%0 Journal Article
%T The case for home monitoring in hypertension
%A Paul L Padfield
%J BMC Medicine
%D 2010
%I BioMed Central
%R 10.1186/1741-7015-8-55
%X In this commentary, I explain why doctors and other healthcare professionals should increase their familiarity with the technology, be aware of its strengths and limitations and work with patients as they become more empowered in the management of their chronic condition, hypertension.Hypertension is the most important risk factor for cardiovascular disease in the world [1], and evidence that lowering blood pressure reduces cardiovascular risk has been substantiated by arguably the greatest body of randomised control trial data in clinical medicine.Given the vast amount of information relating to hypertension in the world literature, it is interesting to reflect on relatively how little importance has been paid to the measurement of blood pressure itself. A cursory glance at many of the landmark trials over the past 25 years will show that there is no consistency in the documentation of the measurement of blood pressure, nor how many readings are taken to establish BP levels at a given time. Particularly surprisingly, some studies do not even detail how blood pressure was measured.The measurement of blood pressure with a mercury sphygmomanometer is now more than 100 years old and although many primary care doctors in the United Kingdom have moved to the use of aneroid devices, it is the mercury manometer that has been the mainstay of clinical trials. There is no doubt that if properly maintained and used correctly, this device will record an accurate measurement of blood pressure at any point in time.One would hope and believe that in clinical trials, great care is taken to measure blood pressure accurately, but outside the confines of a trial we know that terminal digit preference whereby readings end in either '0' or '5' are commonplace and the impact of the relationship between the measurer and the measured can be considerable, giving rise to what has come to be called 'white coat hypertension' in its most extreme form (see below).One of the difficulties imposed
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