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Optimizing Home Blood Pressure Monitoring Protocols in Older Adults: The Atherosclerosis Risk in Communities (ARIC)
Frances M Wang1,2, Hannah Col1, Fredrick Larbi Kwapong1
1Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Insights
Home blood pressure monitoring (HBPM) can be valid in just three days. Shorter, less burdensome protocols using morning and evening sessions with at least two readings each are recommended for hypertension management.
Area of Science:
- Cardiovascular Medicine
- Gerontology
- Clinical Hypertension Research
Background:
- Home blood pressure monitoring (HBPM) is crucial for hypertension diagnosis and management.
- Current guidelines lack established optimal protocols for HBPM measurement frequency.
Purpose of the Study:
- To determine the minimum number of home blood pressure monitoring (HBPM) measurements for valid hypertension assessment.
- To evaluate streamlined HBPM protocols against a comprehensive eight-day protocol and ambulatory BP.
Main Methods:
- An eight-day HBPM protocol with morning/evening measurements and three readings per session was conducted.
- Validity of streamlined protocols (fewer days, readings, or timepoints) was assessed.
- Secondary analysis compared HBPM protocols to ambulatory blood pressure monitoring.
Main Results:
- Stable blood pressure estimates were achieved within three days of HBPM.
- Concordance correlation coefficients exceeded 0.95 by day three.
- Averaging at least two readings per session, morning and evening, improved validity.
Conclusions:
- Three days of home blood pressure monitoring (HBPM), with morning and evening sessions and ≥2 readings each, provide valid estimates in older adults.
- Shorter, less burdensome HBPM protocols can support hypertension management guidelines.
- Generalizability beyond this cohort requires further study.
Background:
Current clinical guidelines recommend home blood pressure monitoring (HBPM) to confirm hypertension diagnosis, guide therapy, and support long-term control. However, the optimal number of HBPM measurements needed for valid assessment is not established.
Methods:
At ARIC Visit 10 (2023), participants completed an eight-day HBPM protocol with morning and evening measurements and three readings per session. We evaluated the validity between the eight-day mean (reference) and streamlined protocols (fewer days, less than three readings per session, or only morning or evening measurements). In secondary analyses, we assessed the validity of these HBPM protocols relative to ambulatory BP.
Results:
Among 812 participants (median age 83 years, 24% Black adults, 40% male, 84% using anti-hypertensive medications), median BP varied by less than 3 mmHg across the eight-day protocol. The greatest improvement in HBPM validity occurred when extending the averaging window from one to two days. By three days, concordance correlation coefficients exceeded 0.95, and ≥97% of participants were within 10 mmHg of the reference for both systolic and diastolic BP. Averaging ≥2 readings per session, including both morning and evening measurements, yielded greater validity than a single reading or timepoint.
Conclusions:
In this community-based cohort of older adults, HBPM provided stable BP estimates within three days (can be non-consecutive within an 8-day period) using morning and evening sessions with ≥2 readings each. While further studies are required to validate generalizability beyond this engaged cohort, these findings support shorter, less burdensome HBPM protocols in clinical guidelines for hypertension management in older adults.
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Prepare for the Procedure:
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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.