Home blood pressure in target range as an additional therapeutic goal in hypertensive patients: a telemonitoring-based analysis

Abstract

Aim: Guidelines recommend treating hypertension (HTN) by keeping office blood pressure (BP) within the therapeutic range (TR). However, little is known about the TR of home BP. Therefore, we aimed to find a reliable proportion of home systolic (S) BP in TR (sBPiTR) using a telehealth platform, which facilitates the access to reliable and structured home BP data. Methods: We used the data of HTN patients who participated in BP telemonitoring and counseling for 3 months. Patients had to manually enter their home BP in electronic diaries. Home SBP readings were averaged by the system itself except the very first or every first day of BP monitoring. We divided sBPiTR (110-130 mmHg) by quartiles. A weighted Cohen’s kappa coefficient was used as an estimate of inter-rater reliability between sBPiTR and office/home SBP in TR. We used a binomial logistic regression to test the predictive value of sBPiTR on target office/home SBP achievement. Results: In total, 123 patients were included (median age 54 years; 102 males) with a median office SBP of 140 mmHg. By 3 months, it decreased to 130 mmHg (P < 0.001), with 60% of patients with target office BP and 70% in the upper sBPiTR quartiles. There was a slight agreement between office SBP in TR and sBPiTR of ≥ 50% (k = 0.19, P < 0.035) and fair agreement when countered against home SBP in TR (k = 0.32-0.65, P < 0.0001). Patients with sBPiTR of ≥ 50% were more likely to fall within the office and home SBP TR after adjustment for baseline covariates. Conclusion: The threshold of 50% of home SBP measurements within 110-130 mmHg has a slight agreement with office BP control and a fair agreement with home BP control. This variable may serve as a predictor for the achievement of target SBP both in and out of office. Larger studies are needed to confirm these preliminary results.