Key result
App-assisted home BP monitoring overestimates 24-hour ambulatory SBP by ~15 mm Hg.
Why the study?
Smartphone app-assisted HBPM enables standardized home BP measurement, but its diagnostic agreement with office BP and reference standard 24-hour ABPM needed evaluation.
Does smartphone application-assisted home blood pressure monitoring agree with 24-hour ambulatory blood pressure monitoring in patients with hypertension?
RCT (n=113)
Open-label
Randomized to 10 clusters (Latin Square method)
Yes
Does smartphone application-assisted home blood pressure monitoring agree with 24-hour ambulatory blood pressure monitoring in patients with hypertension?
Answers are grounded in this paper and cite their sources.
App-assisted home blood pressure monitoring has fair-to-moderate diagnostic agreement with 24-hour ambulatory monitoring but high sensitivity for sustained and masked hypertension, making it a complementary tool rather than a replacement.
BACKGROUND: The development of automated, smartphone application (app)-assisted home blood pressure monitoring (HBPM) allows for standardized measurement of blood pressure (BP) at home. The aim of this study was to evaluate the (diagnostic) agreement between app-assisted HBPM, automated office BP (OBP), and the reference standard 24-hour ambulatory BP monitoring (ABPM). METHODS: In this open randomized 5-way cross-over study, patients diagnosed with hypertension were randomized to one of 10 clusters, each containing 5 BP measurement methods (ABPM, HBPM, attended OBP, unattended OBP, and unattended 30-minute BP) in different order. RESULTS: In total, 113 patients were included. The average 24-hour ABPM was 126±11/73±8 mm Hg compared with 141±14/82±10 mm Hg with app-assisted HBPM, 134±13/80±9 mm Hg with unattended 30-minute BP, 137±16/81±11 mm Hg with attended OBP, and 135±15/81±10 mm Hg with unattended OBP monitoring. Diagnostic agreement between app-assisted HBPM and 24-hour ABPM for diagnosing sustained (OBP >140/90 mm Hg and ABPM ≥130/80 mm Hg or HBPM ≥135/85 mm Hg), white-coat (OBP ≥140/90 mm Hg and ABPM <130/80 mm Hg or HBPM <135/85 mm Hg), and masked hypertension (OBP <140/90 mm Hg and ABPM ≥130/80 mm Hg or HBPM ≥135/85 mm Hg) was fair-to-moderate (κ statistics ranging from 0.34 to 0.40). App-assisted HBPM had high sensitivities (78%-91%) and negative predictive values (90%-97%) for diagnosing sustained and masked hypertension. CONCLUSIONS: This study showed a considerable (diagnostic) disagreement between app-assisted HBPM and ABPM. App-assisted HBPM had high sensitivity in the diagnosis of sustained and masked hypertension and may therefore be used as complementary to, but not a replacement of, ABPM.
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Groenland et al. (2022) conducted an RCT in Hypertension (n=113). Smartphone application-assisted home blood pressure monitoring (app-assisted HBPM) vs. 24-hour ambulatory blood pressure monitoring (ABPM) was evaluated on Mean systolic blood pressure (Mean difference 15.2 mm Hg, 95% CI 12.9-17.5). App-assisted home blood pressure monitoring substantially overestimated 24-hour ambulatory systolic blood pressure by a mean difference of 15.2 mm Hg and demonstrated fair-to-moderate diagnostic agreement.
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