The classic morning-evening home blood pressure protocol significantly overestimated systolic blood pressure compared to daytime ambulatory monitoring (mean difference 7.9 mmHg; 95% CI 6.1-9.7; p<0.001).
Cross-Sectional (n=106)
Random order of measurements
Do different home blood pressure monitoring protocols accurately reflect daytime ambulatory blood pressure in older adults?
In older adults, midday home blood pressure measurements more accurately reflect daytime ambulatory blood pressure than the classic morning-evening protocol, which tends to overestimate it.
Mean Difference: 7.9 (95% CI 6.1–9.7)
Absolute Event Rate: 136% vs 128%
p-value: p=<0.001
Objective: Hypertension prevalence increases with age, however, the relationship between office and out-of-office blood pressure (BP) measurement methods in older adults is uncertain and inadequately investigated. This study aimed to evaluate BP in elderly individuals using different home BP monitoring (HBP) protocols, to compare with 24-hour ambulatory BP monitoring (ABP) and to identify factors associated with discrepancies between methods. Design and method: Adults aged 70 years or older were eligible if they were untreated or on stable antihypertensive therapy for at least four weeks. BP was assessed with office measurements (two visits; triplicate measurements in the seated position one minute apart; Microlife Office), HBP four days; morning, midday (before lunch) and evening duplicate seated measurements; Microlife WatchBP Home, and 24-hour ABP (measurements every 20 minutes for 24 hours; Microlife WatchBP O3), in random order. History of cardiovascular disease (CVD), diabetes mellitus (DM), chronic kidney disease (CKD), neurologic disease (ND) and smoking status was recorded. Frailty was assessed with Clinical Frailty Scale (CFS). Results: A total of 106 individuals were included (age 78±5 years, 41.5% men, 82.1% receiving antihypertensive treatment, CFS 2.0±1.2, 7.5% smokers, 29.2% CVD, 25.5% DM, 18.9% CKD, 13.3% ND). Mean BP values (mmHg) were: office 128±13/70±8; HBP morning–evening 136±12/74±6, HBP morning–midday–evening 133±12/72±7, HBP midday 128±13/70±7; ABP 24-hour 125±10/68±6, daytime 128±10/70±6 and nighttime 119±13/62±8. With daytime ABP as the reference, systolic morning–evening and morning-midday-evening HBP values were significantly higher (mean difference 7.9, 95% CI 6.1 to 9.7 mmHg, p<0.001 and 5.1, 3.4 to 6.9 mmHg, p<0.001, respectively), whereas midday HBP and office measurements did not differ (0.4, -1.7 to 2.4 mmHg, p=0.912 and 0.3, -1.8 to 2.3 mmHg, p=0.996, respectively). In multivariable analysis, HBP–daytime ABP difference was independently associated with age (beta=0.56, 0.17 to 0.96, p=0.006), after adjustment for sex, comorbidities and CFS. Conclusions: In old individuals, the classic morning-evening HBP protocol may overestimate BP compared to awake ABP. Midday HBP appears to be closer to daytime ABP in this population and should be implemented in the HBP monitoring schedule in this population.
Krystallaki et al. (2026) conducted a cross-sectional in Hypertension (n=106). Morning-evening home blood pressure monitoring vs. Daytime ambulatory blood pressure monitoring was evaluated on Difference in systolic blood pressure compared to daytime ambulatory blood pressure (MD 7.9, 95% CI 6.1 to 9.7, p=<0.001). The classic morning-evening home blood pressure protocol significantly overestimated systolic blood pressure compared to daytime ambulatory monitoring (mean difference 7.9 mmHg; 95% CI 6.1-9.7; p<0.001).