The Role First-Day Readings Play in a 3-Day Schedule of Self-Monitoring Home Blood Pressure Based on Prognostic Data. VAMPAHICA Study

Abstract

Background: The optimal schedule for self-monitoring home BP (SMHBP) readings is enormously important in the diagnosis of different phenotypes related to hypertension. The aim of this study was to determine the prognostic capacity of a 3-day SMHBP schedule when using or suppressing the first-day measurements in compiling the results.

Methods: A total of 767 newly diagnosed, nontreated patients with no history of cardiovascular disease (CVD) were followed for 6.2 years. As a baseline, office BP measurements were taken for all the patients who then went on to follow a 3-day SMHBP schedule, taking 2 readings in the morning and 2 in the evening. The prognostic calculation was performed with CVD variables. The prognostic capacity of the 3-day schedule was evaluated with and without the first-day readings (12 and 8 readings).

Results: A total of 223 normotensive subjects (NT), 271 subjects with sustained hypertension (SHT), and 184 white-coat hypertensive subjects (WCH) were followed. The distribution of 98 (14.4%) nonfatal CV events during the follow-up was as follows: WCH 21 (11.4%), NT 9 (4.0%), and SHT 68 (25.1%). No statistically significant differences were observed in the risk of CV events (OR) for the 2 groups of hypertensives, irrespective of the schedule of readings used (SHT with vs. without first-day readings: 8.81 (4.28-18.15) vs. 8.61 (4.15-17.85) and WCH with vs. without first-day readings: 2.71(1.13-6.47) vs. 3.40 (1.49-7.78)).

Conclusions: Our findings show that first-day readings do not need to be discarded in order to calculate the final value of an SMHBP schedule.

Keywords: blood pressure; cardiovascular morbidity; hypertension; reading schedule; self-monitoring home blood pressure; white coat hypertension.