Blood pressure monitoring outside the office for the evaluation of patients with resistant hypertension.

Although severe hypertension is associated with a poor prognosis, there exists a substantial number of patients who have persistently elevated blood pressures, but no signs of target organ damage, and nearly normal life expectancy. In such cases, measurement of blood pressure outside the clinic may give readings that are as much as 30 mm Hg lower than the clinic readings. The first step recommended in the identification of such patients is to use home blood pressure monitoring. If home blood pressures are low, 24-hour ambulatory blood pressure recording is indicated. If this also gives low readings, it is appropriate to treat patients according to their level of home blood pressure. Because of the unreliability of clinic pressures, ambulatory and home blood pressure monitoring may also be of value in assessing the response to treatment.