Improving Blood Pressure Management and Control With Out-of-Office Blood Pressure Monitoring

Out-of-office blood pressure (BP) monitoring is a critical component of modern hypertension diagnosis and management. Measuring BP outside of clinic reduces the stress response that contributes to white coat hypertension and also allows for the identification of masked hypertension, yielding more accurate cardiovascular disease (CVD) risk assessment and improved CVD prevention. Home BP monitoring and 24-hour ambulatory BP monitoring outperform office BP in predicting CVD outcomes and are cost-effective aspects to cardiovascular health promotion by preventing unnecessary treatment, reducing clinic visits, and lowering event-related costs. Despite these advantages, routine implementation remains limited due to patient, provider, and system-level barriers, including validated device access, workflow integration, patient-provider communication tools, and adherence. Efforts to minimize or eliminate these barriers are crucial to CVD prevention. Evidence is also needed to support alternative out-of-office BP measurement strategies, including community-based strategies, such as BP assessment by school nurses, pharmacists, or community health workers. The utility of these modalities in diagnosing and managing children with hypertension are greatly needed as the long-term prognostic data in this population are sparse. Expanding adoption and evidence for out-of-office monitoring is essential to optimize hypertension care and CVD risk reduction.