In plain terms: Home blood pressure monitoring has some human trial evidence supporting it, but the evidence is not yet strong enough for EBL to call it established. It is worth knowing about and worth discussing with your clinician.
Home blood pressure monitoring
The evidence as the record states it
Home BP monitoring, especially with co-interventions, modestly lowers blood pressure vs usual care. Agarwal et al. 2011 (Hypertension; PMID 21115879), meta-analysis of 37 RCTs (n=9,446): systolic -2.63 mmHg (95% CI -4.24 to -1.02), diastolic -1.68 mmHg. TASMINH2 (McManus et al. 2010, Lancet; PMID 20619448, RCT n=480) showed self-monitoring with self-titration lowered systolic BP. Endpoint is a validated surrogate (BP), not a hard outcome, so the ceiling is B. [Corrects a prior page citation that mis-attributed the 37-RCT figure to Bliziotis 2012 and inflated the effect to -3.9/-2.4.]
Why Grade B and not Grade A
Grade B reflects moderate human evidence -- typically a single strong trial, multiple smaller trials, or surrogate endpoint data without hard clinical outcome replication. To reach Grade A, Home blood pressure monitoring would require at least one additional independent randomized trial demonstrating a hard clinical endpoint or objectively measured functional outcome in a comparable population.
What would move this grade
An independent randomized trial demonstrating a hard clinical endpoint -- mortality, major adverse event, or objectively confirmed functional improvement -- in an adequately powered sample, with results independently replicated, would support Grade A.
How this was studied
Form: Home-based blood pressure monitoring compared with clinic-based measurement, with or without telemonitoring (Agarwal 2011 meta-analysis, PMID 21115879); self-monitoring plus self-titration of antihypertensive drugs combined with telemonitoring, versus usual care (McManus 2010 TASMINH2, PMID 20619448). · Dose: Monitoring frequency not stated in the cited abstracts (Agarwal 2011 meta-analysis, PMID 21115879; McManus 2010 TASMINH2, PMID 20619448). · Population: 37 randomized trials, 9,446 participants (Agarwal 2011 meta-analysis, PMID 21115879); 527 patients aged 35 to 85 with blood pressure above 140/90 mmHg despite treatment in 24 UK general practices, 480 analyzed (McManus 2010 TASMINH2, PMID 20619448). · Duration: 6 and 12 months (McManus 2010 TASMINH2, PMID 20619448); not stated for the pooled trials (Agarwal 2011 meta-analysis, PMID 21115879).