PRESENT RECOMMENDED REGIMEN FOR HOME BLOOD PRESSURE MONITORING MAY NEED REVISION FOR ACCURATE MONITORING AND DIAGNOSIS OF HYPERTENSION

Abstract

Objective: Recent NICE guidelines for management of hypertension stress the importance of home blood pressure management (HBPM) to confirm a diagnosis of hypertension. The objectives were to investigate the difference in two subsequent blood pressure (BP) measurements, evaluate diurnal variation using home blood pressure measurement and assess change in BP levels during a standard measurement period in home environment. Design and method: A total of 758 (male 372/female 386, mean age 57.9 ± 8.2 years) treated for primary hypertension were investigated. No intervention was given during the trial period. BP values were obtained by self-measurement at home using a Bluetooth-equipped oscillometric BP monitor connected to a smartphone application (Accumbo AB). For the first two weeks of the trial, participants were asked to measure HBPM on at least seven days in the morning (before breakfast) and at least seven days in the evening. Each measurement consisted of two BP measurements at 1-minute intervals. Results: The second/subsequent BP measurement showed lower values for both systolic BP (mean SBP 135 ± 12 mmHg vs. 134 ± 12 mmHg) and diastolic blood pressure (mean DBP 88 ± 9 mmHg vs. 87 ± 9 mmHg) compared with the first measurement (p < 0.001). Difference was more pronounced for SBP in males (-0.65 mmHg) than females (-0.52 mmHg), (p < 0.05). Diurnal BP variation was non-significant for SBP (p = 0.18) while DBP showed higher values in the morning (89 ± 9 mmHg) compared with evening values (86 ± 9 mmHg), (p < 0.001). The BP morning surge was more pronounced for males vs. females (p < 0.001). Mean BP was lower during the second week (134/87 ± 12/9 mmHg) compared with the first week (135/88 ± 12/9 mmHg, p < 0.001). This difference was driven by a reduction in BP significant for women (p < 0.001), but not for men (p = 0.37). Conclusions: The results indicate significant gender related differences in subsequent blood pressure values over time which might affect decision for treatment. The guidelines for home blood pressure monitoring may need to be revised to include more measurements over a longer period considering gender affiliation.