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Optimal number of days for home blood pressure measurement
Teemu J Niiranen1, Kei Asayama2, Lutgarde Thijs3
1Population Studies Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland; Department of Medicine, Turku University Hospital, Turku, Finland;
Insights
A single home blood pressure (BP) measurement effectively predicts cardiovascular events. However, reliably diagnosing hypertension may require up to seven days of home BP monitoring.
Area of Science:
- Cardiology
- Hypertension Research
- Preventive Medicine
Background:
- Current guidelines lack outcome-based recommendations for home blood pressure (BP) measurement frequency.
- Optimal home BP monitoring schedules require further investigation.
Purpose of the Study:
- To determine the optimal number of home BP measurement days for cardiovascular risk prediction and hypertension diagnosis.
- To assess the prognostic accuracy of home BP measurements with increasing monitoring duration.
Main Methods:
- 4,802 participants were classified by office/home BP and home BP levels.
- Home BP measurement days increased from 1 to 7.
- Prognostic accuracy was assessed using multivariable-adjusted Cox models over an 8.3-year follow-up.
Main Results:
- A single home BP measurement significantly predicted cardiovascular events (P ≤ 0.003).
- Classification agreement reached near-perfect levels (κ ≥ 0.9) after six measurement days.
- Masked hypertension, not white-coat hypertension, increased cardiovascular risk.
Conclusions:
- One home BP measurement is a potent cardiovascular event predictor.
- Seven home BP measurement days may be necessary for reliable hypertension diagnosis.
Background:
Current guidelines make no outcome-based recommendations on the optimal measurement schedule for home blood pressure (BP).
Methods:
We enrolled 4,802 randomly recruited participants from three populations. The participants were classified by their (i) cross-classification according to office and home BP (normotension, masked hypertension, white-coat hypertension, and sustained hypertension) and (ii) home BP level (normal BP, high normal BP, grade 1 and 2 hypertension), while the number of home measurement days was increased from 1 to 7. The prognostic accuracy of home BP with an increasing number of home BP measurement days was also assessed by multivariable-adjusted Cox models.
Results:
Agreement in classification between consecutive measurement days indicated near perfect agreement (κ ≥ 0.9) after the sixth measurement day for both office and home BP cross-classification (97.8% maintained classification, κ = 0.97) and home BP level (93.6% maintained classification, κ = 0.91). Over a follow-up of 8.3 years, 568 participants experienced a cardiovascular event, and the first home BP measurement alone predicted events significantly (P ≤ 0.003). The confidence intervals (CIs) were too wide and overlapping to show superiority of multiple measurement days over the first measurement day (hazard ratios per 10mm Hg increase in systolic BP at initial day, 1.11 [CI 1.07-1.16]; that at 1-7 days, 1.18 [CI 1.12-1.24]). Masked hypertension, but not white-coat hypertension, was associated with increased cardiovascular risk, irrespective of the number of home measurement days.
Conclusion:
Even a single home BP measurement is a potent predictor of cardiovascular events, whereas seven home measurement days may be needed to reliably diagnose hypertension.
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