Comparative Analysis of Recommendations for Timingand Frequency of Home Blood Pressure Monitoring in Clinical Practice Guidelines

Abstract

Objective To compare and analyze the recommendations for the timing and frequency of home blood pressure monitoring (HBPM) in clinical practice guidelines to help clinicians select the best recommendations and provide suggestions for the development of recommendations in the future. Methods Clinical practice guidelines related to hypertension published in the last five years were systematically searched and screened, and the recommendations for the timing and frequency of HBPM were extracted for statistical analysis. Results A total of 21 guidelines developed by institutions in 16 countries or regions were included, containing recommendations related to the timing and/or frequency of HBPM. For the HBPM timing, all guidelines recommend that blood pressure measurements be taken twice a day, in the morning and evening. In the morning blood pressure should be measured before taking antihypertensive medication (94.4%, 17/18), before breakfast (72.2%, 13/18) and after urination (55.6%, 10/18), while in the evening it should be taken before dinner (50.0%, 8/16), before bedtime (37.5%, 6/16) or 2 hours after dinner (6.3%, 1/16).For HBPM frequency, 9 (40.9%, 9/22) guidelines recommend at least 3 consecutive days of measurement in the week before the visit, and others suggest that measurements should be taken consecutively for at least 4 d (18.2%, 4/22), 5 d (13.6%, 3/22) or 7 d (27.3%, 6/22) days. Conclusions The guidelines of different countries and regions have great differences in recommendations on the timing and frequency of HBPM. It is recommended that future guideline developers develop the best recommendations after a thorough search, evaluation, and synthesis of the evidence, with full consideration of the balance of pros and cons, feasibility, patient preferences and values, as well as the context in which the guidelines are implemented.

Keywords

• hypertension guidelines
• home blood pressure monitoring
• recommendations