Participation interest and completion of home blood pressure measurements with mailed devices in adults with and without hypertension

OBJECTIVES: Home blood pressure monitoring (HBPM) is valuable for the detection and monitoring of hypertension. Despite logistical advantages, HBPM has not yet been used in national blood pressure (BP) surveys. We investigated randomly selected adults' willingness to participate in an HBPM study (attitude survey) and piloted this approach (feasibility study). METHODS: The attitude survey, part of the 2020 population representative cross-sectional telephone interview survey, German Health Update (GEDA), assessed willingness to self-measure BP on three days in the morning and evening in 6517 participants. Descriptive analyses and weighted log-binomial regression were used to examine associations between willingness to participate in HBPM and sociodemographic and health factors. The feasibility study piloted self-measurements with mailed devices, video instructions, and before and after online interviews with 258 commercial panel volunteers. RESULTS: In the attitude survey, 38% of randomly selected adults expressed willingness to participate in the HBPM study. Willingness to participate was associated with higher education [risk ratio (RR) 1.63, 95% confidence interval (CI) 1.37-1.94] and medium education (RR 1.30, 95% CI 1.09-1.56) compared to low education, ages 18-39 (RR 1.69, 95% CI 1.45-1.97) and 40-59 (RR 1.37, 95% CI 1.20-1.58) compared to participants from age 60s, and self-reported hypertension (RR 1.19, 95% CI 1.04-1.36). In the feasibility study, 43% ( n = 110) of those receiving a device completed the study. CONCLUSION: Our findings suggest that national BP studies cannot rely solely on HBPM because selective participation would yield biased results. However, HBPM may be used in other epidemiological studies, such as longitudinal studies.