Differences of blood pressure measured at clinic versus at home in the morning and in the evening in europe and asia: a systematic review and meta-analysis

Objective: Although the comparison of clinic blood pressure (BP) and home BP has been investigated, the differences between clinic BP and home morning/evening BP were poorly explored. Thus, we perform the systematic review to determine the quantitative differences of BP measured at clinic versus at home in the morning and in the evening in Europe and Asia.Design and method: PubMed, Embase and Scopus databases were searched up to October 2021. Studies that compared clinic BP with home morning and (or) home evening BP with detailed BP values in European and Asian populations were included. Random effect model was applied to pool the differences between clinic BP and home morning/evening BP. Results: Thirty-five studies, for a total of 49432 patients, were included in the meta-analysis. Mean clinic systolic BP (SBP) values were significantly higher than home morning SBP values by 3.79 mmHg (95% CI, 2.77–4.80). The differences were much larger in Europe [(6.53 mmHg (95% CI, 4.10–8.97)] than in Asia [(2.70 mmHg (95% CI, 1.74–3.66)], and region was a significant predictor for the differences. Mean clinic SBP values were also significantly higher than home evening SBP values by 6.59 mmHg (95% CI, 4.98–8.21). The differences were much smaller in Europe [5.85 mmHg (95% CI, 3.24–8.45)] than in Asia [7.13 mmHg (95% CI, 4.92–9.35)], while age and clinic SBP might contribute to it. Conclusions: The difference between clinic and home morning SBP was much larger in European than Asian populations, whereas the difference between clinic and home evening SBP was the opposite. The differing characteristics of region, ethnic, age and clinic BP might explain the diversities.