Blood pressure monitoring: Which method to use?

Konstantinos Tsioufis, MD, is a professor of cardiology at the University of Athens, Greece, and director of the hypertension unit of the First Cardiology Clinic in the Hippokration Hospital. He has served as president of the European Society of Hypertension (ESH).

Which method of blood pressure monitoring is the best?

Konstantinos Tsioufis, MD: Coming to which method is the best for the measurement of blood pressure, the simple answer is no, there is no ideal method for measuring blood pressure.

The current version of the 2023 European Society of Hypertension (ESH) guidelines recommends office blood pressure for the definition of hypertension, for initiation of therapy, and also for blood pressure targets and during follow-up. Why? Because we have solid evidence, we have data from randomized controlled trials (RCTs), [showing] that therapeutic strategies based on office blood pressure are associated with a favorable cardiovascular outcome.

This does not mean that we ignore the clinical importance of out-of-office blood pressure measurement like ambulatory blood pressure monitoring (ABPM) or home blood pressure measurement. However, we don’t have so much evidence up to now and I am not sure that you will obtain such evidence in the near future.

However, you have to take into consideration that in some cases home blood pressure and ABPM are very, very important. For example, it’s the only way to exclude pseudoresistance or white coat hypertension, or to diagnose masked hypertension, or to see what the nocturnal blood pressure should be, since we know that blood pressure during nighttime may even have a better prognostic role than at daytime.

In summary, I would say, now, in the era of digital technology, we have smart devices, we have cuffless devices, which need to be validated in order to be used for... having an idea of blood pressure levels. But, definitely, we need more evidence on how to use these devices for evaluating the hemodynamic load. So, office blood pressure measurement remains the gold standard despite the associated limitations. In some cases we also have to take into account the blood pressure measurements either with ABPM or with a home blood pressure device.