A 52-year-old man from rural Maharashtra is enrolled in the NPCDCS program for suspected hypertension. During the community health worker's initial visit, his blood pressure reading is 148/94 mmHg. What is the investigation of choice to confirm the diagnosis of hypertension as per NPCDCS guidelines?

## Diagnosis of Hypertension Under NPCDCS **Key Point:** NPCDCS recommends confirmation of hypertension through **home blood pressure monitoring (HBPM) over 7 days using a validated device** rather than relying on a single office reading, which is prone to white-coat effect. ### NPCDCS Protocol for Hypertension Screening | Step | Investigation | Rationale | |------|---|---| | 1st visit | Single BP reading (≥140/90 mmHg) | Screening threshold | | Confirmation | HBPM × 7 days (≥135/85 mmHg) | Reduces white-coat effect; cost-effective | | If HBPM unavailable | Repeat office BP on 2 separate visits | Alternative if HBPM not feasible | | Diagnosis confirmed | ≥3 readings ≥140/90 mmHg on office visits OR HBPM ≥135/85 mmHg | Establishes true hypertension | **High-Yield:** NPCDCS emphasizes **HBPM as the gold standard for confirmation** in resource-limited settings because: - Eliminates white-coat and masked hypertension bias - Cost-effective for community programs - Improves patient compliance and awareness - Reduces unnecessary pharmacotherapy **Clinical Pearl:** The NPCDCS threshold for HBPM is **≥135/85 mmHg** (lower than office BP of ≥140/90 mmHg) because home readings are more representative of true daytime BP. ### Why HBPM Over Other Methods 1. **Validated device at home** → Reduces anxiety, captures true BP 2. **7-day average** → Accounts for day-to-day variability 3. **Feasible in rural India** → Devices now affordable and widely available 4. **Aligns with WHO/ISH guidelines** → Adopted by NPCDCS framework [cite:Park 26e Ch NPCDCS]