Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Optimal schedule for home blood pressure monitoring based on a clinical approach Jouni K. Johansson, Teemu J. Niiranen, Pauli J. Puukka and Antti M. Jula Objective The aim of this study was to determine the optimal schedule for home blood pressure (HBP) measurement based on a clinical approach. Methods Four hundred and sixty-four participants underwent HBP measurement for 7 days (duplicate measurements in the morning and in the evening), ambulatory blood pressure (ABP) monitoring, and measurement of target organ damage (echocardiography and microalbuminuria). To evaluate the optimal schedule for HBP measurement, correlations of HBP with ABP and HBP with indicators of target organ damage were calculated. Results HBP decreased slightly (day 1, 129.9/85.3 mmHg; day 7, 128.6/84.8 mmHg), whereas the association between HBP and ABP or target organ damage increased with the cumulative number of measurements. The highest correlations were obtained by using the mean of all 28 measurements, although no major increase occurred after day 4. There was no change in the correlations when the measurements performed during the first day were discarded. Morning and evening HBP correlated equally well with ABP and microalbuminuria. The mean of the first measurements on each measurement occasion was 2.3/1.2 mmHg higher (P < 0.001 for both) than the mean of the second measurements, but discarding the first measurements did not result in greater correlations. The results were similar in both hypertensive and normotensive populations. Conclusion Duplicate measurements on at least 4 days in the evening and in the morning are needed to reliably estimate an individual’s BP level and the risk for target organ damage. Measurements performed during the first day should not be discarded, as suggested by the current European guidelines. J Hypertens 28:259–264 Q 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins. Journal of Hypertension 2010, 28:259–264 Keywords: ambulatory blood pressure, home blood pressure measurement, self-measurement of blood pressure, target organ damage Abbreviations: ABP, ambulatory blood pressure; ASE, American Society of Echocardiography; BP, blood pressure; HBP, home blood pressure; LVM, left ventricular mass; LVMI, left ventricular mass index Population Studies Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Peltolantie, Turku, Finland Correspondence to Jouni Johansson, MD, Population Studies Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Peltolantie 3, 20720 Turku, Finland Tel: +358 503586060; e-mail: jouni.johansson@utu.fi Received 29 April 2009 Revised 3 September 2009 Accepted 7 September 2009 See editorial comment on page 226 Introduction A reliable estimate of an individual’s blood pressure (BP) level is essential for the assessment of cardiovascular risk. During the last decade, home BP (HBP) measurement has become more widely used in diagnosing and controlling hypertension due to the advent of cheap, simple, and small HBP monitors. In addition, HBP predicts target organ damage, stroke, and mortality better than clinic BP [1– 5]. HBP also offers better reproducibility than clinic BP [6]. Despite the popularity of HBP monitoring, the optimal schedule for HBP measurement is still unclear, as dis- agreement exists between various international guide- lines [7 – 9]. It has been proposed that to define a reliable and reproducible schedule for HBP measurements at least following four questions should be answered: What is the optimal amount of HBP measurements that should be averaged? On how many occasions per day should the measurements be taken? How many measurements per occasion are needed? Should some of the measurements be ignored? [10]. The European Society of Hypertension guidelines and American Heart Association statement for HBP monitor- ing recommend that HBP should be monitored for at least 3 and preferably 7 days, with a minimum of two morning and two evening measurements. The average of all values should be used with the exception of the first day, which should be discarded [9,11]. However, this recom- mendation is mostly based on studies [6,10,12–15] that have examined the optimal schedule for HBP measure- ments on the basis of statistical methods: HBP reprodu- cibility, stability over time, and relationship to ambulatory BP (ABP) monitoring. Clinical data are, of course, a more suitable method than statistical methods for defining the best amount of HBP measurements needed. Only a few studies [16,17] have tried to identify the best frequency of HBP measurements based on prognostic clinical data, and no study has suggested a schedule for HBP measurement based on its association with target organ damage. We suggest that the optimal schedule for HBP measure- ment should be based on a clinical, instead of a statistical, Original article 259 0263-6352 ß 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins DOI:10.1097/HJH.0b013e328332fa5e