Who requires baseline blood pressure (BP) and blood glucose monitoring?

Who Needs Baseline BP and Blood Glucose Monitoring?

All adults should receive baseline blood pressure and blood glucose assessments as part of routine cardiovascular and metabolic risk screening. 1

Universal Baseline Assessments

Blood Pressure Monitoring

• All adults require baseline BP measurement as part of standard cardiovascular risk assessment 1
• BP should be measured at every clinic visit for all patients 1
• Patients with readings ≥120/80 mmHg need repeated measurements on multiple occasions to establish their usual BP 1
• Those with known or suspected hypertension require ambulatory BP monitoring for accurate diagnosis 1

Blood Glucose Monitoring

• All adults should undergo baseline fasting plasma glucose testing as part of routine metabolic screening 1
• If fasting glucose is >5.6 mmol/L (100 mg/dL) or HbA1c is 5.7-6.4%, proceed with glucose tolerance testing 1
• Annual screening with fasting glucose and HbA1c is recommended for all adults to detect diabetes and prediabetes 1

High-Priority Populations Requiring Intensive Monitoring

Patients on Insulin Therapy

All persons using insulin require ongoing glucose monitoring, not just baseline assessment 1, 2:

• Those on intensive insulin regimens (multiple daily injections or pump therapy) need testing at least 4 times daily: before meals and snacks, at bedtime, prior to exercise, when hypoglycemia is suspected, after treating hypoglycemia until normoglycemic, and before critical tasks like driving 1, 2
• Patients on basal insulin alone need at minimum fasting glucose monitoring to guide dose adjustments 1, 3
• Continuous glucose monitoring (CGM) is preferred over fingerstick monitoring for all insulin users when available 1

Patients on Specific Oral Medications

• Sulfonylurea users should be considered for ongoing glucose monitoring due to hypoglycemia risk 1
• Glinide users require similar monitoring considerations as sulfonylurea patients 1

Cardiovascular Disease Patients

• Patients with known or suspected hypertension need ambulatory BP monitoring for accurate diagnosis and treatment guidance 1
• Those with diabetes and clinically diagnosed cardiovascular disease should target BP <130/80 mmHg, requiring frequent BP monitoring 1
• Patients with 10-year ASCVD risk ≥15% warrant more intensive BP monitoring and lower treatment targets 1

Children and Adolescents with Diabetes

• All youth with diabetes require BP measurement at every clinic visit 1
• Those with BP ≥90th percentile for age, sex, and height (or ≥120/80 mmHg in adolescents ≥13 years) on three separate measurements need ambulatory BP monitoring 1
• Blood glucose monitoring plans must be individualized based on treatment regimen, with CGM considered for those requiring frequent monitoring 1

Ongoing Monitoring Requirements Beyond Baseline

Patients with Established Diabetes

• Annual assessments of BP, lipids, and glycemia are required for all persons with diabetes 1
• eGFR and albuminuria testing annually to detect kidney disease 1
• ECG annually for most adults with diabetes to screen for atrial fibrillation and acute coronary syndrome 1

Patients on Antihypertensive Therapy

• BP should be measured frequently during treatment initiation and dose adjustments 1
• Home BP monitoring is recommended for all patients on antihypertensive medications to assess treatment effectiveness 1, 4
• Post-myocardial infarction patients previously treated for hypertension need frequent BP monitoring as values may normalize, requiring medication adjustment 1

Common Pitfalls to Avoid

Do not rely on single BP measurements for diagnosis—multiple readings on separate occasions are essential, as many patients show "white coat" elevation that disappears after initial visits 1

Do not assume office glucose values are sufficient—home monitoring provides critical information about glycemic patterns, hypoglycemia detection, and treatment response that office values miss 4

Do not overlook ethnic disparities—African Americans and Mexican Americans have significantly lower rates of BP and glucose control despite treatment, requiring more intensive monitoring and intervention 5, 6

Do not prescribe glucose monitoring without education—patients must receive training on proper technique, result interpretation, and how to use data for treatment adjustments, or monitoring provides no benefit 1

Avoid fingerstick-only monitoring in insulin users when CGM is available—CGM detects significantly more hypoglycemic episodes (77.5% vs 5.0% detection rate) and provides superior glycemic pattern data 7, 2