Caribbean and South American team-based strategy to control hypertension (CATCH): Rationale and study design of a cluster randomized trial.

Poor blood pressure control is common in the United States. We conducted a study to determine whether health coaching with home titration of antihypertensive medications can improve blood pressure control compared with health coaching alone in a low-income, predominantly minority population. We randomized 237 patients with poorly controlled hypertension at a primary care clinic to receive either home blood pressure monitoring, weekly health coaching, and home titration of blood pressure medications if blood pressures were elevated (n = 129) vs home blood pressure monitoring and health coaching but no home titration (n = 108). The primary outcome was change in systolic blood pressure from baseline to 6 months. Both the home-titration arm and the no-home-titration arm had a reduction in systolic blood pressure, with no significant difference between them. When both arms were combined and analyzed as a before-after study, there was a mean decrease in systolic blood pressure of 21.8 mm Hg (P <.001) as well as a decrease in the number of primary care visits from 3.5 in the 6 months before the study to 2.6 during the 6-month study period (P <.001) and 2.4 in the 6 months after the study (P <.001). The more coaching encounters patients had, the greater their reduction in blood pressure. Blood pressure control in a low-income, minority population can be improved by teaching patients to monitor their blood pressure at home and having nonprofessional health coaches assist patients, in particular, by counseling them on medication adherence. The improved blood pressure control can be achieved while reducing the time spent by physicians.

BackgroundHypertension is a leading cause of cardiovascular and kidney disease in the United States, yet blood pressure (BP) control at a population level is poor and worsening. Systematic home BP monitoring (HBPM) programs can lower BP, but programs supporting HBPM are not routinely used. The MyBP program deploys automated bidirectional text messaging for HBPM and disease self-management support.ObjectiveWe aim to produce a qualitative analysis of input from providers and staff regarding implementation of an innovative HBPM program in primary care practices.MethodsSemistructured interviews (average length 31 minutes) were conducted with physicians (n=11), nurses, and medical assistants (n=6) from primary care settings. The interview assessed multiple constructs in the Consolidated Framework for Implementation Research domains of intervention characteristics, outer setting, inner setting, and characteristics of individuals. Interviews were transcribed verbatim and analyzed using inductive coding to organize meaningful excerpts and identify salient themes, followed by mapping to the updated Consolidated Framework for Implementation Research constructs.ResultsHealth care providers reported that MyBP has good ease of use and was likely to engage patients in managing their high BP. They also felt that it would directly support systematic BP monitoring and habit formation in the convenience of the patient’s home. This could increase health literacy and generate concrete feedback to raise the day-to-day salience of BP control. Providers expressed concern that the cost of BP devices remains an encumbrance. Some patients were felt to have overriding social or emotional barriers, or lack the needed technical skills to interact with the program, use good measurement technique, and input readings accurately. With respect to effects on their medical practice, providers felt MyBP would improve the accuracy and frequency of HBPM data, and thereby improve diagnosis and treatment management. The program may positively affect the patient-provider relationship by increasing rapport and bidirectional accountability. Providers appreciated receiving aggregated HBPM data to increase their own efficiency but also expressed concern about timely routing of incoming HBPM reports, lack of true integration with the electronic health record, and the need for a dedicated and trained staff member.ConclusionsIn this qualitative analysis, health care providers perceived strong relative advantages of using MyBP to support patients. The identified barriers suggest the need for corrective implementation strategies to support providers in adopting the program into routine primary care practice, such as integration into the workflow and provider education.Trial RegistrationClinicalTrials.gov NCT03650166; https://tinyurl.com/bduwn6r4

Background: Uncontrolled hypertension is a major global public health challenge, especially in low- and middle-income countries. In the Caribbean and South America Team-based Strategy to Control Hypertension (CATCH) trial, we are testing the effectiveness and implementation of a team-based care strategy for blood pressure control among patients with uncontrolled hypertension in Colombia and Jamaica. Objectives: To describe the baseline characteristics of participants in the CATCH trial. Methods: The CATCH is a cluster randomized-effectiveness implementation trial conducted in 40 primary care clinics in Colombia and Jamaica. We randomly assigned 20 clinics to the team-based care intervention and 20 to provider training intervention stratified by county and urbanization. A care team consisting of physicians-nurses-community health workers collaborated to deliver the intervention. The intervention and data collection will last for 18 months. Results: We screened 2,339 individuals and successfully recruited 1,710 hypertensive patients (1,050 in Colombia and 660 in Jamaica) who met the eligibility criteria. A total of 692 individuals were excluded from the trial: 563 (81.4%) due to BP &lt;130/80mmHg with standardized measurement, 63 (9.1%) due to kidney disease or heart failure, and 58 (8.4%) due to other reasons. Approximately 1% refused to consent for the trial. Participants were, on average, 62 years old, 70% were women, and 51% has less than high school education. Overall, 50% of participants identified as Mixed race and 36% identified as Black. Almost all (98%) of participants were taking antihypertensive medications at recruitment. In addition, 29% participants had diabetes, 46% had hypercholesterolemia, and 7% had grade 3 or 4 chronic kidney disease. Compared to Jamaicans, participants from Colombia were older (63 vs. 60 years) and more likely to be male (37% vs. 18%), and to identify as Mixed race (76% vs. 10%). Education status was similar between the two countries. Participants in Jamaica had a higher cardiovascular disease risk burden - diabetes (35% vs. 24%), hypercholesterolemia (51% vs. 43%), and chronic kidney disease (11% vs. 5%). Conclusion: We successfully recruited primary care patients with hypertension into the CATCH trial representative of primary care patients in Jamaica and Colombia. In future work we will assess reach by comparing our participants’ demographic characteristics to those of the overall hypertensive populations in both countries.

Patients with hypertension and additional cardiovascular risk factors pose a challenge by requiring more intensive blood pressure (BP) control. Single-pill combination (SPC) therapy can benefit these patients by improving medication adherence. This prospective, multicenter observational study assessed the real-world safety and effectiveness of an SPC containing olmesartan, amlodipine, and hydrochlorothiazide (O/A/H) in South Korean patients with hypertension and cardiovascular risk factors. BP control rates, defined as the percentage of patients achieving systolic BP (SBP) < 130mmHg and diastolic BP (DBP) < 80mmHg for intensive BP control, and < 140mmHg and < 90mmHg, respectively, for standard BP control, were investigated across various cardiovascular risk groups, along with changes in SBP and DBP from baseline to week24. The most prevalent cardiovascular risk factor was age (≥ 45years in men, ≥ 55years in women, 86.1%), followed by cardiovascular diseases (64.4%), dyslipidemia (53.7%), body mass index ≥ 25 kg/m2 (53.5%), and diabetes mellitus (DM) (46.3%). Switching to O/A/H showed significant BP reduction, with a mean change of - 17.8mmHg/- 9.3mmHg in SBP/DBP within 4weeks. The intensive BP control rate was 41.4% (95% confidence interval [CI] 39.5, 43.4), and the standard BP control rate was 73.3% (95%CI 71.5, 75.1), with better control rates in the risk age group (43.1% and 74.1%, respectively) and cardiovascular disease group (42.0% and 73.8%, respectively). The DM group had relatively lower control rates (37.5% for intensive control and 69.4% for standard control). Common adverse drug reactions included dizziness (2.91%), hypotension (1.51%), and headaches (0.70%). The SPC therapy of O/A/H caused a rapid and sustained reduction in SBP/DBP in patients' hypertension and additional cardiovascular risk factors. The therapy was safe and well tolerated. KCT0003401 ( https://cris.nih.go.kr/cris/search/detailSearch.do/20795 ).

Comparative effectiveness of team-based care with a clinical decision support system versus team-based care alone on cardiovascular risk reduction among patients with diabetes: Rationale and design of the D4C trial

Objective: From the National Health Examination Survey, one-fourth of Thai population had hypertension (HTN) but more than half were unaware of their high blood pressure (BP). Furthermore, only one-third of treated HTN patients had their BP under control. Uncontrolled HTN is a major risk factor for cardiovascular events, especially in low and middle-income countries. Therefore, we aimed to determine the effectiveness of the EASY HTN clinic model in terms of BP outcome. Design and method: The EASY HTN clinic was established in the year 2013 with 3 goals; easy access, minimal resource use, and provide standard treatment. The EASY concept included “Encourage home BP monitoring (HBPM), Adequate health education, Stage of change behavioral theorY”. The clinic consists of a doctor who was responsible for medication adjustment, and a well-trained nurse who was responsible for health education, and reinforcing a BP goal and healthy lifestyles. The clinic was run 6 hours per session, 1 day per week. The first 30 minutes was for group health education, and a question/answer session modulated by the nurse. Every new case was health-educated individually. Treatment was according to standard HTN guidelines. Doctor's treatment time was 7–10 minutes per case, including HBPM check. The follow-up was scheduled every 4 weeks by online messaging and every 3 months at the clinic. The effectiveness of the clinic model in terms of BP control and complication rate from 1st January 2016 to 30th September 2018 were analyzed. Results: There were 269, 312, and 206 new patients in 2016,2017, and 2018, respectively. The BP control rate (&lt;140/90 mmHg) was 56.7% in 2016 and increased to 63.7% and 80.8% in 2017 and 2018. Anti-HTN medication can be down-titrated safely in 15.2%, 11.8%, and 12.3% of patients in 2016, 2017, and 2018. There was 2% of patients who can sustainably stop anti-HTN medication for 2 years. Low rate of cardiovascular complications were observed (1.8%). Conclusions: The EASY HTN clinic model is effective for BP control. It may be a good model for the primary care clinic in Southeast Asia due to the minimal medical resources need.

Background The new hypertension (HT) guidelines recommend the use of out-of-office blood pressure (BP) measures for its diagnosis however, in the scope of public health in Brazil, it is still based on office BP (OBP) for logistical and financial reasons. Furthermore, in our country, it is not yet clear whether the use of out-of-office BP would really be more reliable for the diagnosis. Objective To evaluate the importance of using Home Blood Pressure Monitoring (HBPM) in diagnosing HT in a young adult population in primary care in Brazil. Methods A cross-sectional population study enrolled adults between 20 and 50 years in a primary healthcare unit in Rio de Janeiro. Office BP was the mean value of 2 measures, while the HBPM followed a 7-day protocol. It was considered normal a Home BP &amp;lt; 135x85 mmHg and OBP &amp;lt;140x90 mmHg. Patients were classified into 4 phenotypes: normotension (controlled OBP and HBPM); white coat HT (uncontrolled OBP and controlled HBPM); masked HT (controlled OBP and uncontrolled HBPM) and sustained HT (uncontrolled OBP and HBPM). Results A total of 462 individuals were enrolled [38% males; mean age 36±9 years]. Sedentary lifestyle (43%), dyslipidemia (38%) and obesity (28%) were the main CV risk factors. OBP, the prevalence of HT was 13%, HBPM it was 19%, with low concordance between them (kappa=0.472). After HBPM, 17% changed the diagnosis, being 6% of them white-coat HT and 11% masked HT. The variables that were independently associated with HT diagnosed by OBP were male gender (OR 1.83,CI95%:1.01-3.33,p=0.04) and increased neck circumference (OR 3.77,CI95%:1.59-8.93,p=0.003), whilst by HBPM they were obesity (OR 2.18,CI95%:1.27-3.76,p=0.005) and increased neck circumference (OR 2.37,CI95%:1.05-5.33,p=0.04). Conclusions If the diagnosis was based only in the office BP values, 17% of the subjects would've had an erroneous diagnosis of hypertension, suggesting the importance of implementing out-of-office BP measurements in primary care. Key messages Home monitoring blood pressure corrected the diagnosis of hypertension of 17% of patients, allocating them correctly into white-coat HT and masked HT. Increased neck circumference was independently associated with the diagnosis of hypertension by both methods.

TEST 02 - Elsevier's Scopus, the largest abstract and citation database of peer-reviewed literature. Search and access research from the science, technology, medicine, social sciences and arts and humanities fields.

Introduction For practical reasons, blood pressure values measured by physicians or nurses in a medical environment remain the clinical basis of the diagnosis and management of arterial hypertension around the world as recommended by all guidelines [1–4]. Nevertheless, measurements of blood pressure outside the office have gained an increasing popularity over the last decades not only to ascertain the diagnosis of hypertension but also to follow the impact of therapeutic interventions. Out-of-office blood pressure measurements can be obtained either by 24-h ambulatory blood pressure monitoring or by home blood pressure monitoring. As reviewed recently [5], both sets of out-of-office blood pressure offer undeniable advantages when compared to office blood pressure. First, both ambulatory blood pressure and home blood pressure monitoring provide more reliable and reproducible information on blood pressure. Second, blood pressure values obtained by ambulatory blood pressure and home blood pressure monitoring appear to be more closely related to target organ damage than office blood pressure and hence have a greater prognostic relevance than office blood pressure. Third, certain diagnosis such as white coat hypertension and masked hypertension can only be diagnosed using out-of-office blood pressure measurements. Fourth, when used in the clinical follow-up of treated hypertensive patients to evaluate the impact of drug treatment, ambulatory blood pressure monitoring as well as home blood pressure monitoring has the advantage of not being affected by a placebo effect. Finally, evidence has been provided that treatment-induced reduction in 24-h blood pressure may predict better than office blood pressure the regression of end organ damage (particularly the cardiac one) induced by antihypertensive drug. Many of these information have been achieved during the past two decades by a number of studies carried out in different populations around the world, including the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study [6–10]. When should out-office blood pressure be measured? Despite their advantages, ambulatory blood pressure monitoring as well as home blood pressure monitoring is not regarded as a routine procedure that should be applied to all hypertensive patients essentially for economical reasons. However, this issue is debated because the clinical information gathered with these measurements may potentially result in financial savings when applied adequately. The European and American guidelines for the management of hypertension have defined some indications for the use of ambulatory blood pressure monitoring in hypertension [1,2]. These include patients with resistant hypertension, patients with a high variability of office blood pressure, low-risk patients with a high blood pressure, patients with suspected episodes of hypotension, patients with a large discrepancy between office and home blood pressures, and finally patients with special clinical conditions such as pregnancy or sleep apnea syndrome. Outside these indications, the use of ambulatory blood pressure monitoring could be discussed both in terms of feasibility and economics. Theoretically, a measurement of out-of-office blood pressure could be recommended to all new patients with as suspected hypertension to confirm the diagnosis of hypertension and to refine the patient's cardiovascular risk profile. Therefore, ambulatory blood pressure monitoring could be recommended to all high cardiovascular risk patients before starting any treatment and later under therapy to ascertain the adequacy of the control of blood pressure. Ambulatory blood pressure values in diabetic patients In this issue of the Journal of Hypertension, Leitao et al.[11] report the results of a cross-sectional study performed to estimate the daytime ambulatory blood pressure monitoring values corresponding to the target office blood pressure of 130/80 mmHg for diabetic (as defined by the American Diabetes Association) and to assess which diabetic patients may actually benefit from ambulatory blood pressure monitoring. They included 554 patients in this analysis. Regression analyses were performed to analyze the ambulatory blood pressure monitoring values corresponding to office blood pressure and receiver operating characteristics (ROC) curves were used to assess the sensitivity and specificity of office blood pressure in diagnosing daytime ambulatory blood pressure monitoring hypertension. According to their regression equations, the daytime ambulatory blood pressure monitoring corresponding to the target office blood pressure of 130/80 mmHg was 129/79 mmHg and the daytime ambulatory blood pressure monitoring value corresponding to 140/90 mmHg at the office was 134/82 mmHg. As expected, discrepancies between ambulatory blood pressure monitoring and office blood pressure were due essentially to masked hypertension (about 10% of cases) and white coat hypertension (between 19% for systolic blood pressure and 26% for diastolic blood pressure). Interestingly, when office blood pressure was lower than 120 mmHg systolic and 70 mmHg diastolic, the sensitivity to rule out hypertension using ambulatory blood pressure monitoring was 90%. Similarly, when office blood pressure was more than 145 mmHg systolic and more than 90 mmHg diastolic the sensitivity to confirm hypertension using ambulatory blood pressure monitoring was 90%. Within these two sets of limits, 38% of patients would be misclassified if only office blood pressure values would be considered for the diagnosis. Thus, using the cut-off values of less than 120/70 mmHg and more than 140/90 mmHg at the office, 56% of the population sample would need an ambulatory blood pressure monitoring to confirm the diagnosis of hypertension. According to these results, only diabetics with an office blood pressure between 120 and 140 mmHg systolic and/or a diastolic blood pressure between 70 and 90 mmHg would really benefit from an out-office assessment of blood pressure. This would limit the use of ambulatory blood pressure monitoring to only 50% of the diabetic patients. Studies implications and limitations The results of this provide interesting practical information on the use of ambulatory blood pressure monitoring in diabetic patients. However, they also have some limitations. The first one is the fact that the entire analysis is based on daytime ambulatory blood pressure only. Although the authors have measured 24-h blood pressure, they have not considered the nighttime blood pressure. This is unfortunate because there is increasing evidence that nighttime is a better predictor of cardiovascular risk than daytime blood pressure. Moreover, diabetic patients are often characterized by an absence of the physiological fall in blood pressure reflecting a nondipping pattern at night. Diabetes may even be the cause of a reverse dipping, that is an increase in blood pressure at night. Both the nondipping and the reverse dipping pattern of blood pressure have been associated with an increased risk of developing target organ damages such as left ventricular hypertrophy, microalbuminuria, renal dysfunction, and cerebral vascular lesions [5,12]. Thus, when assessing the cardiovascular risk profile linked to hypertension in diabetic patients, nighttime blood pressure should be included. Indeed, it is not uncommon in diabetes that daytime normotensive patients exhibit a nocturnal hypertension. This type of patients would be misdiagnosed using the algorithm proposed by the authors. Recently, the results of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial have shown that in diabetic patients the reduction of cardiovascular morbidity and mortality obtained by lowering office blood pressure below 120 mmHg systolic is not greater than that seen reducing blood pressure below 130 mmHg [13]. On the contrary, a systolic blood pressure below 120 mmHg may result in an increased risk of developing cardiac complications, as suggested by the recent post hoc analysis of diabetic patients with coronary heart diseases having participated in the INternational VErapamil SR-Trandolapril (INVEST) Study [14]. If a low blood pressure increases the risk of cardiac complications in diabetics, one might have to reconsider the necessity to perform an ambulatory blood pressure monitoring in diabetic patients with a blood pressure <120/70 mmHg in contrast to the proposals of Leitao et al. Indeed, in treated diabetic patients with a low office blood pressure, ambulatory blood pressure monitoring could be of importance to diagnosis episodes of asymptomatic hypotension episodes which might increase their cardiac risk. Thus, in the analysis of daytime and nighttime blood pressure values, it would be of interest to assess whether the percentage of ambulatory blood pressure values below a certain level is indeed associated with an increased risk of some cardiovascular complications. In this respect, it is important to mention that the analysis presented by Leitao et al. does not provide any information on the presence in this particular patients population of cardiac organ damage. The study also does not provide any data such on the occurrence of cardiovascular events and deaths, as it was not a prospective cohort study. Both these two sets of information should be thus provided by future clinical trials.

Matchmaking and the Future of Hypertension Management.

Despite the availability of blood pressure (BP)-lowering medications and dietary education, hypertension is still poorly controlled in the chronic kidney disease (CKD) population. As glomerular filtration rate declines, the number of medications required to achieve BP targets increases, which may lead to reduced patient adherence and therapeutic inertia by the clinician. Home BP monitoring (HBPM) has emerged as a means of improving diagnostic accuracy, risk stratification, patient adherence, and therapeutic intervention. The definition of hypertension by HBPM is an average BP >135/85 mm Hg. Twelve readings over the course of 3-5 days are sufficient for clinical decision making. Diagnostic accuracy is especially important in the CKD population as approximately half of these patients have either white coat hypertension or masked hypertension. Preliminary data suggest that HBPM outperforms office BP monitoring in predicting progression to end-stage renal disease or death. When combined with additional support such as telemonitoring, medication titration, or behavioral therapy, HBPM results in a sustained improvement in BP control. HBPM must be adapted to provide information on the phenomena of nondipping (absence of nocturnal fall in BP) and reverse dipping (paradoxical increase in BP at night). These diurnal patterns are more prevalent in the CKD population and are important cardiovascular risk factors. Ambulatory BP monitoring provides nocturnal BP readings and unlike HBPM may be reimbursed by Medicare when certain criteria are met. Further studies are needed to determine whether HBPM is cost-effective in the current US healthcare system.

In 2004, the American Academy of Pediatrics (AAP) Board of Directors formed the Task Force on Mental Health and charged it with developing strategies to improve the quality of child and adolescent mental health* services in primary care. The task force acknowledged early in its deliberations that enhancing the mental health care that pediatricians and other primary care clinicians† provide to children and adolescents will require systemic interventions at the national, state, and community levels to improve the financing of mental health care and access to mental health specialty resources. Systemic strategies toward achieving these improvements are the subject of other publications of the task force: “ Strategies for System Change in Children's Mental Health: A Chapter Action Kit ” (chapter action kit),1 “Improving Mental Health Services in Primary Care: Reducing Administrative and Financial Barriers to Access and Collaboration,”2 and “Enhancing Pediatric Mental Health Care: Strategies for Preparing a Community.”3 The task force also recognized that enhanced mental health practice will require competencies not currently achieved by many primary care clinicians; in the policy statement “The Future of Pediatrics: Mental Health Competencies for Pediatric Primary Care,”4 the task force collaborated with the AAP Committee on Psychosocial Aspects of Child and Family Health to outline these competencies and propose strategies for achieving them. This report offers strategies for preparing the primary care practice itself for provision of enhanced mental health care services. The task force proposes incrementally applying chronic care principles to the care of children with mental health and substance abuse problems as primary care clinicians apply them to the care of children with chronic medical conditions such as asthma. Most primary care clinicians will find that significant gaps exist between their current practice and the proposed ideal. The task force offers guidance in … Address correspondence to Jane Meschan Foy, MD, Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157. E-mail: jmfoy{at}wfubmc.edu

See related article, pp 1081–1086 The growing worldwide epidemic of high blood pressure in both developed and developing nations is a challenge on many levels.1 The need for better prevention of cardiovascular disease through control of hypertension is clear.2 Public awareness of the need to treat hypertension is partly reflected by the widespread purchases of home blood pressure devices in several of the developed countries. In the United States, Japan, and Finland, the estimates are that 55% to 75% of hypertensive patients already have a home device.3 Research studies have provided a robust epidemiological basis for supporting the greater accuracy of home blood pressure monitoring (HBPM) compared with clinic pressures for prognosis of fatal and nonfatal cardiovascular disease in long-term follow-up surveys and in cross-sectional designs.4 There is a general consensus that HBPM is more convenient, available, and less costly than ambulatory blood pressure monitoring, but the superiority of ambulatory blood pressure monitoring for special clinical problems (ie, detection of nondippers or need for sleep pressures in chronic renal disease, autonomic neuropathies, and sleep apnea) is also clearly recognized.5 Surveys of both physicians6 and patients7 suggest that HBPM is both appreciated and recognized as a valuable strategy. Several experts in the field of hypertension research and care have published appeals to expand the use of HPBM for routine care and to have it supported by health care …

Home blood pressure monitoring (HBPM) overcomes many of the limitations of traditional office blood pressure (BP) measurement and is both cheaper and easier to perform than ambulatory BP monitoring. Monitors that use the oscillometric method are currently available that are accurate, reliable, easy to use, and relatively inexpensive. An increasing number of patients are using them regularly to check their BP at home, but although this has been endorsed by national and international guidelines, detailed recommendations for their use have been lacking. There is a rapidly growing literature showing that measurements taken by patients at home are often lower than readings taken in the office and closer to the average BP recorded by 24-hour ambulatory monitors, which is the BP that best predicts cardiovascular risk. Because of the larger numbers of readings that can be taken by HBPM than in the office and the elimination of the white-coat effect (the increase of BP during an office visit), home readings are more reproducible than office readings and show better correlations with measures of target organ damage. In addition, prospective studies that have used multiple home readings to express the true BP have found that home BP predicts risk better than office BP (Class IIa; Level of Evidence A). This call-to-action article makes the following recommendations: (1) It is recommended that HBPM should become a routine component of BP measurement in the majority of patients with known or suspected hypertension; (2) Patients should be advised to purchase oscillometric monitors that measure BP on the upper arm with an appropriate cuff size and that have been shown to be accurate according to standard international protocols. They should be shown how to use them by their healthcare providers; (3) Two to 3 readings should be taken while the subject is resting in the seated position, both in the morning and at night, over a period of 1 week. A total of >/=12 readings are recommended for making clinical decisions; (4) HBPM is indicated in patients with newly diagnosed or suspected hypertension, in whom it may distinguish between white-coat and sustained hypertension. If the results are equivocal, ambulatory BP monitoring may help to establish the diagnosis; (5) In patients with prehypertension, HBPM may be useful for detecting masked hypertension; (6) HBPM is recommended for evaluating the response to any type of antihypertensive treatment and may improve adherence; (7) The target HBPM goal for treatment is <135/85 mm Hg or <130/80 mm Hg in high-risk patients; (8) HBPM is useful in the elderly, in whom both BP variability and the white-coat effect are increased; (9) HBPM is of value in patients with diabetes, in whom tight BP control is of paramount importance; (10) Other populations in whom HBPM may be beneficial include pregnant women, children, and patients with kidney disease; and (11) HBPM has the potential to improve the quality of care while reducing costs and should be reimbursed.

Home Blood Pressure Monitoring in Patients After Carotid Endarterectomy: A Feasibility Study