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Received: 5 November 2017 Revised: 28 November 2017 Accepted: 13 December 2017 DOI: 10.1111/jch.13216
ORIG INAL PAPER
Guidance on home blood pressure monitoring: A statement of the HOPE Asia Network Kazuomi Kario MD, PhD1
| Sungha Park MD, PhD2 |
Peera Buranakitjaroen MD, MSc, DPhil3 | Yook-Chin Chia MBBS, FRCP4,5 | Chen-Huan Chen MD6 | Romeo Divinagracia MD, MHSA7 | Satoshi Hoshide MD, PhD1
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Jinho Shin MD8 | Saulat Siddique MBBS, MRCP (UK), FRCP (Lon)9 | Jorge Sison MD10 | Arieska Ann Soenarta MD11 | Guru Prasad Sogunuru MD, DM12,13 | Jam Chin Tay MBBS, FAMS14 | Yuda Turana MD, PhD15 | Lawrence Wong MD16 | Yuqing Zhang MD17 | Ji-Guang Wang MD, PhD18 1
Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
2
Division of Cardiology, Cardiovascular Hospital, Yonsei Health System, Seoul, Korea
3
Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
4
Department of Primary Care Medicine, Faculty of Medicine, University of Malaya Kuala, Lumpur, Malaysia
5
Sunway Institute for Healthcare Development, Sunway University, Subang Jaya, Selangor Darul Ehsan, Malaysia
6
Department of Medicine, Faculty of Medicine National Yang-Ming University, Taipei, Taiwan
7
University of the East Ramon Magsaysay Memorial Medical Center Inc, Quezon City, Philippines
8
Faculty of Cardiology Service, Hanyang University Medical Center, Seoul, Korea
9
Punjab Medical Center, Lahore, Pakistan
10
Section of Cardiology, Department of Medicine, Medical Center Manila, Manila, Philippines
11
Department Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia-National Cardiovascular Center, Harapan Kita, Jakarta, Indonesia
12
Apollo Hospitals, Chennai, India
13
College of Medical Sciences, Kathmandu University, Bharatpur, Nepal
14
Department of General Medicine, Tan Tock Seng Hospital, Singapore, Singapore
15
Department of Neurology, Faculty of Medicine, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
16
Department of Medicine & Therapeutics, Division of Neurology, Chinese University of Hong Kong, Hong Kong
17
Divisions of Hypertension and Heart Failure, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
18
Department of Hypertension, Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
Correspondence Prof. Kazuomi Kario, Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine (JMU), JMU Center of Excellence, Cardiovascular Research and Development (JCARD), Hypertension Cardiovascular Outcome Prevention and Evidence (HOPE) Asia Network/World Hypertension League (WHL), Shimotsuke, Tochigi, Japan. Email:
[email protected] Funding information Pfizer
Hypertension is an important modifiable cardiovascular risk factor and a leading cause of death throughout Asia. Effective prevention and control of hypertension in the region remain a significant challenge despite the availability of several regional and international guidelines. Out-of-office measurement of blood pressure (BP), including home BP monitoring (HBPM), is an important hypertension management tool. Home BP is better than office BP for predicting cardiovascular risk and HBPM should be considered for all patients with office BP ≥ 130/85 mm Hg. It is important that HBPM is undertaken using a validated device and patients are educated about
This study was done on Behalf of the Hypertension Cardiovascular Outcome Prevention and Evidence (HOPE) Asia Network.
J Clin Hypertens. 2018;1–6.
wileyonlinelibrary.com/journal/jch ©2018 Wiley Periodicals, Inc. | 1
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KARIO et al.
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how to perform HBPM correctly. During antihypertensive therapy, monitoring of home BP control and variability is essential, especially in the morning. This is because HBPM can facilitate the choice of individualized optimal therapy. The evidence and practice points in this document are based on the Hypertension Cardiovascular Outcome Prevention and Evidence (HOPE) Asia Network expert panel consensus recommendations for HBPM in Asia.
1 | I NTRO D U C TI O N Hypertension is one of the major modifiable risk factors for cardiovascular disease. It represents an important public health issue, particularly in South East Asia, where the disease kills nearly 1.5 million people each year.1 This is likely due, at least in part, to absent or poor disease management, with rates of uncontrolled hypertension as high as 70%-95% in South Asia. 2 Although several countries or regions in Asia have local guidelines for the diagnosis and management of hypertension,3-8 effective prevention and control of hypertension remain a significant challenge in the region. A number of potential barriers could contribute to this problem, including cultural norms that promote unhealthy behaviors and misconceptions about hypertension, high rates of cigarette smoking, healthcare disparities, high out-of-pocket treatment costs, and poor adherence to treatment.9 It is also possible that the volume of information prevents busy clinicians from identifying the most important points for their own clinical practice. Out-of-office measurement of blood pressure (BP), including ambulatory and home BP monitoring (ABPM and HBPM, respectively), is recognized internationally as an important tool to facilitate effective detection and management of hypertension, and to monitor BP variability. 5,10-13 Deficits in knowledge about out-of-office BP measurement and gaps in clinical practice among general practitioners and specialists have recently been identified in Singapore.14 This is likely to reflect the situation elsewhere in Asia, highlighting the need for accessible, key evidence-based information for physicians. The Hypertension Cardiovascular Outcome Prevention and Evidence (HOPE) Asia Network, recently studied the current evidence of HBPM15 and developed a set of expert panel consensus
F I G U R E 1 Practice points
recommendations for HBPM in Asia.16 Here, we provide the key
(office BP ≥ 140/90 mm Hg but home BP