indicate hypertension. Circumstantial data suggest that levels of the self-measured blood pressure below 120/80 and 130/85 mmHg are optimal and normal, respectively. Therapeutic targets of the self-measured blood pressure to be attained on antihypertensive drug treatment are currently unknown, but should logically be lower (<135/85 mmHg) than those used to diagnose hypertension. Currently, there is no proof that therapeutic thresholds for the home blood pressure should be lower in high-risk compared with normal-risk patients. A large body of evidence, however, demonstrated that each millimetre of mercury of blood pressure lowering counts in the prevention of cardiovascular complications and that in high-risk patients even small decreases in blood pressure result in large absolute benefit.


CONCLUSIONS
The thresholds to diagnose hypertension from self-measured blood pressure readings at home remain unaltered since the 2000 consensus conference, but are currently supported by outcome data. Further studies need to establish what values of the self-measured blood pressure are optimal and normal in terms of cardiovascular outcome.
Staessen
Jan A
JA
Genetic Epidemiology Unit, Department of Epidemiology, Maastricht University, University Hospital Maastricht, Maastricht, The Netherlands. jan.staessen@med.kuleuven.be
Thijs
Lutgarde
L
Ohkubo
Takayoshi
T
Kikuya
Masahiro
M
Richart
Tom
T
Boggia
José
J
Adiyaman
Ahmet
A
Dechering
Dirk G
DG
Kuznetsova
Tatiana
T
Thien
Theo
T
de Leeuw
Peter
P
Imai
Yutuka
Y
O'brien
Eoin
E
Parati
Gianfranco
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination / Q000592:standards*; D018660:Blood Pressure Monitoring, Ambulatory / Q000592:standards*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010824:Physicians' Offices; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012044:Regression Analysis; D012106:Research; D012648:Self Care; D012955:Societies, Medical