Is Home BP Monitoring the Best Approach For Diagnosing HTN?
One week of home blood pressure (BP) monitoring may be more reliable and more strongly associated with left ventricular mass index (LVMI) vs. office BP or ambulatory BP, suggesting that home BP monitoring may be the best approach for diagnosing hypertension and its associated risk of cardiovascular disease, according to a study published Dec. 14 in the Journal of the American College of Cardiology.
Joseph E. Schwartz, PhD, et al., sought to assess the reliability of office BP, home BP and ambulatory BP and evaluate their associations with LVMI in untreated patients in a community-based observational study. The 408 participants had their office BP assessed at three visits, and completed three weeks of home BP, two 24-h ambulatory BP recordings and a two-dimensional echocardiogram.
Results showed that the reliability of one week of home BP, three office visits with mercury sphygmomanometry, and 24-h ambulatory BP were 0.938, 0.894, and 0.846 for systolic BP, and 0.918, 0.847, and 0.843 for diastolic BP, respectively. Among other results, the authors also found that the correlations among office BP, home BP and ambulatory BP, corrected for dilution bias, were 0.74 and 0.89.
"[Home BP monitoring] was the only BP measurement associated with LVMI when all three types of BP were simultaneously included in a regression model," write the authors. "This was true for analyses performed with and without correction for regression dilution bias. Also, [one] week of [home BP monitoring] provided more reliable estimates of both [systolic BP] and [diastolic BP] than either office BP or 24-h [ambulatory BP monitoring]."
In an accompanying editorial comment, Robert M. Carey, MD, et al., discuss how home BP requires fewer resources, time, and personnel and is more cost-effective when compared to ambulatory BP. "[Home BP] monitoring was performed by participants who had only [five minutes] of in-office training and an instruction sheet for reference, consistent with the constraints of practice, and [home BP monitoring] was conducted for only [one] week; yet, the results demonstrated the highest degree of reliability and association with target organ damage among the tested modalities," they explain.
Keywords: Blood Pressure, Cardiovascular Diseases, Cost-Benefit Analysis, Reproducibility of Results, Blood Pressure Monitoring, Ambulatory, Hypertension, Office Visits, Cardiology, Mercury
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