Introduction: Engagement with home blood pressure monitoring (HBPM) usually declines over time; however, published studies have not described inter-individual variability of HBPM behaviors. We aimed to describe different 1-year patterns of HBPM behaviors, identify predictors of those patterns, and examine the association of HBPM behaviors with BP levels over time. Methods: We analyzed BP records from the Health eHeart (HeH) Study, an ongoing prospective e-cohort study, limiting our analysis to participants with a wireless consumer-purchased device that transmitted date-and time-stamped BP data to the HeH server through a full 12 months of observation starting from the first day they used the device. Participants received no instruction on device use. We applied clustering analysis to identify 1-year HBPM patterns. Results: The sample (N=2099) had a mean age of 52.0±12.0 years and BMI of 28.9±6.5 kg/m ² ; most were male (89.1%) and White (88.6%). Using clustering algorithms, we found that a model with three patterns fit the data well (Figure); 69.7% were Sporadic Users, 21.2% were Weekly Users, and only 9.1% were Daily Users. Daily Users were older, unemployed, lower income, and more likely to have diabetes, coronary heart disease, and a history of myocardial infarction (p<.05 for all). Daily Use was also associated with lower BP levels that remained persistently lower than the Weekly or Sporadic Users throughout the year (estimated mean ± standard error, respectively: SBP: 126.2±0.8 vs.128.8±0.5 vs.128.3±0.3, p=.036; DBP: 76.3±0.6 vs. 80.2±0.4 vs. 79.9±0.2, p<.001). Conclusion: We identified 3 distinct HBPM use patterns, with nearly 10% sustaining a daily use pattern that was associated with lower BP levels despite being in socially and medically higher risk groups.