Self-measured versus ambulatory blood pressure in the diagnosis of hypertension.
OBJECTIVE
We examined to what extent self-measurement of blood pressure at home (HBP) can be an alternative to ambulatory monitoring (ABP) to diagnose white-coat hypertension.


METHODS
In 247 untreated patients, we compared the white-coat effects obtained by HBP and ABP. The thresholds to diagnose hypertension were > or = 140/> or = 90 mmHg for conventional blood pressure (CBP) and > or = 135/> or = 85 mmHg for daytime ABP and HBP.


RESULTS
Mean systolic/diastolic CBP, HBP and ABP were 155.4/100.0, 143.1/91.5 and 148.1/95.0 mmHg, respectively. The white-coat effect was 5.0/3.5 mmHg larger on HBP compared with ABP (12.3/8.6 versus 7.2/5.0 mmHg; P < 0.001). The correlation coefficients between the white-coat effects based on HBP and ABP were 0.74 systolic and 0.60 diastolic (P < 0.001). With ABP as a reference, the specificity of HBP to detect white-coat hypertension was 88.6%, and the sensitivity was 68.4%.


CONCLUSIONS
Our findings are in line with the recommendations of the ASH Ad Hoc Panel that recommends HBP for screening while ABP has a better prognostic accuracy.
Hond
Elly Den
ED
Study Coordinating Centre, Hypertension and Cardiovascular Rehabilitation Unit, Department of Molecular and Cardiovascular Research, Katholieke Universiteit Leuven, Belgium. elly.denhond@med.kuleuven.ac.be
Celis
Hilde
H
Fagard
Robert
R
Keary
Louis
L
Leeman
Marc
M
O'Brien
Eoin
E
Vandenhoven
Guy
G
Staessen
Jan A
JA
D000328:Adult; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory / Q000523:psychology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D012648:Self Care