Diagnosis and Management of Suspected Hypertension

Initial Assessment and Confirmation

The European Society of Cardiology recommends confirming the diagnosis of hypertension with out-of-office blood pressure measurements using ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM), with the specific approach determined by the initial screening BP level and cardiovascular risk 1
Individuals with increased cardiovascular disease (CVD) risk should have their blood pressure confirmed with out-of-office measurements using ABPM and/or HBPM, or if not feasible, repeat office measurements on multiple visits 1
The European Society of Cardiology suggests scheduling repeat assessment within 1 year for individuals with elevated blood pressure 1

The American Heart Association recommends obtaining at least 12-14 home blood pressure measurements over 1 week for optimal treatment decisions 2, 3
Home blood pressure monitoring should be performed using validated automated devices with appropriate cuff size, and patients should measure their blood pressure in the morning and evening before taking any medications 2, 3
The threshold for hypertension using home blood pressure monitoring is ≥135/85 mmHg, which is 5 mmHg lower than office readings 2, 5

The European Society of Cardiology recommends using validated automated devices with appropriate cuff size for blood pressure measurement 1, 5
Patients should be seated with their arm at heart level, and the average of 2-3 readings taken 1-2 minutes apart should be used 2, 3
Blood pressure should be measured in both arms at some point, and a variation of <10 mmHg is acceptable 2, 3

White coat hypertension occurs in 10-20% of primary care patients with elevated office blood pressure, and is defined as office blood pressure >140/90 mmHg but out-of-office blood pressure <135/85 mmHg 2
Masked hypertension has a prevalence of 10-40%, and carries the same cardiovascular risk as true hypertension, but is frequently missed without out-of-office monitoring 2, 3
The European Society of Cardiology recommends considering ambulatory blood pressure monitoring in patients with suspected white coat hypertension, masked hypertension, episodic hypertension, resistant hypertension, autonomic dysfunction, or unexplained end-organ damage 2, 3

The European Society of Cardiology recommends reassessing blood pressure within 1 year for individuals with blood pressure 120-139/70-89 mmHg 1
Individuals with blood pressure 140-159/90-99 mmHg should have their blood pressure confirmed with out-of-office monitoring, but there is no specific urgent timeline 1
The European Society of Cardiology suggests confirming blood pressure within 1 month for individuals with blood pressure 160-179/100-109 mmHg, and within 1 week if no emergency for individuals with blood pressure ≥180/110 mmHg 1