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''NICE guidelines (new in 2012)''

Thresholds for Rx - gives two stages 
Use ABPM or HBPM in preference to clinic readings (unless severe) (so if raised in clinic but not severe then do ABPM/HBPM pre diagnosis)

|stage|clinic|ABPM/HPBM|
|1|140/90|135/85|
|2|160/100|150/95|
|severe|180/110||

ABPM - use daytime average (>14 readings, ~2/hour) - to confirm diagnosis
HBPM - use if ABPM not tolerated or refused (preferred by pt) - sit down, relax 1 min, measure twice (1 min apart) and record - daily bd for 7 days - ignore 1st day and use average of >3 days
If severe in clinic - needs immediate Rx
(If diabetic aim for 140/80 and if end organ damage 130/80

''Monitour'' 
with clinic BP for follow up and Mx (unless clinic and home/ABPM are distinctly different)  
repeat every 5 years unless close to threshold ? yearly

''Aim''
over 80's aim for below 150/90 (clinic)
under 80's aim for below 140/90 (little evidence base)

If diagnosed years ago on clinic reading and pt now wants to check with ABPM, remember BP goes up with age etc
if was diagnosed with what would now be stage 1 and no other risk factors, then first off do home monitouring on treatment and see how close to 135/85 it is ..... then consider stopping and checking diagnosis - but will have had decreased risk of stoke etc and so why stop if tolerated ??
problem with withdrawing treatment .... BP may take a year to drift back up to "normal" for you as there are rapid effects and longer term ones (structural - remodelling small arteries)
never stop if documented evidence of structural damage (eg LVH)

''NICE extras''
measure BP in both arms and repeat if difference is >20 (if stays >20 always use higher arm) - remember causes of unequal BP (supravalvular aortic stenosis) and exclude
If first reading >140/90 then repeat and use lower reading