The values considered to
be normal cut-offs are different for clinical (<140/90 mmHg) and home (<135/85
mmHg) blood pressure [5]. Home self-measurement is therefore establishing
itself as a monitoring method thanks to an ever-increasing number of devices
available on the market and greater patient education regarding risk factors
such as hypertension or dyslipidemia. There is now a wide choice of automatic
devices for self-measurement of blood pressure, all based on the use of the
oscillometric method. The advantages provided by HBPM are manifold. In several
studies, HBPM was found to be more closely associated with cardiovascular risk
than with clinical pressure [8-13]. Self-monitoring also allows the execution
of multiple measurements at different times of the day, reducing confounding
factors such as the white coat effect, directly evaluating the patient in his
daily environment. An advantageous implication, demonstrated in an increasing
number of studies, appears to be the increase in patient adherence to therapy
[14,15]. In fact, active participation in monitoring induces patients to become
more involved in their therapeutic path. Furthermore, an increasing number of
studies indicate that self-monitoring favors the achievement of therapeutic
goals [16-18]. In the elderly patient, the usefulness of HBPM is increased by
the higher incidence of hypertension from lab coats in these age groups, as
well as by the greater blood pressure variability, a factor that makes it
necessary to perform multiple repeated measurements to provide true average
values. Blood pressure variability is also in itself a known cardiovascular
risk factor, especially in the elderly patient, especially if associated with a
marked increase in the morning or "morning surge" [19]. As already
mentioned, the greater percentage of elderly people with white coat
hypertension can cause therapeutic excesses when therapy is titrated to
clinical rather than home values. The decreased self-regulatory capacity of
circulation in the elderly favors the onset of hypotensive episodes, which can
lead to falls and fractures. In our study we wanted to compare the values
recorded at the HBPM with those obtained through the ABPM. The average pressure
reported using each method is shown in table 2. As can be seen from the graph
(graph 1) there is a substantial overlap of the values. These data suggest that
the measurements obtained using the HBPM are comparable to those obtained using
the ABPM. The HBMP therefore made it possible to obtain reliable values using
very simple tools, within everyone's reach and immediately available. In fact,
the HBPM does not require expensive tools and is easily performed by the
patient without any intervention by the doctor or other healthcare personnel.
