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Home monitoring of blood pressure: limited value in general practice
G S Stergiou1, J S Malakos, A V Voutsa
1Hypertension Centre, Third University Department of Medicine, Sotiria Hospital, Athens, Greece.
Insights
Home blood pressure (HBP) measurement is unreliable in practice. Poor technique and device issues mean HBP offers no advantage over clinic blood pressure (CBP) for predicting ambulatory blood pressure (ABP).
Area of Science:
- Cardiology
- Hypertension Management
- Medical Device Accuracy
Background:
- Home blood pressure (HBP) monitoring is increasingly used for hypertension management.
- The reliability of HBP measurements as performed by patients without specific training is not well established.
- Clinic blood pressure (CBP) measurements may not accurately reflect a patient's typical blood pressure readings.
Purpose of the Study:
- To evaluate the accuracy and reliability of home blood pressure (HBP) measurements compared to clinic blood pressure (CBP).
- To assess the predictive value of HBP and CBP for daytime ambulatory blood pressure (ABP).
- To identify factors contributing to inaccuracies in home blood pressure monitoring.
Main Methods:
- Studied 50 hypertensive patients with at least 6 months of HBP monitoring experience.
- Compared HBP and CBP to daytime ambulatory blood pressure (ABP) as the reference standard.
- Assessed patient technique via questionnaire and device accuracy against a mercury column.
Main Results:
- No significant difference in agreement between ABP and HBP or CBP for systolic blood pressure (SBP).
- Little difference in agreement for diastolic blood pressure (DBP).
- Variability of discrepancies indicated HBP was not a better predictor of ABP than CBP, despite frequent measurements.
Conclusions:
- Home blood pressure measurement, as commonly practiced without standardized technique or device maintenance, offers no advantage over clinic blood pressure readings in predicting ambulatory blood pressure.
- Incorrect measurement techniques and poor device standardization are common issues.
- Patient education and regular device maintenance are crucial for HBP to provide any benefit over CBP.
Abstract:
To investigate the reliability of home blood pressure (HBP) measurement as it is generally used in practice, we studied 50 consecutive newly referred hypertensive patients that were measuring HBP for at least 6 months before referral. No specific instructions on the technique of HBP measurement were given to the patients. HBP was compared to clinic BP (CBP) by using daytime ambulatory BP (ABP) as a reference method. The technique of HBP measurement used by the patients was assessed on the basis of a detailed questionnaire and the accuracy of the devices was tested against a mercury column. There was no difference between the degree of similarity of ABP with HBP or CBP (mean value of discrepancies and correlation coefficients) for systolic BP (SBP) and little difference for diastolic BP (DBP). However, the variability of discrepancies between HBP and ABP was equal to the corresponding variability between CBP and ABP, indicating that HBP was not better predictor of ABP than CBP. Although patients measured HBP more frequently than generally recommended, poor standardisation of measurement and wrong technique were particularly common. In conclusion, in the present study HBP measurement offered no advantage over CBP in predicting ABP. The theoretical advantages of HBP may be partially offset by incorrect technique and less standardised conditions of measurement. Without patients education and regular maintenance of devices HBP offers no advantage over CBP and should not be used. (This article is based on data presented at the 7th European Hypertension Society Meeting in Milan, June 1995).