Midday home blood pressure monitoring improved agreement with 24-hour ambulatory monitoring in classifying hypertension control compared to the classic morning-evening protocol (85% vs 78%).
Cross-Sectional (n=87)
Random order of measurement methods
Does the inclusion of midday home blood pressure measurements improve agreement with 24-hour ambulatory monitoring in older individuals with treated hypertension?
Incorporating midday home blood pressure measurements improves agreement with 24-hour ambulatory monitoring for assessing hypertension control in older adults.
Effect estimate: kappa 0.621
Absolute Event Rate: 85% vs 78%
p-value: p=<0.001
Objective: Accurate diagnosis of hypertension require blood pressure (BP) assessment using both office and out-of-office methods. Long-term follow-up of treated hypertensive patients relies largely on home blood pressure monitoring (HBP). In older individuals, the classic HBP protocol may not adequately estimate BP variations as captured in ambulatory BP monitoring (ABP). This study aimed to evaluate the performance of different HBP protocols in identifying hypertension control in treated hypertensive old patients. Design and method: Adults aged 70 years or older receiving stable antihypertensive treatment for at least four weeks underwent BP evaluation with office measurements (two visits with three seated and one standing reading one-minute apart; Microlife Office), HBP monitoring four days with duplicate seated measurements in the morning, midday (before lunch), and evening; Microlife WatchBP Home, and ABP monitoring (measurements every 20 minutes over 24 hours; Microlife WatchBP O3), in random order. Control rates were calculated for each method: office <130/80mmHg, 24 h ABP <130/80mmHg, HBP <135/85mmHg. History of cardiovascular disease (CVD), diabetes mellitus (DM), chronic kidney disease (CKD), neurologic disease (ND) and smoking status was noted. Frailty was evaluated using the Clinical Frailty Scale (CFS). Agreement between BP measurement methods was tested with Cohen's kappa. Results: Data from 87 participants were analyzed (age 78±5 years, 43.7% men, CFS 2.1±1.2, 9.2% smokers, 32.2% CVD, 28.7% DM, 20.7% CKD, 14% ND). Mean BP (mmHg) was: office seated 128±13/70±8, office standing 132±15/75±9; HBP morning–evening 136±13/74±7, HBP morning–midday–evening 133±12/73±6, HBP midday 127±13/70±7; ABP 24-hour 125±10/67±6, daytime 127±10/70±6 and nighttime 119±14/62±7. BP control rates were 56% with office measurements, 55% with classic HBP, 62% with morning-midday-evening HBP, 74% with midday HBP, and 72% with 24-hour ABP. Agreement with 24 h ABP in classifying hypertension control was: 70% with office (kappa=0.366, p<0.001), 78% (kappa=0.542, p<0.001) with classic HBP, 84% (kappa=0.635, p<0.001) with morning–midday–evening HBP and 85% (kappa=0.621, p<0.001) with midday HBP. Conclusions: In old individuals treated for hypertension, reliance on the classic morning–evening HBP protocol alone may lead to misclassification of BP control. Additional assessment of midday HBP improves agreement with ABP monitoring and may support more accurate clinical decisions in this population.
Krystallaki et al. (Fri,) conducted a cross-sectional in Treated hypertension (n=87). Midday home blood pressure monitoring vs. Classic morning-evening home blood pressure monitoring was evaluated on Agreement with 24-hour ambulatory blood pressure monitoring in classifying hypertension control (kappa 0.621, p=<0.001). Midday home blood pressure monitoring improved agreement with 24-hour ambulatory monitoring in classifying hypertension control compared to the classic morning-evening protocol (85% vs 78%).