Comparison of Home Blood Pressure Monitoring with and without Training: Does Adherence to the Recommended Instructions Overlook Hypertension?

Home blood pressure monitoring (HBPM) is commonly used to diagnose hypertension (HT), with a diagnostic threshold of ≥135/85 mm Hg, the same as daytime ambulatory BP monitoring (ABPM). This study hypothesizes that training and adherence to HBPM guidelines will yield more accurate BP readings compared to ABPM. The study involved 129 patients with elevated office BP but no prior HT diagnosis. After a two-week observation period with lifestyle advice, HBPM was conducted over a week before and after structured measurement training, with ABPM performed in each period. Adherence to instructions post-training was also assessed. Post-training, mean systolic and diastolic home BP values significantly decreased (from 128 ± 13.1/84.9 ± 8.2 to 122.6 ± 12.7/81.8 ± 7.8; P < 0.001 for both), while daytime ABPM values remained unchanged (131.7 ± 11.1/86.7 ± 9.3 before vs. 130.7 ± 11.7/85.9 ± 8.6 after; P = 0.185). Although HBPM values were consistently lower than ABPM values, the discrepancy grew post-training. The number of patients reaching the HT threshold via HBPM decreased significantly post-training [71 (55%) to 54 (41.9%); P = 0.006], whereas the number via daytime ABPM remained similar [82 (64.3%) vs. 84 (65.1%); P = 1.000]. Training and adherence to HBPM guidelines led to lower BP readings and fewer HT diagnoses. Contrary to the hypothesis, this method under "ideal conditions" underestimated HT prevalence when compared to daytime ABPM. Further studies with clinical endpoints are needed to refine HBPM methods and establish new BP thresholds for more accurate HT detection.