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. Conclusion 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. Blood Press Monit 13:352-365 (C) 2008 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.