What does this research mean for the field?

Lowering the home blood pressure threshold to 130/80 mmHg improved diagnostic accuracy from 73.1% to 87.8%, increasing sensitivity to 89.5% while reducing specificity to 69.1%. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

What question did this study set out to answer?

This study aimed to determine if lowering the home blood pressure threshold enhances diagnostic accuracy for hypertension.

February 12, 2026

Reassessing home blood pressure thresholds: clinical implications of lowering the diagnostic criteria to 130/80 mmHg

Key Result

Lowering home BP threshold from 135/85 to 130/80 mmHg increased sensitivity to 89.5%, improved overall diagnostic accuracy to 87.8%, reducing masked hypertension misclassification.

Key Points

This study aimed to determine if lowering the home blood pressure threshold enhances diagnostic accuracy for hypertension.
Analyzed data from 646 untreated participants with valid BP measurements.
Utilized 3-day office BP, 7-day home BP, and 24-hour ambulatory BP monitoring.
Classified hypertension phenotypes based on office BP and ABPM criteria.
Increased sensitivity from 72.3% to 89.5% when lowering the threshold.
Specificity decreased from 81.8% to 69.1%, but overall diagnostic accuracy improved from 73.1% to 87.8%.
Significant misclassification of masked and sustained hypertension at higher thresholds was reduced.

Structured PICO

Does lowering the home blood pressure diagnostic threshold to 130/80 mmHg improve diagnostic accuracy for hypertension compared to 135/85 mmHg in untreated participants?

Population

646 untreated participants with preserved renal function, mean age 52 ± 10 years, 310 men, with valid 3-day office BP, 7-day home BP, and 24-h ABPM data.

Intervention

Lowering the home blood pressure diagnostic threshold to 130/80 mmHg

Comparator

Conventional home blood pressure diagnostic threshold of 135/85 mmHg

Outcome

Diagnostic accuracy (sensitivity, specificity, overall accuracy, and kappa coefficient) assessed against ambulatory blood pressure monitoring (ABPM)

Lowering the home blood pressure diagnostic threshold to 130/80 mmHg improves diagnostic precision and reduces the misclassification of masked and sustained hypertension compared to the conventional 135/85 mmHg threshold.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Objectives: This study investigated whether lowering the home blood pressure (BP) threshold for the diagnosis of hypertension from 135/85 to 130/80 mmHg enhances diagnostic accuracy when assessed against ambulatory BP monitoring (ABPM). Methods: A total of 646 untreated participants (mean age 52 ± 10 years; 310 men) with valid 3-day office BP, 7-day home BP, and 24-h ABPM data and preserved renal function were included. Hypertension phenotypes were classified as normotension, white-coat, masked, and sustained hypertension according to office BP and ABPM criteria. Results: Lowering the home BP threshold increased sensitivity from 72.3 to 89.5% but reduced specificity from 81.8 to 69.1%, thereby improving overall diagnostic accuracy from 73.1 to 87.8% and the kappa coefficient from 0.238 to 0.247. At the conventional threshold of 135/85 mmHg, 63.2% of masked and 15.1% of sustained hypertension were misclassified as normotension, whereas these rates declined to 30.3 and 3.4%, respectively, at the 130/80 mmHg threshold. Individuals with home BP between 130/80 and 134/84 mmHg showed intermediate office and ambulatory BP values, with a high prevalence of masked (32.9%) and sustained hypertension (11.7%). Within this subgroup, isolated nighttime and daytime–nighttime hypertension were identified in 35.7 and 13.5% of participants, respectively. Conclusion: The conventional home BP threshold of 135/85 mmHg may fail to identify a considerable proportion of masked, sustained, and nighttime hypertension. Lowering the threshold to 130/80 mmHg, or designating 130/80–134/84 mmHg as a diagnostic ‘gray zone’ warranting ABPM confirmation, may improve diagnostic precision and facilitate earlier detection of hypertension in clinical practice.

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