title: Level of blood pressure control in a hypertensive population when measurements are performed outside the clinical setting.
abstract: BACKGROUND
  To determine whether the number of optimally controlled hypertensive patients is higher using self-measurement of blood pressure at home and ambulatory monitoring, compared to using conventional blood pressure measurements at the doctor's office.
  
  
  METHODS
  An observational, cross-sectional, multicentre, descriptive study of a random sample of 237 primary health care patients, known to be hypertensive, from Badajoz (Spain). Blood pressure was measured at the doctor's office and by self-measurement at home. Those patients showing good control by self-measurement were subjected to 24-hour ambulatory monitoring. Optimal control was understood as blood pressure < 140/90 mm Hg when measured at the doctor's office, and < 135/85 mm Hg when self-measured at home and by daytime ambulatory monitoring.
  
  
  RESULTS
  Mean systolic/diastolic measurements at the doctor's office and by self-measurement were 145.6/83.9 and 134.0/78.7 mm Hg, respectively (p < 0.000). In the population optimally controlled by self-measurement and who subsequently received ambulatory monitoring, the mean blood pressure was 121.8/73.4 and 125.6/76.2 mm Hg, respectively (p = 0.002; p < 0.000). When measured at the doctor's office blood pressure was controlled in about 29.5% (95% CI 23.7-35.3%) of patients, in 38% when self-measured (95% CI 31.4-44.2%; p < 0.000), and in 24.5% when it was confirmed through ambulatory monitoring (95% CI 15.4-33.6%). Sensitivity and positive predictive values of the office measurements for the detection of patients who were well-controlled by self-measurement were 50% and 64.3%, respectively, and 53.4% and 73.8% as regards ambulatory monitoring.
  
  
  CONCLUSIONS
  A higher level of control is achieved with self-measurement at home not confirmed by ambulatory monitoring. Therefore, the white coat effect does not seem to influence the percentage of well-controlled patients detected at the doctor's office. Office blood pressure does not appear to be useful in distinguishing which individual patients are optimally controlled.
authors.affiliation: Villanueva 1 Health Centre, Extremadura Health Service, Villanueva de la Serena, Spain. fjfelixr@telefonica.net
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Félix-Redondo
authors.forename: Daniel
authors.initials: D
authors.lastname: Fernández-Bergés
authors.forename: Jacinto
authors.initials: J
authors.lastname: Espinosa-Garcia
authors.forename: Jerónimo
authors.initials: J
authors.lastname: Pozuelos-Estrada
authors.forename: Luis M
authors.initials: LM
authors.lastname: Molina-Martínez
authors.forename: José F
authors.initials: JF
authors.lastname: Pérez-Castán
authors.forename: José
authors.initials: J
authors.lastname: Ríos-Rivera
authors.forename: José I
authors.initials: JI
authors.lastname: Valiente-Rubio
authors.forename: Agustín
authors.initials: A
authors.lastname: Gómez-de-la-Cámara
authors.forename: Nieves
authors.initials: N
authors.lastname: Rodríguez-Pascual
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D001795:Blood Pressure Determination / Q000379:methods*; D018660:Blood Pressure Monitoring, Ambulatory; D003430:Cross-Sectional Studies; D003971:Diastole; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D011237:Predictive Value of Tests; D011320:Primary Health Care; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013030:Spain; D013599:Systole
chemical_list: D000959:Antihypertensive Agents