A 3-day home blood pressure monitoring protocol with ≥2 readings per session achieved high concordance (>0.95) with an 8-day reference, with ≥97% of participants within 10 mmHg.
Cohort (n=812)
Do streamlined home blood pressure monitoring protocols provide valid BP estimates compared to an 8-day protocol in older adults?
A streamlined 3-day home blood pressure monitoring protocol with morning and evening sessions (≥2 readings each) provides valid BP estimates comparable to an 8-day protocol in older adults.
Effect estimate: Concordance correlation coefficient >0.95
BACKGROUND: Current clinical guidelines recommend home blood pressure monitoring (HBPM) to confirm hypertension diagnosis, guide therapy, and support long-term control. However, the optimal number of HBPM measurements needed for valid assessment is not established. METHODS: At ARIC Visit 10 (2023), participants completed an eight-day HBPM protocol with morning and evening measurements and three readings per session. We evaluated the validity between the eight-day mean (reference) and streamlined protocols (fewer days, less than three readings per session, or only morning or evening measurements). In secondary analyses, we assessed the validity of these HBPM protocols relative to ambulatory BP. RESULTS: Among 812 participants (median age 83 years, 24% Black adults, 40% male, 84% using anti-hypertensive medications), median BP varied by less than 3 mmHg across the eight-day protocol. The greatest improvement in HBPM validity occurred when extending the averaging window from one to two days. By three days, concordance correlation coefficients exceeded 0.95, and ≥97% of participants were within 10 mmHg of the reference for both systolic and diastolic BP. Averaging ≥2 readings per session, including both morning and evening measurements, yielded greater validity than a single reading or timepoint. CONCLUSIONS: In this community-based cohort of older adults, HBPM provided stable BP estimates within three days (can be non-consecutive within an 8-day period) using morning and evening sessions with ≥2 readings each. While further studies are required to validate generalizability beyond this engaged cohort, these findings support shorter, less burdensome HBPM protocols in clinical guidelines for hypertension management in older adults.
“In a study of 812 older adults, researchers found that just three days of home blood pressure monitoring, with morning and evening measurements, correlated strongly with results from a full eight-day protocol. This finding could significantly reduce the self-monitoring burden for millions of older individuals managing hypertension. This study offers a clear, actionable framework: a three-day monitoring period, with at least two measurements each morning and evening, provides a statistically robust and clinically reliable blood pressure assessment.”
Wang et al. (2026) conducted a cohort in Hypertension (n=812). Streamlined home blood pressure monitoring protocols (fewer days, <3 readings, or single timepoint) vs. Eight-day protocol with morning and evening measurements and 3 readings per session was evaluated on Validity between streamlined protocols and the eight-day mean reference (Concordance correlation coefficient >0.95). A 3-day home blood pressure monitoring protocol with ≥2 readings per session achieved high concordance (>0.95) with an 8-day reference, with ≥97% of participants within 10 mmHg.