Home Blood Pressure Monitoring in Children, Pregnancy, and Chronic Kidney Disease

The accurate diagnosis and management of hypertension is based on out-of-office blood pressure (BP) measurements. Home BP monitoring has several advantages over office and ambulatory BP monitoring including convenience and the ability to obtain repeated measurements in the usual environment of the individual over several days, weeks, or months. Evidence on the role of home BP monitoring in special populations including children and adolescents, pregnant women, and patients with renal disease is currently accumulating. In children, as in adults, home BP appears to be a useful alternative to ambulatory monitoring in detecting white-coat and masked hypertension and in following children treated for hypertension. In pregnancy, the potential for home BP monitoring in following women with hypertension and in the early identification of preeclampsia is fundamental. In patients with chronic kidney disease home BP has been shown to be prognostically superior to office BP in predicting end-stage renal disease. Moreover, home BP recordings are superior to peridialysis BP measurements in predicting all-cause mortality. Duplicate, morning and evening home BP measurements for 7 days (minimum of 3 days) are recommended for optimal home BP evaluation. In end-stage renal disease patients on hemodialysis, it is recommended that home BP be measured twice daily, at bedtime and on waking, after the midweek dialysis for 4 days. Automated oscillometric devices that have been successfully validated in adults may not be accurate in children, pregnant women, and in patients with nephropathy, and separate validation is required.