The importance of experience: insights into optimal home-blood pressure monitoring regimens from the TASMINH4 Trial.

OBJECTIVES

This study investigates how prior home blood pressure monitoring (HBPM) experience affects blood pressure variability and evaluates if reduced HBPM regimens could be recommended for experienced patients.

METHODS

This posthoc analysis of the TASMINH4 trial included self-monitored blood pressure (BP) data from 225 patients. The standard deviation of systolic BP recordings was calculated for each patient-week to assess how BP variability changes with HBPM duration. A subgroup of 84 patients, who submitted at least 1 reading a day for 7 days at months 1, 3, and 6, was analysed to assess the impact of reduced HBPM regimens on BP estimates.

RESULTS

Day 1 readings were significantly higher than day 2-7 in the first 3 months of HBPM: 1.1 (95% CI 0.4, 1.8) day 1 vs. day 2. This effect diminished after 6 months: 1.0 (95% CI -0.8, 2.8) day 1 vs. 2. Long term monitoring significantly reduced intra-week BP variability, with the standard deviation of systolic BP recordings within each patient-week significantly reduced after 6 months. After 6 months of HBPM, the inclusion of day 1 readings or use of an abbreviated monitoring regimen had a reduced impact on estimates of mean systolic and diastolic blood pressure.

CONCLUSIONS

Long-term HBPM reduces intra-week BP variability, making day 1 readings insignificantly raised after 6 months of HBPM. This provides rationale for different HBPM recommendations: longer regimes, excluding day one readings, for diagnosis and short-term monitoring; and abbreviated regimes including day 1 for longer term monitoring in those with HBPM experience.