Morning hypertension assessed by home or ambulatory monitoring: different aspects of the same phenomenon?
OBJECTIVE
There is increasing interest in morning hypertension assessed using out-of-office blood pressure (BP) measurement methods. This study compared morning BP taken by home (mHBP) versus morning ambulatory BP (mABP) monitoring.


METHODS
A total of 588 hypertensives were included [mean age 53 +/- 12.4 (SD) years, 57% men, 59% untreated]. Average mHBP (6 days, duplicate morning measurements) was compared with mABP (first 1, 2 or 3 h after arising, readings at 20-min intervals). Morning 'hypertensives' were defined as individuals with mHBP or mABP at least 135/85 mmHg and morning 'reactors' as those with a difference between mHBP and average home BP or mABP and average awake ambulatory BP at the upper quartile of the respective distribution.


RESULTS
Average mABP (2 h) was the closest to mHBP with mean difference 0.4 +/- 14.0/1.2 +/- 8.6 mmHg, 95% confidence intervals -0.8, 1.5/0.5, 1.9, P NS < 0.01, for systolic/diastolic and was strongly correlated with mABP (r = 0.60/0.68, P < 0.001). There was moderate agreement between mHBP and mABP in detecting morning 'hypertensives' (agreement 72%, kappa 0.44, for systolic BP and 75%, kappa 0.51, for diastolic) and slight agreement in detecting morning 'reactors' (agreement 68%, kappa 0.15, for systolic BP and 67%, kappa 0.13, for diastolic). These findings did not change when mABP of 1 or 3 h after arising were used or when untreated and treated individuals were analyzed separately.


CONCLUSIONS
Despite their methodological differences, there seems to be considerable similarity between mHBP and mABP. Thus, both home and ambulatory BP monitoring appear to be interchangeable methods for the assessment of morning hypertension.
Stergiou
George S
GS
Hypertension Centre, Third University Department of Medicine, Sotiria Hospital, Athens, Greece. gstergi@med.uoa.gr
Nasothimiou
Efthimia G
EG
Roussias
Leonidas G
LG
D000328:Adult; D000368:Aged; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods / Q000706:statistics & numerical data; D002940:Circadian Rhythm / Q000502:physiology*; D003971:Diastole; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013599:Systole