Home BP Readings Often Beat Office Measurements

Medscape

24-07-2025

This transcript has been edited for clarity.
Do you trust home blood pressure monitoring? You should, especially if it's done correctly. In fact, for many patients, it gives better data than occasional in-office readings, especially if they have white coat hypertension or masked hypertension.
Here's how I interpret these data. First, I always ask if the device is validated and used properly. Upper arm cuffs are preferred, not wrist cuffs. Make sure they're sitting quietly for 5 minutes, back is supported, feet are flat, and no caffeine, smoking, or exercise within 30 minutes of the measurement.
Then I look at the pattern, not one-off values. I ask patients to check twice in the morning and twice in the evening for 5 or 7 days. That gives me about 20-28 readings, which is enough to assess the true averages.
I'm aiming for a home blood pressure goal that is slightly lower than the threshold used in the office, per the guidelines. If the average is above that consistently and the technique is solid, then I consider adjusting the therapy for that particular patient.
Also, don't ignore variability. Wide swings may suggest nonadherence, autonomic dysfunction, or even secondary hypertension. If numbers are too low, especially with symptoms, it may be time to reduce the medications.
Bottom line, home blood pressure data are reliable when done right. It often gives us a more accurate picture of real-world control than those seen in the office, and it should be part of routine hypertension management.