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Measurement of home blood pressure by hypertensive individuals is gaining acceptance as a supplement to office readings, although guidelines for the timing of home blood pressure (HBP) monitoring is contradictory. We compared morning and evening home blood pressure measurements at the beginning(proximal,day1-5) and end(distal, day 25-30) of a one month monitoring period with an ambulatory blood pressure monitor(ABPM) performed within that month to acertain the optimal timing for home measurements in a middle aged cohort of women taken from the MAP study. The cohort includes both african american (n 42)and caucasian(n 58) women. Data for HBP readings were retrieved from weekly mailed-in reports provided by women on treatment for hypertension who were recruited for a larger sudy on cognition and adherence, the MAP Trial. Results: Cohort Mean ABPM: SBP 132,SD 13; DBP 76,SD 9.39;clinic blood pressure(CBP) mean(avg. of two readings)SBP 132,SD 20.30;DBP 80,SD 10.97. Correlation between 24 hour ABPM mean and CBP readings was moderate(r .59,p .005 for SBP;r .62,p .005 for DBP).Comparing correlation results for 24 hour ABPM mean and proximal and distal HBP(day and evening)readings revealed moderately strong associations: r .67/.62/.71/.60,p .005 for SBP, and r .62/.66/.65/ .54,p .005)for DBP, respectively. Daytime proximal HBP DBP readings showed the greatest correlation difference between CBP according to age(r 58 for younger(30-60) and r .70 for older(60-80)).Evening proximal HBP DBP were different for caucasian women(r .72;p .005) vs. African American (r .54,p .000). A significantly weaker correlation was shown between CBP and evening proximal HBP DBP readings in subjects with higher education than for those with less (r .75, p .05 vs. r .27,p .125). Based on correlations with ABPM ,these results support research that electronic devices provide reliable measures for home readings.The lack of correlation with clinic blood pressures and home readings in those with higher educational levels will need to be confirmed in larger sudies. These findings also suggest need for analyses to explore other situational factors impacting on proximal and distal home blood pressure. Larger studies are needed to explore the optimal timing of HBP in women,and better define optimal timing in relation to ethnicity and age, as well as correlates of home blood pressure to morbidity and mortality.

Comparison of ambulatory blood pressure measurement, clinic, and morning and evening home blood pressures in a cohort of middle aged women