Self blood pressure monitoring: a worthy substitute for ambulatory blood pressure?
The European Society of Hypertension (ESH), the American Heart Association (AHA) and the American Society of Hypertension (ASH) have published guidelines for self-monitoring of blood pressure (SBPM). We aimed to demonstrate the equivalence of SBPM with ambulatory blood pressure monitoring (ABPM) in the assessment of hypertension. A total of 87 consecutive subjects referred from primary care for standard ABPM underwent a 1-week period of SBPM, as defined by the ESH guidelines, either before or after ABPM. There was no difference in mean blood pressure (BP): SBPM 142/87 mm Hg, daytime average ABPM 141/86 mm Hg. The intra-class correlation coefficient was 0.72 and 0.89 for systolic and diastolic pressure, respectively. SBPM is concordant with ABPM in classifying subjects as hypertensive or normotensive in 87% of cases (κ=0.56). The coefficient of variation of SBPM compared with ABPM was 5%. In answer to a direct question 81% of subjects preferred SBPM to ABPM. The current self-monitoring schedule recommended by the ESH, AHA and ASH is valid. The mean BP obtained from SBPM is equivalent to awake-time BP on ABPM, the accepted reference standard for 'out of office' BP measurement. SBPM is simpler to carry out, preferred by patients and should be considered on a par with ABPM.
McGowan
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Metabolic Unit, University Department of Medical Sciences, Western General Hospital, Edinburgh, UK. neilmcgowan@doctors.net.uk
Padfield
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D000368:Aged; D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000379:methods*; D018660:Blood Pressure Monitoring, Ambulatory; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D057240:Patient Preference; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012606:Scotland; D011795:Surveys and Questionnaires; D013997:Time Factors