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Changing relation between home and clinic blood-pressure measurements: do home measurements predict clinic
Insights
Home blood pressure monitoring is a practical way to assess hypertension. It accurately predicts clinic outcomes and offers a viable alternative to frequent in-office measurements for hypertensive patients.
Area of Science:
- Cardiovascular Medicine
- Clinical Hypertension
- Health Services Research
Background:
- Elevated blood pressure readings in a family health center identified a cohort requiring further assessment.
- Initial screening revealed a significant number of patients with diastolic pressures of 95 mm Hg or greater.
Purpose of the Study:
- To evaluate the efficacy of home blood pressure monitoring as an alternative to repeated clinic measurements.
- To assess the predictive value of home blood pressure readings in hypertensive patients.
Main Methods:
- Patients with elevated blood pressure were instructed on using an electronic sphygmomanometer for home monitoring over 3 days.
- Clinic blood pressure measurements were repeated at 2 and 4 weeks post-initial screening.
- Comparison of home blood pressure readings with subsequent clinic measurements.
Main Results:
- Blood pressure decreased on successive clinic visits, with fewer patients meeting the hypertension threshold at the final visit.
- Average daytime home blood pressure measurements were not significantly different from third clinic visit readings.
- Home blood pressure monitoring successfully predicted the third clinic visit outcome in 79% of patients.
Conclusions:
- Home blood pressure monitoring is a practicable and acceptable method for the initial assessment of hypertensive patients.
- Home monitoring effectively identified patients whose blood pressure remained elevated, with a low rate of persistent severe hypertension.
- This approach reduces the need for repeated clinic visits in the diagnostic process.
Abstract:
Blood-pressure screening in a family health centre identified 114 patients (53 male, 61 female) with diastolic pressures of 95 mm Hg and greater after three readings in the seated position (mean 163 [SEM 2]/104 mm Hg). All were instructed in the use of the 'Copal UA 231/251' electronic sphygmomanometer and produced a series of readings taken at home over 3 days. They were recalled after 2 weeks and 4 weeks for repeat clinic measurements of blood pressure. Blood pressure fell on successive clinic visits; at the final visit only 59 patients (31 male, 28 female) had diastolic pressures of 95 mm Hg or greater. Average day-time home blood-pressure measurements (155/94 mm Hg) were significantly lower than the screening blood-pressure measurements but were not significantly different from those at the third clinic visit (154/97 mm Hg). Home blood-pressure measurements were successful in predicting outcome at the third clinic visit in 90 (79%) patients; home-monitored pressures suggested normotension when the final clinic visit diastolic blood pressure was still above 95 mm Hg in only 16 (14%) patients. Only 2 of these had a final clinic diastolic pressure above 105 mm Hg. Home monitoring represents a practicable and acceptable alternative to repeated clinic measurements in the initial assessment of hypertensive patients.
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