Optimizing home blood pressure monitoring protocols in older adults: The Atherosclerosis Risk in Communities study

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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 a valid assessment is not established. Methods: At ARIC Visit 10 (2023), participants completed an 8-day HBPM protocol with morning and evening measurements and 3 readings per session. We evaluated the validity between the 8-day mean (reference) and streamlined protocols (fewer days, less than 3 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 mm Hg across the 8-day protocol. The greatest improvement in HBPM validity occurred when extending the averaging window from 1 to 2 days. By 3 days, concordance correlation coefficients exceeded 0.95, and ≥97% of participants were within 10 mm Hg 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 3 days (including non-consecutive measurements 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.
Funding Information
  • National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health, and Human Services (75N92022D00001)
  • National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health, and Human Services (75N92022D00002)
  • National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health, and Human Services (75N92022D00003)
  • National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health, and Human Services (75N92022D00004)
  • National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health, and Human Services (75N92022D00005)

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