Asleep blood pressure: relevance to the proper definition of isolated-office and masked hypertension

A recently published study by Nasothimiou et al. concluded that daytime at-home blood pressure (BP) self-measurement is a reliable alternative to ambulatory BP monitoring (ABPM) to identify isolated-office, masked, and sustained hypertension. In this letter, we challenge the conclusions of such study, based on the findings of the literature and the data of the MAPEC database. We conclude that the asleep BP mean determined by ABPM must be used to properly identify out-of-office hypertension and cannot be omitted in the definition of isolated office and masked hypertension. Accordingly, these two conditions cannot be defined by comparing clinic BP with awake-time self measurements at home, as is frequently done and misleadingly recommended as an alternative to ABPM.