Which measurement of home blood pressure should be used for clinical evaluation when multiple measurements are made?
OBJECTIVE
We evaluated which home blood pressure (BP) measurement was most useful in clinical evaluation when we measured it three times per sitting.


METHODS
Home BP measurements in the morning and evening were performed for 7 days in 572 volunteers (384 men, 188 women, mean age 41.2 years) in 2002 (period 1) and 2003 (period 2). Five sets of measurements were analyzed: A, mean of the first; B, mean of the second; C, mean of the first and second; D, mean of the second and third; and E, mean of all measurements. By analyzing BP in five sets in both periods, their reproducibility was examined.


RESULTS
For all five sets of measurements, little difference was found when BP readings were compared between both periods [the differences were -0.6 +/- 6.7 to -0.4 +/- 7.0 mmHg for morning systolic BP (SBP), 0 +/- 4.9 to 0.3 +/- 5.0 mmHg for morning diastolic BP (DBP), -0.1 +/- 7.1 to 0.1 +/- 7.0 mmHg for evening SBP, and 0.1 +/- 5.3 to 0.4 +/- 5.4 mmHg for evening DBP]. Furthermore, BP readings between both periods correlated well; the correlation coefficients were 0.90-0.92 for morning BP and 0.86-0.89 for evening BP. In addition, the concordance rates of three BP categories (normotension, borderline and hypertension) were excellent using morning home BP (kappa coefficient 0.64-0.68) in all five sets, and higher than those using evening home BP (0.52-0.57).


CONCLUSIONS
This study has shown that even one measurement on each occasion is as useful as several measurements when 7 consecutive days of home BP measurements are used for clinical evaluation.
Kawabe
Hiroshi
H
Health Center, Keio University, Tokyo, Japan. kawabe-h@viola.ocn.ne.jp
Saito
Ikuo
I
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D001795:Blood Pressure Determination / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D018401:Sample Size; D012648:Self Care / Q000379:methods*
D000959:Antihypertensive Agents