Interrelationship Between the Morning-to-Evening Changes in Home Blood Pressure and Pulse Rate

We investigated the morning-to-evening changes in home blood pressure (BP) and pulse rate for demographic and clinical determinants, interrelationship, and association with BP control in treated patients with hypertension.

We performed a cross-sectional analysis in patients (≥55 years of age) with hypertension, enrolled in a China nationwide registry on home BP monitoring between 2020 and 2025. Home BP was measured three times consecutively in the morning and evening, respectively, for seven consecutive days. The change was calculated by subtracting the BP and pulse rate values in the morning from those in the evening.

The 4,787 participants had a mean (±SD) age of 66.1 (±7.5) years, and included 2,366 (49.4%) men. Overall, systolic/diastolic BP decreased from 129.1/80.6 mmHg in the morning to 127.2/78.7 mmHg in the evening by a mean change of -1.9 ± 7.8/-1.8 ± 4.7 mmHg. Pulse rate, however, increased from 70.5 beats/min in the morning to 73.7 beats/min in the evening by a mean change of +3.1 ± 5.8 beats/min. Adjusted analyses showed that the changes in pulse rate were negatively associated with those in both systolic (r = -0.20, 95% CI: -0.22 to -0.17) and diastolic BP (r = -0.12, 95% CI: -0.14 to -0.09). Patients with a change in pulse rate above the median (≥3.0 beats/min) had a lower control rate of office systolic/diastolic BP (60.1% vs. 65.5%, P < 0.001) than those with a change in pulse rate below the median.

There were interrelated morning-to-evening changes in home BP and pulse rate, being a drop and rise, respectively.