Jul 2026· American Journal of Hypertension· 0 citations
Medicine
TL;DR
In this community-based cohort of older adults, HBPM provided stable BP estimates within three days (can be non-consecutive within an 8-day period) using morning and evening sessions with ≥2 readings each, supporting shorter, less burdensome HBPM protocols in clinical guidelines for hypertension management in older adults.
Abstract
Background
Current clinical guidelines recommend home blood pressure monitoring (HBPM) to confirm hypertension diagnosis, guide therapy, and support long-term control. However, the optimal number of HBPM measurements needed for valid assessment is not established.
Methods
At ARIC Visit 10 (2023), participants completed an eight-day HBPM protocol with morning and evening measurements and three readings per session. We evaluated the validity between the eight-day mean (reference) and streamlined protocols (fewer days, less than three readings per session, or only morning or evening measurements). In secondary analyses, we assessed the validity of these HBPM protocols relative to ambulatory BP.
Results
Among 812 participants (median age 83 years, 24% Black adults, 40% male, 84% using anti-hypertensive medications), median BP varied by less than 3 mmHg across the eight-day protocol. The greatest improvement in HBPM validity occurred when extending the averaging window from one to two days. By three days, concordance correlation coefficients exceeded 0.95, and ≥97% of participants were within 10 mmHg of the reference for both systolic and diastolic BP. Averaging ≥2 readings per session, including both morning and evening measurements, yielded greater validity than a single reading or timepoint.
Conclusions
In this community-based cohort of older adults, HBPM provided stable BP estimates within three days (can be non-consecutive within an 8-day period) using morning and evening sessions with ≥2 readings each. While further studies are required to validate generalizability beyond this engaged cohort, these findings support shorter, less burdensome HBPM protocols in clinical guidelines for hypertension management in older adults.
The results of the CareBP study show the extended value of 14 days of individual blood pressure monitoring and underline the relevance of this approach for cardiovascular disease prevention.
Nighttime SBP variability (SD) from ABPM independently predicts subclinical TOD and guides organ protection in hypertension and subclinical TOD prediction in hypertension is confirmed.
Objective Blood pressure (BP) variability provides prognostic information beyond mean BP. However, the class‐specific associations of antihypertensive medications with BP variability remain uncertain, and few studies have directly contrasted home and office BP variability within the same patients while accounting for the white‐coat effect. Methods In a multicenter prospective registry, patients with hypertension and adequate measurements (≥ 10 home and ≥ 5 office readings) were analyzed. The primary outcomes were systolic and diastolic average real variability (ARV) of home and office BP. Associations of renin–angiotensin system inhibitors, beta‐blockers, dihydropyridine calcium channel blockers (DHP‐CCBs), and diuretics with BP variability were estimated using inverse probability of treatment weighting (IPTW) and doubly robust models. The white‐coat effect was further adjusted using both a continuous office‐home mean difference and a guideline‐based white‐coat definition. A true‐monotherapy subcohort sensitivity analysis and class‐by‐class interaction tests were additionally performed. Results Among 495 participants, home ARV differed minimally by antihypertensive class; a small beta‐blocker‐associated increase in home systolic BP (SBP)‐ARV was attenuated with additional adjustment. In contrast, office BP ARV was higher with DHP‐CCBs and diuretics, although the beta‐blocker association was weakened after further adjustment. Following white‐coat effect adjustment, home BP ARV remained neutral across drug classes, whereas DHP‐CCB remained associated with higher office SBP‐ARV and diuretics with higher office diastolic BP ARV. DHP‐CCBs were also associated with a lower probability of office BP control. Home BP control rates did not differ significantly by antihypertensive class. Conclusions In this cross‐sectional observational cohort, antihypertensive medication classes showed context‐dependent associations with BP variability, which were minimal for home BP but more pronounced for office BP, partially independent of the white‐coat effect. Given potential residual confounding by indication, these hypothesis‐generating findings warrant prospective confirmation.
D. Cho, Mi-Na Kim, J. Cha et al.· International Journal of Hyp...· 0 citations
The May Measurement Month (MMM) campaign was conducted in Oman in 2023 to raise awareness of raised blood pressure (BP). Adults aged ≥18 years were recruited through convenience sampling at hospitals, clinics, workplaces, and public spaces in eight regions of Oman. Three seated BP readings were taken on each participant, and a questionnaire collected information on demographics, lifestyle factors, and comorbidities. Hypertension was defined as a systolic BP ≥140mmHg or diastolic BP ≥90mmHg or being on BP-lowering medication. Controlled BP was defined as being on BP-lowering medication with a BP <140/90mmHg. Multiple imputation was used to estimate missing BP readings. In total, 3,114 were screened, with a mean age of 40.1 years and 38.4% of whom were female. Of all participants, 1,010 (32.4%) had hypertension, of whom 421 (41.7%) were aware, and 389 (38.5%) were on antihypertensive medication. Of those on antihypertensive medication, 221 (56.8%) had controlled BP, and of all participants with hypertension, 21.9% had controlled BP.
The MMM campaign in Oman identified a substantial number of participants with untreated or inadequately treated hypertension. These findings highlight persistent gaps in the awareness, identification, and management of hypertension across Oman. The MMM campaigns emphasise the need for broader community screening, targeted educational initiatives, and system-level strategies to improve hypertension control and reduce cardiovascular risk.
Mahfoudha Al Shezawi, Saed Al Bimani, Asaad Al Toubi et al.· European Heart Journal, Supp...· 0 citations
Hypertension is a major contributor to cardiovascular morbidity and mortality. Ambulatory blood pressure monitoring (ABPM) complements office blood pressure measurement by detecting white-coat hypertension, masked hypertension, and nocturnal blood pressure abnormalities, and this study aimed to assess its diagnostic value in the management of hypertension in private cardiology practice in Senegal. A prospective, descriptive, and analytical study was conducted from July to September 2024 at Clinique Urgence Cardio in Dakar, including patients aged 18 years or older with a valid 24-hour ABPM recording. Clinical, anthropometric, and treatment data, together with cardiovascular risk factors, were collected; office and ambulatory blood pressure measurements were compared; and logistic regression was used to identify factors associated with discordance between the two methods. Of the 104 patients assessed, 97 had valid ABPM recordings. The mean age was 53.2 ± 14.1 years, and women predominated. Cardiovascular risk factors included abdominal obesity (77.3%), known hypertension (54.6%), physical inactivity (43.3%), dyslipidemia (37.1%), and diabetes (16.5%). Mean office blood pressure was 145.7/91.4 mmHg, compared with 130.5/80.2 mmHg over 24 hours, 134.4/82.4 mmHg during daytime, and 125/75 mmHg during nighttime. ABPM identified sustained hypertension in 53.61% of patients, white-coat hypertension in 18.56%, masked hypertension in 9.28%, and normotension in 18.56%, with overall agreement between office and ambulatory measurements of 72.2%. Among patients with elevated office blood pressure, 25.7% had white-coat hypertension, while 33.3% of those with normal office blood pressure had masked hypertension. Non-dipping and reverse-dipping patterns were observed in 45.4% and 19.6% of patients, respectively, and discordance was independently associated with alcohol consumption (OR = 5.08; p = 0.007). ABPM improves the diagnostic classification of hypertension and reveals a high prevalence of discordant phenotypes and nocturnal blood pressure abnormalities, and wider use of ABPM may help optimize patient management in this setting.
N. Gaye, J. Mingou, Coumba Kaba et al.· Cardiology and Cardiovascula...· 0 citations
OBJECTIVE/BACKGROUND
Home blood pressure monitoring (HBPM) has become the standard of care for diagnosing hypertension - the most prevalent comorbidity of obstructive sleep apnea (OSA) - and for monitoring blood pressure response to treatment. Connected devices have been used in recent studies to monitor blood pressure in patients with OSA initiated on continuous positive airway pressure (CPAP). We compared the respective evolution of HBPM completion rate and CPAP adherence rate in the first six months of treatment.
PATIENTS/METHODS
98 patients were prospectively included, and were asked to record 6 daily HBPM measurements. CPAP adherence was obtained using telemonitoring. HBPM completion rates and CPAP adherence rates were monthly calculated. A Mann- Kendall test was performed to describe the changes in rates and adjusted linear mixed models were used to assess the association between these two rates.
RESULTS
HBPM completion rate significantly decreased from 44% during the 1st month to 19% at six months. CPAP adherence rate significantly increased from 35% the 1st month to 41% at six months. A similar decrease of HBPM completion rate was shown among different patients' profiles. Linear mixed models showed that an increase in CPAP adherence rates of 1% was associated with an increase in HBPM completion rates of 0.17% [0.08; 0.25].
CONCLUSION
The use of HBPM device decreased regardless the patients' clinical phenotype, whereas adherence to CPAP increased slightly. The positive association between the two rates was modest and non-clinically significant suggesting a limited interaction between the use of the two connected devices.
O. Coiffier, Sébastien Bailly, M. Joyeux-faure et al.· Sleep Medicine· 0 citations