HOME BLOOD PRESSURE MONITORING SCHEDULE: OPTIMAL AND MINIMUM BASED ON 2,122 INDIVIDUAL SUBJECTS' DATA

OBJECTIVE: Home blood pressure (HBP) monitoring has become a primary method for hypertension diagnosis and management. Most hypertension guidelines suggest HBP monitoring for 3-7 days and exclusion of first day for calculation of the average. This analysis investigated the optimal and minimum schedule for HBP monitoring using a European database. DESIGN AND METHOD: A retrospective analysis of cross-sectional research data was performed, which involved HBP and 24-hour ambulatory BP (ABP) monitoring in adults collected within the context of clinical studies in Finland, Greece, and UK. Participants with 6-7 HBP monitoring days and at least 12 HBP readings were included. The stability of HBP was assessed by evaluating the average value and variability (SD) of an increasing number of readings. The association of different HBP schedules with awake ABP was also assessed. RESULTS: Data from 2,122 participants were analyzed (mean age 53.9 ± 11.3 years, males 53%, treated 34%). A progressive HBP decline was observed in succeeding days, reaching a plateau after day 3. Day 1 average HBP was higher than in the next days by about 2.8/1.4 mmHg (systolic/diastolic, p < 0.001). Similarly, day 1 HBP SD was higher than in the next days. In a 3-day HBP monitoring schedule, the exclusion of day 1 reduced average HBP and SD, with a clinically important HBP decline in 115 participants (5%) and different hypertension diagnosis in 120 (6%). For HBP monitoring schedules including more than 3 days, the exclusion of day 1 had negligible impact. In a 6-day HBP monitoring schedule, the exclusion of day 1 led to clinically important HBP decline in 0.4% of participants and to different hypertension diagnosis in 3%. The 3-day average HBP was strongly correlated with awake ABP (correlation coefficient r = 0.70/0.77 systolic/diastolic, p < 0.05), with little improvement thereafter. CONCLUSIONS: These data support the recommendation for 7-day HBP monitoring as optimal schedule and 3-day as minimum. Readings of the first day should better be excluded, particularly when the minimum 3-day monitoring is obtained.