Home blood pressure monitoring and the risk of falls in older adults with hypertension: The AMBROSIA-HOME study

Background: Concerns about hypotension and excessive blood pressure (BP) variability leading to falls may be a barrier to achieving BP treatment goals among older adults. Home BP monitoring (HBPM) may allow for better BP management while avoiding falls. Methods: = 541), were instructed in proper HBPM technique and asked to take 2 morning and 2 evening readings for 7 days. Among 499 participants with ≥4 days of HBPM, white coat effect was defined as mean clinic BP minus mean BP on HBPM. Day-to-day variability was calculated using standard deviation independent of the mean (SDIM). Participants reported falls monthly for 1 year. We estimated hazard ratios (HRs) for falls across quartiles of systolic BP on HBPM, white coat effect and SDIM, separately, adjusting for demographic characteristics and chronic conditions. Results: The mean ± SD age of participants was 74.2 ± 6.1 years, and 57.3% were women. Prefrailty and frailty prevalence were 50.7% and 3.4%, respectively. Participants in the highest versus lowest quartile of mean SBP from HBPM were older and more frequently male. Over 379 person-years, 187 participants reported falls. Comparing the highest and lowest quartiles, the HRs (95% confidence interval) were 0.85 (0.53-1.37), 0.84 (0.51-1.40), and 0.97 (0.62-1.51) for mean systolic BP, white coat effect, and SDIM, respectively. There was no evidence of associations between these measures for diastolic BP and falls. Conclusion: BP measured using HBPM was not associated with falls among older US adults with treated hypertension.