abpm and hbpm provide somewhat different information on the subject 's bp status and risk , and the two methods should thus be regarded as complementary , rather than competitive or alternative . in order to decide for whom and when to use office bp , abpm , and hbpm , randomized trials are required . these trials should be sufficiently large and controlled to draw firm conclusions that affect overall morbidity and mortality . self - monitoring of bp at home and work is a practical approach to assess differences between office and out - of - office bp before consideration of abpm . for those whose out - of - office bps are consistently < 130/80  mm  hg despite an elevated office bp , and who lack evidence of target organ disease , 24-h monitoring , or drug therapy can be avoided . ambulatory bp in general is a more sensitive risk predictor of clinical cardiovascular outcomes , such as coronary morbidity or fatal events and stroke , than office bp . out - of - office bp monitoring has been recommended by several guidelines for the management of ht . recent esh / esc guidelines pointed out that the following clinical indications regarding to out - of - office monitoring : 
 suspicion of wch -grade 1 ht in the office . -high office bp in individuals without organ damage and at low total cardiovascular risk.suspicion of masked ht -high normal bp in the office . -normal office bp in individuals with asymptomatic organ damage or at high total cardiovascular risk.identification of white - coat effect in hypertensive patients.considerable variability of office bp over the same or different visits.autonomic , postural , postprandial , siesta- and drug - induced hypotension.elevated office bp or suspected pre - eclampsia in pregnant women.identification of true and false resistant ht . -normal office bp in individuals with asymptomatic organ damage or at high total cardiovascular risk . identification of true and false resistant ht . whether subjects with wch can be considered equal to true normotensive individuals is an issue still under debate , because in a recent study marked increase in adjusted risk of developing sustained ht , a significant increase in adjusted risk for all - cause mortality and cardiovascular mortalities were demonstrated in wch patients compared with normotensive subjects . hbpm is indicated especially in patients with newly diagnosed or suspected ht , in whom it may distinguish between white - coat and sustained ht . in patients with pre - ht , hbpm may be useful for detecting masked ht . hbpm is recommended for evaluating the response to any type of antihypertensive treatment and may improve adherence . hbpm is particularly useful in the elderly , in whom both bp variability and the white - coat effect are increased ; in patients with diabetes , in whom tight bp control is of foremost importance , such as pregnancy , children with suspected ht , and patients with kidney diseases . according to jnc 7 guidelines , abpm is recommended for the evaluation of : 
 suspected wch in patients with ht and no target organ damage.apparent drug resistance ( office resistance).hypotensive symptoms with antihypertensive medication.episodic ht.autonomic dysfunction . in addition to that , the most recent guideline of esh / esc lists clinical indications of abpm as follows : 
 marked discordance between office and home bp.assessment of dipping status.suspicion of nocturnal ht or absence of dipping , such as in patients with sleep apnea , chronic kidney disease , or diabetes.assessment of bp variability . suspicion of nocturnal ht or absence of dipping , such as in patients with sleep apnea , chronic kidney disease , or diabetes . the main advantage of abpm is its unique ability to measure nocturnal bp , the measure reported to be most accurate for prognosis . despite all the advantages of home and abpm suggested , outcome studies evaluating cost effectiveness , their predictive value in short- and long - term morbidity and mortality , and comparing office , home , and ambulatory measurements are warranted . office sphygmomanometers still remain as the primary tool for diagnosing and monitoring ht . however , home readings are increasingly used , both to confirm the diagnosis and to provide better assurance of appropriate therapy . out - of - office monitoring appears of particular value in evaluating wch and therapy resistance , and to determine the adequacy of therapy .
blood pressure measurement in the diagnosis and management of hypertension , including the technique required for ambulatory blood pressure monitoring and home blood pressure monitoring , will be reviewed in this article . 
 home and ambulatory measurements are widely used , both to confirm the diagnosis and to improve adherence to therapy . 
 the major advantage of out - of - office blood pressure monitoring is that it provides a large number of blood pressure measurements away from the medical environment , which represents a more reliable assessment of actual blood pressure than office blood pressure . 
 the advantage of ambulatory blood pressure monitoring is its unique ability to measure nocturnal blood pressure . 
 although not fully validated in large - scale clinical trials , ambulatory blood pressure monitoring appears to correlate best with prognosis . 
 ambulatory blood pressure monitoring and home blood pressure monitoring provide somewhat different information on the subject 's blood pressure status , and the two methods should thus be regarded as complementary , rather than competitive or alternative .