Abstract 13199: Home Blood Pressure Monitoring Among Us Adults Without Hypertension: How Do Existing Patient and Physician Behaviors Correspond to Current Recommendations?

Introduction: Home blood pressure monitoring (HBPM) is an option recommended by the 2017 ACC/AHA guidelines to confirm a hypertension diagnosis or identify masked hypertension. Using clinic BP and patient characteristics, the Predicting Out-of-Office BP in the Clinic (PROOF-BP) algorithm can be used to guide HBPM decisions. It is unknown how existing patient use and physician recommendations for HBPM align with current screening recommendations. Methods: We used the 2009-2014 National Health and Nutrition Examination Survey (NHANES) to identify US adults aged ≥20 years without hypertension or antihypertensive medication use. We identified those who would have been recommended to undergo HBPM by ACC/AHA guidelines as those with a mean BP 120-159/<100 mm Hg and by the PROOF-BP algorithm as those with a predicted out-of-office BP 125-134/75-84 mm Hg. We required individuals to have complete data needed for the PROOF-BP algorithm (demographics, BP, smoking, alcohol use, kidney disease) and reported HBPM actual/recommended use. All analyses were weighted to be representative of the US population. Results: We included 7,185 NHANES adults without hypertension; weighted mean (SE) age was 41.5 (0.3) years, 48% female, and mean BP 117.0 (0.3)/70.4 (0.3) mm Hg. Overall, 50.3% of adults without hypertension would have been recommended to undergo HBPM by ACC/AHA guidelines and 29.7% by PROOF-BP ( Table ). Only 13.3% of those recommended HBPM by ACC/AHA guidelines used or were told to use HBPM, compared to 11.5% of those not recommended screening. Similar results were seen among those recommended HBPM by PROOF-BP ( Table ). Conclusions: Our analysis shows that prior to 2017 guidelines, a substantial proportion of US adults may have had their hypertensive status misclassified due to a lack of HBPM or undergo unnecessary monitoring. These findings suggest an opportunity for clinicians and health systems to more clearly target HBPM to those who need it given guidelines currently in use.