Abstract Body: Background Home blood pressure monitoring (HBPM) is increasingly used as a more accessible alternative to office blood pressure (BP). However, agreement between office and home BP among very old adults has not been characterized.
Objective To identify clinical factors related to discordance between office and home BP among very old adults.
Methods ARIC participants underwent 3 office BP measures, using an Omron HEM907XL after a 5-minute rest with a 60-second pause interval (2023). In addition, using Omron Series 10 BP7450, participants measured BP three times at home in the morning and evening after a 5-minute rest with a 60-second pause interval over an 8-day period. We subtracted mean home systolic BP (SBP) from mean office SBP to determine discordance and characterized it via Bland-Altman plots. We used adjusted linear regression to determine whether age, sex, obesity, diabetes, frailty, or hypertension medications, were associated with discordance.
Results Among 776 participants (59.3% female; mean age 84.1±3.9 [SD] years), we observed no difference between office and home SBP; however, bias increased with higher mean SBP (Figure, Panel 1). Compared to home, office SBP was significantly lower among the oldest, male, and frail participants, and higher among female and robust participants (Figure, Panel 2).
Conclusion In this population of very old adults, office and HBPM generated similar estimates of resting SBP. Nevertheless, resting SBP, sex, and frailty may result in discordant measures that could influence treatment decisions. Comprehensive BP monitoring, including office and HBPM, may be necessary for accurate hypertension diagnosis and management in these subgroups of very old adults.