The impact of changing home blood pressure monitoring cutoff from 135/85 to 130/80 mmHg on hypertension phenotypes

This study investigated the impact of changing abnormal home blood pressure monitoring (HBPM) cutoff from 135/85 to 130/80 mmHg on the prevalence of hypertension phenotypes, considering an abnormal office blood pressure cutoff of 140/90 mmHg. We evaluated 57 768 individuals (26 876 untreated and 30 892 treated with antihypertensive medications) from 719 Brazilian centers who performed HBPM. Changing the HBPM cutoff was associated with increases in masked (from 10% to 22%) and sustained (from 27% to 35%) hypertension, and decreases in white‐coat hypertension (from 16% to 7%) and normotension (from 47% to 36%) among untreated participants, and increases in masked (from 11% to 22%) and sustained (from 29% to 36%) uncontrolled hypertension, and decreases in white‐coat uncontrolled hypertension (from 15% to 8%) and controlled hypertension (from 45% to 34%) among treated participants. In conclusion, adoption of an abnormal HBPM cutoff of 130/80 mmHg markedly increased the prevalence of out‐of‐office hypertension and uncontrolled hypertension phenotypes. Several studies published in last decade have suggested that abnormal home blood pressure monitoring (HBPM) levels should be considered when ≥130/80 mmHg rather than ≥135/85 mmHg. Shifting the HBPM cutoff from 135/85 to 130/80 mmHg and keeping the office abnormal cutoff at 140/90 mmHg led to a twofold increase in the prevalence of masked hypertension phenotypes, an approximate 50% decrease in the prevalence of white‐coat hypertension phenotypes, and increased the detection of sustained hypertension phenotypes and decreased the detection of normotension and controlled hypertension.