What is the best way to measure blood pressure?

Thus, what in the past was only the classifi cation of individuals, based on offi ce measures, normotensive and hypertensive, we now have two other situations where the behavior of blood pressure is systematically changed (≥140×90mm Hg) in the offi ce whereas in the mean of the 24hour period by ABPM the values are normal (<130×80mm Hg) and another group characterized by always normal behavior in offi ce measurements (<140×90mm Hg) and altered in ABPM (≥ 130×80mm Hg).

Since Scipiano Riva-Rocci [1] created the device to measure Blood Pressure (BP), more than a century has passed with gains in knowledge of this way of assessing BP.
Currently, the methods for assessing blood pressure in the 24 hours using devices capable of making these records are well established [2].
Hypertension is frequently diagnosed using offi ce Blood Pressure (BP) measurements. However, recent guidelines strongly recommend out-of-offi ce BP monitoring (including Ambulatory BP Monitoring (ABPM) for the diagnosis and management of Hypertension [3][4][5][6].
Due to limitations in offi ce measures, since the 1960s, six decades after the creation of the fi rst device capable of measuring during the daily activities of patients ( Figure 1), identifi ed as ABPM, this form of blood pressure recording has been gaining prominence and proving to be able to represent the real behavior of blood pressure assessed for a period of 24 hours.
With the natural evolution of technology, ABPM equipment became lighter, lower-noise and more comfortable.
The limitations to its use, due to possible discomfort during its performance, frequently referred to in the literature, were not confi rmed in a study conducted by Nobre, et al. [7] ( Figure  2).
With the advent of ABPM, it was possible to identify phenotypes previously unknown, such as: white coat hypertension and masked hypertension [8].
Based on the blood pressure record for 24 hours, outside the offi ce, today we can consider the classifi cation of blood pressure behavior as shown in Figure 3.

Sustained hypertension, normotension, white coat hypertension and masked hypertension: Defi nitions and prevalences
Susteined hypertension was a conventional blood pressure  Folowing, we will consider the prognosis and behaviors indicated for the two main phenotypes: White coat hypertension and masked hypertension.

Normotension, sustained hypertension, white coat hypertension, and masked hypertension: Prognosis and conduct
According to Hansen TW [11], the prognosis of the White

White coat hypertension
There is no evidence of the benefi ts of interventions in this group of patients [12,13]. These patients need followup, and changes in lifestyle are imperative for everyone. It is recommended that the diagnosis of white coat hypertension be confi rmed in 3 to 6 months, and the patient be followed annually with ABPM to detect progression to maintained hypertension, as these patients are more likely to become established hypertensive [14].
To our knowledge, there is currently no evidence from randomized clinical trials testing whether lowering versus not lowering offi ce BP in white-coat hypertensive might result in benefi t [14]. Lifestyle changes are consensual in these patients with white coat hypertension.

Masked hypertension
In view of the high-risk profi le associated with masked hypertension, the 2017 American College of Cardiology/ American Heart Association [3] and the 2018 European [15] hypertension guidelines consistently recommend that masked hypertensive patients should implement lifestyle interventions and be treated with antihypertensive drugs. However, in the absence of supporting evidence from randomized clinical trials, this recommendation rests largely on expert opinion [13].

Conclusions and perspectives
With the advent of the 24-hour ABPM, a blood pressure record was able to more accurately refl ect the behavior of blood pressure for the purpose of diagnosis, prognosis and evaluation of the antihypertensive therapy instituted.
In addition, there was the possibility of defi ning new blood pressure phenotypes such as: white coat hypertension and masked hypertension.
White coat hypertension and masked hypertension have not been identifi ed as benign conditions and the data currently available recommend specifi c care for the patient populations that fall into these two groups, as much as the diagnosis, as well as the assessment of prognosis and treatment.
Several and recent publications [16][17][18][19] have confi rmed the importance of measures taken during a day of usual activities of patients, by ABPM. Thus, this method has been gradually gaining a prominent place in medical practice.
In the near future, with the expansion of that used by MAPA, the existing knowledge will be consolidated and new studies will complete the gaps that exist today.
Anyway, we can assure that ABPM, in relation to blood pressure measurement, brought more light and less shadows.