Home Blood Pressure Measurements are Predictive of Heart Disease
A review in the Annals of Internal Medicine shows convincing, but not finite proof, that home blood pressure measurements are predictive of heart disease. Would it be safe to assume that mobile home blood pressure measurements will present with the same results?
Blood pressure measured by office mercury sphygmomanometry is known to be associated with cardiovascular outcomes (130). We compared Ambulatory Blood Pressure Measurments (ABPM) and Home Blood Pressure Measurements (HBPM )with manual office methods and found that systolic ABPM consistently and statistically significantly predicted stroke and other cardiovascular outcomes independently of Office Blood Pressure Measurements (OBPM). In an exploratory, comparative meta-analysis (n = 13 906), we found no apparent difference among 24-hour, daytime, and nighttime ABPM protocols within our included evidence base. Our results were similar to those of a systematic review by the National Institute for Health and Care Excellence (131), which concluded that ABPM was superior for predicting clinical outcomes, with no protocol favored in a qualitative review of the data (n > 17 621). However, we did not evaluate certain outcomes (such as angina or revascularization) or populations with comorbid conditions (such as diabetes or kidney disease) and only included studies conducted in countries rated “very high” on the Human Development Index. Two other large meta-analyses (one that included 13 843 hypertensive patients [132] and one that analyzed 23 856 hypertensive patients and 9641 randomly recruited persons [133]) reported that nighttime systolic ABPM was a stronger predictor of cardiovascular events than daytime ABPM or OPBM. Evidence gaps suggested by these conflicting meta-analyses include the influence of treatment and age (133) and of composite outcomes and population composition on the predictive values of 24-hour, daytime, and nighttime ABPM. We also found that systolic HBPM predicted cardiovascular outcomes in a pattern similar to that of ABPM; however, too few studies were available to allow us to draw firm conclusions about HBPM.