A9728 Comparison of awake home blood pressure using evening measurements to measurement done before bedtime in Malaysian hypertensive patients

Objectives: Studies have reported that home blood pressure (HBP) is a better predictor of cardiovascular mortality and morbidity than office blood pressure (BP). Guidelines recommend averaging the morning and evening HBP measurements to derive the mean awake BP. However recommendation in guidelines regarding the timing of evening HBP measurements is not consistent. Furthermore it is not convenient for most patients to measure the evening HBP before dinner. Hence this study aimed to compare the mean awake HBP when done in the morning and evening to HBP done in the morning and before going to bed. Methods: This is a cross-sectional study of 306 hypertensive patients in a primary care setting in Malaysia. A convenience sampling method was used to recruit patients. Patients were educated according to the standard guidelines on how to measure HBP using a validated oscillometric BP device. Two consecutive BP measurements were taken three times a day (morning, evening before dinner and at bedtime) for seven days. After excluding the measurements of the first day, the remaining measurements were used to derive the mean awake BP. Paired t-test was used for analysis. Results: The mean age of the population was 67 ± 10 years, 46.6% were males. The mean morning HBP was 129.5 mm ± 15 mmHg; mean evening BP taken before dinner was 126.9 ± 14.3 mmHg and bedtime 125.7 ± 15.9mmHg. The mean awake BP using morning and evening was 128.0 mmHg compared with 127.5 mmHg based on morning and bedtime readings, a difference of 0.5 mmHg (p = 0.13). Conclusion: There is no difference in awake HBP whether it is measured in the evening or before bedtime. For convenience of the patients, it would appear to be acceptable the HBP to be done before bed instead of the recommended time of evening before dinner.