Therefore, the Work Group concluded there was very low quality evidence supporting the utility of out-of-office blood pressure measurements in confirming diagnosis of HTN prior to the initiation of drug therapy. Nevertheless, ABPM and HBPM are valuable methods in identifying masked HTN, which is diagnosed with elevated out-of-office blood pressure in the setting of normal or controlled office blood pressure. Masked HTN should be suspected in individuals with normal or controlled office blood pressure if they report higher home blood pressure values, in the presence of target organ damage and certain chronic conditions, such as CKD. We did not find any evidence of harm associated with ABPM and HBPM; however, patient training is required for both methods, and there could be some differences in patient preferences due to increased burden of out-of-office blood pressure monitoring. Overall, the equipment used for HBPM is more readily available than for ABPM. Some patients may not be willing to wear a 24-hour ABPM on multiple occasions. As this is a Reviewed, New-replaced recommendation, the Work Group systematically reviewed evidence related to this recommendation in the evidence review conducted as part of this guideline update [37,38] as well as the evidence from the 2014 VA/DoD HTN CPG.[44-48] The Work Group s confidence in the quality of the evidence is very low. The body of evidence had some limitations, such as observational study design, small sample sizes, selection and attrition bias in individual studies, and a lack of consistent reporting of blood pressure measurement methods. 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. 