Concordance between awake blood pressure on home and ambulatory blood pressure monitoring in older adults

Determining the agreement between ambulatory blood pressure (BP) monitoring (ABPM) and home BP monitoring (HBPM) can inform their use.

Participants ≥65 years of age taking antihypertensive medication in the AMBROSIA-HOME study completed 24 hours of ABPM and 7 days of HBPM. Controlled office and awake BP was defined as mean systolic BP (SBP)/diastolic BP (DBP) <130/<80 mm Hg and uncontrolled office and awake BP as mean SBP or DBP ≥130/80 mm Hg. Masked uncontrolled hypertension was defined as controlled clinic BP with uncontrolled BP on HBPM or ABPM, and white coat effect as uncontrolled clinic BP with controlled BP on HBPM or ABPM.

Among 510 participants (mean age: 74 years; 57% female), mean (SD) awake SBP/DBP was 135.6 (13.9)/73.7 (7.9) mm Hg on HBPM and 134.7 (13.9)/73.6 (8.5) mm Hg on ABPM. The mean difference (limits of agreement) between HBPM and ABPM for awake SBP and DBP was 0.84 (-20.6 to 22.3) mm Hg and 0.07 (-12.5 to 12.6) mm Hg, respectively. Intraclass correlation coefficients for mean awake SBP and DBP between HBPM and ABPM were 0.68 (95% CI: 0.63-0.73) and 0.69 (95% CI: 0.64-0.73), respectively. The Kappa statistics (95% CI) for uncontrolled BP, masked uncontrolled hypertension, and white coat effect were 0.47 (0.39-0.55), 0.43 (0.31-0.54), and 0.35 (0.21-0.49), respectively.

HBPM and ABPM yielded comparable mean awake BP values with a wide limit of agreement and fair to moderate agreement for identifying BP phenotypes in older adults taking antihypertensive treatment.