Home blood pressure monitoring for people with suspected or confirmed hypertension
Scottish Health Technologies Group (SHTG)
Recommendations for NHSScotland
Home blood pressure monitoring (HBPM) should be available for patients with suspected and diagnosed hypertension. Only upper arm cuff monitors that have been validated by the British & Irish Hypertension Society should be used to ensure accuracy of the monitors.
Evidence shows that HBPM is effective at lowering blood pressure compared with routine care. Within NHSScotland, the Connect Me blood pressure (BP) programme has shown that HBPM is likely to be cost effective. To better understand the impact of HBPM on long term health outcomes, ongoing data collection is essential.
Patients using HBPM programmes such as Connect Me BP should receive tailored education and regular feedback to support the active management of their condition. It is important to ensure equitable access to HBPM for all patients, particularly people from lower socioeconomic groups who may need additional support to engage in HBPM programmes such as Connect Me BP.
NHSScotland is required to consider the Scottish Health Technologies Group (SHTG) recommendations.
How the Council reached the recommendation
- The Council discussed the importance of using home monitor devices that have been validated for accuracy and effectiveness. The Council asked the clinical experts for their opinion on the validation measures that clinicians and members of the public should be aware of when providing or buying BP home monitoring devices. It was stated that only home BP monitors that had been validated by the British & Irish Hypertension Society should be used.
- The Council sought clarity on any differences in accuracy between upper arm cuff-based BP monitors and wrist BP monitors. Clinical experts clarified that upper arm cuff-based BP measures are more accurate that wrist BP monitors. The Council noted that the available evidence related to upper arm cuff-based BP monitors.
- The Council emphasised the need for equitable access to HBPM across NHSScotland. The Council acknowledged that while some people may be able to purchase their own monitor, the monitors should be available to everyone with suspected or confirmed hypertension following clinical review. A clinical expert noted that there was ongoing work within the SG proactive and preventative care portfolio to address equity and access to technologies such as home BP monitors.
- The Council discussed the critical role of active monitoring within HBPM. A clinical expert stated that structured approaches, such as the Connect Me BP telemonitoring programme, which provides individuals with support while monitoring their blood pressure, are more effective in reducing blood pressure than HBPM without support.
- The Council acknowledged the established link between BP and CVD particularly in relation to long term CVD outcomes. It was noted that the evidence presented to inform the Council may not fully reflect the potential impact of BP reduction through HBPM, partly due to the underpowered nature of the available studies.
- The Council reflected on the importance of achieving clinically meaningful reductions in BP, beyond merely statistically significant changes. The Council noted variation in clinical expert opinion on what constitutes a meaningful reduction. Clinical experts emphasised that, in their experience, sustained reduction in BP (that is, controlled BP) is more critical to improving outcomes for people with hypertension than achieving a specific numerical threshold.
- The council noted the applicability of the economic analysis to the Scottish context.
- The Council discussed the ongoing need for continued data collection, particularly in relation to longer term morbidity and mortality outcomes. It was noted that the current evidence base does not sufficiently address the direct link between HBPM interventions and longer term health outcomes, highlighting a critical gap that future research should seek to address.
- The Council considered the range of patient perceptions surrounding HBPM. While qualitative data indicated a generally positive view, there were concerns about over monitoring, limited access to technology, and insufficient information support. Clinical experts acknowledged both the benefits and challenges identified in the evidence base and noted that potential issues are being actively addressed within existing BP reduction programmes.
Date of publication: 28 August 2025