Agreement Between Different Types of Blood Pressure Monitoring A Systematic Review and Network Meta-analysis

Background: Accurate blood pressure measurement (BPM) is essential for managing hypertension, but previous studies have not systematically compared different monitoring methods across varying BP levels. To address this gap, a comprehensive analysis using network meta-analysis (NMA) and meta-regression was done to evaluate their agreement and clinical implications. Purpose: To compare BP values obtained using different BPM methods using office BPM (OBPM) as the reference. Data Sources: Studies published in MEDLINE and Scopus up to October 2024. Study Selection: Studies aimed to compare the values between BPM methods in participants older than 18 years. Data Extraction: Risk of bias was assessed on the basis of the internal validity of the study overall and the quality of the BPM methods. The mean differences between BPMs were calculated using NMA and meta-regression. Data Synthesis: Sixty-five studies encompassing 40 022 participants were analyzed. Compared with research office systolic BPM, the pooled mean differences from corresponding systolic BPs were 2.69 mm Hg (95% CI, −0.13 to 5.51 mm Hg) higher for convenient OBPM, 4.57 mm Hg (CI, 2.54 to 6.60 mm Hg) lower for automated OBPM, 4.59 mm Hg (CI, 2.83 to 6.34 mm Hg) lower for home BPM, 4.22 mm Hg (CI, 2.62 to 5.82 mm Hg) lower for daytime ambulatory BPM (ABPM), 18.14 mm Hg (CI, 16.21 to 20.06 mm Hg) lower for nighttime ABPM, and 8.63 mm Hg (CI, 6.97 to 10.28 mm Hg) lower for 24-hour ABPM. Differences varied by reference research OBPM levels: Higher reference BP levels are associated with larger differences between research office and other BPM methods. Limitation: Heterogeneity due to the inclusion of studies with different research designs. Conclusion: Our analysis found differences among BPM methods that varied from the recommendations of current hypertension guidelines. Furthermore, discrepancies were more pronounced at elevated BP levels.