Feasibility, reliability and safety of self-assessed orthostatic blood pressure at home

Abstract

Abstract Background A postural blood pressure assessment is required to diagnose Orthostatic Hypotension. With increasing remote consultations, alternative methods of performing postural blood pressure assessment are required. Objective Determine whether postural blood pressure measurement at home, without a clinician, is reliable, feasible and safe. Design Service improvement project within a falls and syncope service in Northeast England. Subjects Eligibility criteria: aged ≥60 years; postural blood pressure measurement is indicated and is physically and cognitively able to perform. Exclusion criteria: nursing home residents, attending clinic in person. Methods Postural blood pressure measurements were performed in patients’ homes under clinical observation. Patient-led assessments were performed independent of the clinician, following written guidance. This was followed by a clinical-led assessment after 10-minute supine rest. Outcomes Agreement between patient and clinician derived postural blood pressure values and diagnosis of Orthostatic Hypotension; intervention safety, feasibility and acceptability. Results Twenty-eight patients were eligible and 25 participated (mean age 75, median Clinical Frailty Score five). There was 95% agreement (Cohen’s kappa 0.90 (0.70, 1.00)) between patient and clinician derived readings to diagnose orthostatic hypotension. Postural systolic blood pressure drop correlated strongly (r = 0.80), with patient derived readings overestimating by 1 (−6, 3) mmHg. Limits of agreement, determined via Bland Altman analysis, were +17 and −20 mmHg, greater than pre-determined maximum clinically important difference (±5 mmHg). Twenty participants performed valid postural blood pressure assessments without clinical assistance. Conclusions Patient-led postural blood pressure assessment at home is a reliable, safe and acceptable method for diagnosing Orthostatic Hypotension.