Home sphygmomanometers: what should a nephrologist know?

Inaccuracy of home sphygmomanometers is a common, neglected and often ignored problem. The aims of this review are to emphasize the advantages of self-measurement of blood pressure (BP) at home, to summarize basic features of automated home BP measurement devices, to point out the distinction between validation, calibration and accuracy of home sphygmomanometers and to discuss some practical points for the improvement of BP control in chronic kidney disease (CKD) patients for nephrologists. Four features of automated sphygmomanometers need to be emphasized: measurement site, cuff-size, validation status and accuracy. The validation protocols do not guarantee the accuracy of a particular device for an individual patient. Special patient groups such as those with early stages of CKD or diabetic nephropathy or patients having extraosseous/vascular calcifications may require specific validation tests. Active guidance by nephrologists in all steps of self-measurement of BP at home will improve the control of BP and will increase the quality of patient care in CKD. Health care providers must urgently reimburse the cost of accurate home sphygmomanometers for patients with CKD in countries where CKD is considered a major public health problem.