Simpler Method to Leverage Home Blood Pressure Readings

Home blood pressure (HBP) monitoring data can be scanned quickly by physicians to determine a summary blood pressure statistic that may reveal which patients have uncontrolled blood pressure, according to an article published in the January/February issue of the Annals of Family Medicine.

"Although not a perfect discriminator of true blood pressure control, we found that patients with at least 30% of the last 10 home systolic blood pressure readings ≥135 mm Hg were more likely to have uncontrolled blood pressure as defined by 24-hour [ambulatory blood pressure]," James E. Sharman, BHMS, PhD, from the University of Tasmania, and colleagues write.

The investigators analyzed blood pressure diaries from 286 patients with treated hypertension and measured 7-day HBP and 24-hour ambulatory blood pressure (ABP).

Approximately one third (34%) of the patients had controlled blood pressure based on HPB lower than 135 mm Hg. In contrast, 44% had controlled blood pressure based on an average 24-hour ABP daytime systolic blood pressure lower than 135 mm Hg.

The researchers found that having three or more of the last 10 home systolic blood pressure readings 135 mm Hg or higher was the best predictor of 24-hour ABP systolic blood pressure above treatment/target threshold.

"The positive and negative predictive values of ≥3 elevations were 0.85 (95% CI, 0.78-0.91) and 0.56 (95% CI 0.48-0.64), respectively, for 24-hour ABP systolic blood pressure ≥130 mm Hg, and 0.79 (95% CI 0.72-0.86) and 0.63 (95% CI 0.55-0.71), respectively, for 24-hour ABP daytime systolic blood pressure ≥135 mm Hg," the authors report.

In addition, the patients who met this criterion were more likely to have evidence of target organ disease relative to patients who did not. Measures of target organ disease included aortic stiffness, left ventricular relative wall thickness, left atrial area, and left ventricular ejection fraction.

International expert committees as well as blood pressure management guidelines recommend the use of patient HBP diaries. Unfortunately, many of the home readings conflict with clinic blood pressure readings, thereby underscoring the possibility of erroneous diagnosis. The result is a lack of consensus as to how best to interpret HBP values.

The new method thus represents an empirically validated approach for assessing a patient's HPB measurements that is practical for a busy clinical practice.

The authors have disclosed no relevant financial relationships.

Ann Fam Med. 2016;14:63-69. Full text

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