Home BP monitoring best for diagnosing hypertension and estimating CVD risk: Study
USA: Monitoring home BP (HBP) for 1 week is the best approach for diagnosing hypertension compared with office blood pressure (OBP), ambulatory BP (ABP), suggests a recent study in the Journal of the American College of Cardiology.
The results are in contrast to the currently followed guidelines that recommend ambulatory BP (ABP) over HBP for hypertension diagnosis. The JACC study questions home BP monitoring's role as second fiddle.
The accurate measurement of blood pressure (BP) is very important for the diagnosis and management of hypertension and its associated cardiovascular disease (CVD) risk. Although BP measurement in an office setting has been the cornerstone of clinical management. However, several meta analyses and systematic reviews have shown that out-of-office BP measured either with home BP monitoring (HBPM) or ambulatory BP monitoring (ABPM), has a stronger association with CVD risk and target organ damage.
Determining the reliability and predictive validity of OBP, ABP, and HBP can inform which is best for diagnosing hypertension and estimating CVD risk. Considering this, Joseph E. Schwartz, Columbia University, Irving Medical Center, New York, New York, USA, and colleagues aimed to assess the reliability of OBP, HBP, and ABP and evaluate their associations with left ventricular mass index (LVMI) in untreated persons.
For the purpose, they performed The Improving the Detection of Hypertension (IDH) study -- a community-based observational study. The study enrolled 408 participants who had OBP assessed at 3 visits, and completed 3 weeks of HBP, 2 24-h ABP recordings, and a 2-dimensional echocardiogram.
Key findings of the study include:
- The reliability of 1 week of HBP, 3 office visits with mercury sphygmomanometry, and 24-h ABP were 0.938, 0.894, and 0.846 for systolic and 0.918, 0.847, and 0.843 for diastolic BP, respectively.
- The correlations among OBP, HBP, and ABP, corrected for regression dilution bias, were 0.74 to 0.89.
- After multivariable adjustment including OBP and 24-h ABP, 10 mm Hg higher systolic and diastolic HBP were associated with 5.07 and 3.92 g/m2 higher LVMI, respectively.
- After adjustment for HBP, neither systolic or diastolic OBP nor ABP was associated with LVMI.
"Our analyses demonstrate that office BP, HBPM, and ABPM do not measure the same underlying parameter and that 1 week of HBPM has a stronger association with LVMI than awake, asleep, or 24-h ABPM or 9 office BP readings taken over 3 visits. Also, 1 week of HBPM provided more reliable estimates of both SBP and DBP than either office BP or 24-h ABPM," wrote the authors.
"These data support the use of HBPM over ABPM and office BP for the diagnosis of hypertension and its associated risk of CVD," they concluded.
The study, "Reliability of Office, Home, and Ambulatory Blood Pressure Measurements and Correlation With Left Ventricular Mass," is published in the Journal of the American College of Cardiology.
DOI: https://www.jacc.org/doi/10.1016/j.jacc.2020.10.039
