Accuracy of Home Blood Pressure Monitoring in Youth: A Systematic Review and Meta-Analysis.

Abstract

To evaluate the accuracy of home blood pressure monitoring (HBPM) in youth compared with the reference standard of ambulatory BP monitoring (ABPM). MEDLINE, Embase, Web of Science, and Cochrane Library were systematically searched from inception to November 13, 2024. Two authors identified studies testing the accuracy of HBPM compared with ABPM in youth ≤18 years. We assessed outcomes on the continuous scale (mean difference [MD]) or categorical scale (sensitivity, specificity, κ). We conducted a meta-analysis using hierarchical random effects weights. Of the 2966 titles screened, 26 studies were included (total n = 1992 patients, median 59 per study). Daytime home BP was lower than awake ambulatory BP (systolic MD, -6.4 mmHg [95% CI, -10.7 to -2.0]; diastolic MD, -3.3 mmHg [95% CI, -6.0 to -0.7]). Diagnosing daytime ambulatory hypertension by HBPM had modest sensitivity (0.52-0.64) and good specificity (0.82-0.97), with moderate agreement (κ 0.50-0.65). Accuracy was higher for white coat hypertension (sensitivity, 0.77-0.89; specificity, 0.85-0.94; κ, 0.66-0.73) and specificity was slightly higher for masked hypertension (sensitivity, 0.23-0.38; specificity, 0.92-0.96; κ, 0.27-0.36). Nocturnal home BP was higher than asleep ambulatory BP (systolic MD, 2.6-5.0 mmHg; diastolic MD, 2.2-3.2 mmHg) with moderate agreement (κ, 0.33-0.49). Limitations included different hypertension thresholds and HBPM protocols. The accuracy of HBPM may not be sufficient to replace ABPM as a single test. However, HBPM may be a practical alternative when ABPM is not available, particularly when clinic and home BPs are concordant. Future work is needed to determine the best approach to HBPM in clinical practice.