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The utility of home blood pressure load in predicting average self-measured blood pressure
Alan L Hinderliter1, Feng-Chang Lin2,3, Yumei Yang2
1Department of Medicine.
Insights
Home blood pressure (BP) load effectively estimates average self-measured BP and confirms elevated readings. This method offers a practical way to assess cardiovascular disease risk using home BP monitoring data.
Area of Science:
- Cardiology
- Hypertension Management
- Preventive Medicine
Background:
- Self-measured blood pressure (SMBP) is more accurate for cardiovascular risk assessment than office measurements.
- Calculating average SMBP is often impractical during clinic visits.
- Home BP load, a proportion of elevated readings, is easily calculable.
Purpose of the Study:
- To evaluate the utility of home BP load in predicting mean SMBP.
- To assess the effectiveness of home BP load in confirming elevated SMBP.
Main Methods:
- 420 untreated adults aged 30+ performed SMBP twice daily for 10 days.
- True SMBP was defined as the mean of 40 home measurements.
- Home BP load was calculated using a systolic BP threshold of 130 mmHg.
Main Results:
- A home BP load of 0.50 corresponded to an average SMBP of 130 mmHg (95% CI: 126-133 mmHg).
- Systolic SMBP varied by approximately 6 mmHg with BP loads of 0.25 and 0.75.
- A home BP load of at least 0.60 indicated a 90% probability of true systolic SMBP > 130 mmHg.
Conclusions:
- Home BP load serves as a reliable estimator for average SMBP.
- Home BP load can effectively confirm elevated SMBP, aiding in cardiovascular risk stratification.
Objectives:
Average values for self-measured blood pressure (SMBP) more accurately reflect a patient's risk of cardiovascular disease than do office measurements. Oftentimes, however, patients provide lists of individual home blood pressure (BP) measurements, and average values cannot be computed within the time constraints of a clinic visit. In contrast, the home BP load - defined as the proportion of BP values greater than a partition value (e.g., 130 mmHg) - can be easily calculated. We examined the utility of the BP load in predicting the mean SMBP and confirming elevated SMBP.
Methods:
Four hundred twenty untreated adults at least 30 years of age acquired SMBP data twice in the morning and twice in the evening over 10 days. The 'true' SMBP was defined as the mean of these 40 determinations.
Results:
Using all 10 days of BP data and a systolic BP threshold of 130 mmHg, the average SMBP associated with a home BP load of 0.50 was 130 mmHg, with a 95% prediction interval of 126-133 mmHg. True systolic SMBP was approximately 6 mmHg lower and higher at home BP loads of 0.25 and 0.75, respectively. There was a 90% probability that the true systolic SMBP was greater than 130 mmHg if the systolic home BP load was at least 0.60. Corresponding values for 3 days and 1 day of SMBP were at least 0.68 and at least 0.84, respectively.
Conclusion:
Our analysis demonstrates that the home BP load can be used to estimate the average BP acquired on home monitoring and confirm elevated SMBP.
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Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
01:23Assessment of blood pressure in brachial artery(two-step method)
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