What is the proper protocol for an adult with a history of hypertension to monitor their blood pressure at home?

How to Perform Home Blood Pressure Monitoring

Adults with hypertension should take at least 2 readings in the morning before medications and 2 readings in the evening before supper, 1 minute apart, using a validated automated upper-arm cuff device, and average all readings over 4-7 days (excluding day 1) for clinical decision-making. 1

Device Selection and Validation

• Use only validated automated oscillometric upper-arm cuff devices with memory storage capability 1
• Verify the device appears on validated device lists at www.stridebp.org 1
• Ensure appropriate cuff size—the bladder should encircle 75-100% of arm circumference 1
• Avoid wrist and finger devices, as they cannot be recommended for accurate measurement 2
• Auscultatory devices (mercury, aneroid) are not useful for home monitoring because patients rarely master the required technique 1

Initial Setup and Training

Bring the device to your healthcare provider's office for accuracy verification and technique confirmation 1. This should be repeated annually 1.

The provider can perform a simple 5-reading validation protocol:

• Patient takes 2 readings (D1, D2) with their device
• Provider takes 1 reading (M1) with office equipment
• Patient takes 1 reading (D3)
• Provider takes final reading (M2)
• Compare device readings against office measurements 1

Proper Measurement Technique

Pre-Measurement Preparation (30 minutes before):

• Empty bladder 1, 3
• Avoid smoking, caffeinated beverages, and exercise 1, 3

Body Positioning:

• Sit in a straight-backed chair (not a sofa) with back fully supported 1, 3
• Keep feet flat on floor, legs uncrossed 1, 3
• Rest arm on flat surface (table) with upper arm at heart level (midpoint of sternum) 1, 4, 3
• Remain still and do not talk during measurement 1

Taking the Reading:

• Rest quietly for 5 minutes before first measurement 1, 4
• Position cuff on bare arm with bottom edge directly above the antecubital fossa (elbow bend) 1
• Take at least 2 readings, 1 minute apart 1, 5, 3
• Record all readings accurately—do not discard high values 1

Measurement Schedule

Standard protocol for diagnosis or treatment adjustment:

• Measure twice daily: morning (before medications) and evening (before supper) 1
• Take 2-3 readings per session, 1 minute apart 1, 5
• Continue for 4-7 consecutive days 5
• Discard all readings from day 1 and average the remaining 12-24 readings for clinical decisions 5

Ongoing monitoring after stable control:

• Measure daily if possible, or as directed by your provider 1
• Ideally obtain weekly readings beginning 2 weeks after treatment changes and during the week before clinic visits 1

Interpreting Your Readings

Diagnostic Thresholds:

• Home BP ≥135/85 mmHg confirms hypertension (equivalent to office BP ≥140/90 mmHg) 1, 4, 3
• Home BP <120/80 mmHg is considered normal 1
• Home BP 120-134/80-84 mmHg represents elevated blood pressure 1

Key Principles:

• Individual readings vary substantially—this is normal 1
• Single high or low readings have little significance 1
• Use the average of multiple readings over several days, not individual values 5, 3
• Home readings are typically 5-10 mmHg lower than office readings 1

What NOT to Do

• Do not take readings at random times when you feel stressed or think your BP is high—this creates anxiety and unreliable data 1
• Do not become obsessional about checking BP multiple times daily 1
• Do not adjust medications based on single readings without consulting your provider 1
• Do not use home monitoring if you have atrial fibrillation or frequent ectopic beats, as oscillometric devices may not work reliably 1

Recording and Reporting

• Use devices with automatic memory storage rather than manual diaries when possible 1
• If recording manually, write down every reading—do not rely on memory 1
• Bring your device and readings to all clinic appointments 1
• Report the average of all readings over the monitoring period, not just selected values 5

Clinical Value

Home BP monitoring provides superior prognostic information compared to office readings for predicting cardiovascular events, stroke, and mortality 6, 7. It identifies white-coat hypertension (15-30% of patients with elevated office BP) and masked hypertension (10-15% with normal office BP but elevated home BP) 1. When used to guide treatment, home monitoring improves long-term BP control rates 5.