Home blood pressure monitoring can provide the basis for accurate diagnoses of hypertension

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Blood pressure measurements taken regularly at home are more likely to provide the basis for accurate diagnoses of hypertension than those taken in a clinical setting, according to a new study by Kaiser Permanente investigators.

The findings come from a randomized controlled trial of 510 adults who visited one of 12 Kaiser Permanente primary care centers in western Washington between 2017 and 2019 published today in the Journal of General Internal Medicine.

“Blood pressure varies a lot throughout the day -; about 30 systolic points -; and 1 or 2 measurements in the clinic may not reflect your average blood pressure,” said Beverly B. Green, MD, MPH, first author of the study, who is a senior researcher at the Kaiser Permanente Washington Health Research Institute and a physician at the Washington Permanente Medical Group. “Home blood pressure monitoring allows you to collect many more readings and average them.”

To conduct the study, researchers used electronic health records to identify potential participants who were at high risk for hypertension based on a recent clinic visit. They then randomly divided the participants into 3 groups based on the method of obtaining blood pressure monitoring measurements: in the clinic, at home, or at kiosks in medical clinics or pharmacies.

In addition to these measurements, each participant received 24-hour ambulatory blood pressure monitoring, or ABPM, the gold standard test for re-diagnosing hypertension. MAPA uses a full upper arm cuff connected to a waist-worn device that is worn continuously for 24 hours and inflates every 20-30 minutes during the day and every 30-60 minutes at night. The ABPM provides the most accurate diagnostic information but is not available for general use. The researchers were able to determine the accuracy of the other 3 methods by comparing their results with the MAPA results.

The study found:

  • Blood pressure readings taken at home were consistent with MAPA
  • Blood pressure readings based on follow-up clinic visits were significantly lower for the systolic measurement, leading to missing more than half of people with hypertension based on ABPM
  • Kiosk blood pressure readings were significantly higher than ABPM-based measurements, leading to a higher likelihood of overdiagnosis of hypertension

“Home blood pressure monitoring was a better option because it was more accurate than in-clinic blood pressure readings,” Dr. Green said. “Furthermore, an additional study found that patients preferred taking their blood pressure at home.” The results of the follow-up study were presented at a meeting on hypertension of the American Heart Association.

The number of people in the United States with undiagnosed hypertension is likely in the millions. A recent analysis published in JAMA estimated that 23% of American adults with high blood pressure were unaware they had the disease and were not receiving treatment.

Proper diagnosis of hypertension can save a patient’s life. When hypertension is identified, doctors usually prescribe medication to lower blood pressure. Left untreated, high blood pressure can cause heart attack, stroke, and kidney damage, among other problems.

Current guidelines for the diagnosis of hypertension recommend that patients who have in-clinic high blood pressure readings undergo another test to confirm the results. Although guidelines recommend ABPM or home blood pressure monitoring before making a diagnosis of hypertension, research shows that providers continue to use the measurement in the clinic at the second reading.

While previous studies have found similar benefits to home blood pressure readings, this may offer the strongest evidence to date due to its large number of participants, involvement in healthcare clinics primary and its use of real-world practitioners to take blood pressure. measures rather than research personnel. In addition, this study is the first to compare the results of kiosks and MAPAs.

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