Photo Credit: Alena Iagupa

The following is a summary of “Accuracy of Home Blood Pressure Monitoring in Youth: A Systematic Review and Meta-Analysis,” published in the May 2025 issue of Journal of Pediatrics by Cueto et al. 

Researchers conducted a retrospective study to assess the accuracy of home blood pressure monitoring (HBPM) in youth compared with the reference standard of ambulatory BP monitoring (ABPM).   

They systematically searched MEDLINE, Embase, Web of Science, and the Cochrane Library from inception to November 13, 2024, and 2 authors identified studies that tested the accuracy in the youth for HBPM compared with ABPM aged ≤18 years. Outcomes were assessed on a continuous scale (mean difference [MD]) or categorical scale (sensitivity, specificity, κ). A meta-analysis was conducted using hierarchical random effects weights.   

The results showed that out of 2,966 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 using HBPM showed modest sensitivity (0.52-0.64) and high specificity (0.82-0.97), with moderate agreement (κ 0.50-0.65). Higher accuracy was observed for white coat hypertension (sensitivity, 0.77-0.89; specificity, 0.85-0.94; κ, 0.66-0.73), while slightly higher specificity was noted 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 variability in hypertension thresholds and HBPM protocols.   

Investigators concluded that while the accuracy of HBPM may not have been sufficient to replace ABPM as a single test, it could serve as a practical alternative when ABPM was unavailable, especially when clinic and home BP were concordant. 

Source: jpeds.com/article/S0022-3476(25)00173-8/abstract