New considerations regarding this recommendation included evidence that AOBP provides similar blood pressure values as day-time ambulatory and home blood pressure, and that there are no outcome trials that have used out-of-office blood pressures as either entry criteria or as treatment goals. While we did not identify head-to-head comparison studies between HBPM and ABPM, both approaches seem to be of similar value for making a decision in patients in whom the diagnosis or control of HTN remains uncertain (e.g., when AOBP is not available, when there is significant discrepancy between self-monitored home blood pressure and office blood pressure, and if masked HTN is suspected). HBPM is more readily available than ABPM and requires fewer resources; however, careful patient education on proper blood pressure measurement technique and the frequency and use of validated HBPM are recommended. More research is needed to evaluate the effectiveness of using out-of-office blood pressure to manage HTN and whether treating to ABPM or HBPM guided blood pressure goals would improve cardiovascular morbidity and mortality in hypertensive individuals. c. Monitoring Recommendation 5. Among patients treated for hypertension, we suggest offering home blood pressure self- monitoring with co-interventions for lowering systolic and diastolic blood pressure. (Weak for | Reviewed, New-added) Discussion When compared with usual care, home blood pressure self-monitoring has been shown to improve SBP and DBP control when paired with a co-intervention. Our evidence review found two SRs of RCTs comparing blood pressure self-monitoring or HBPM with usual care.[49,50] One SR of 29 RCTs showed improved blood pressure control compared to usual care (adjusted MD in SBP 2.7 mm Hg).[49] Another SR and meta-analysis comparing blood pressure self-monitoring alone to usual care found that self- monitoring was not associated with lower blood pressure. 