title: Isolated clinic hypertension: diagnostic criteria based on 24-h blood pressure definition.
abstract: OBJECTIVE
  The use of diagnostic criteria based on 24-h ambulatory blood pressure (BP) values could improve prognostic value by incorporating night BP, minimize biases and improve the diagnostic reproducibility of isolated clinic hypertension (ICH). We estimate the 24-h BP cut-off points that best discriminate and predict the two diagnostic thresholds of mean daytime BP for ICH (135/85 and 130/80 mmHg).
  
  
  METHODS
  Cross-sectional, comparative, multicentre study in 6176 untreated hypertensive patients, whose BP was measured by ambulatory BP monitoring. ICH was defined with an office BP of ≥140/≥90 mmHg and a daytime BP of <135/<85 mmHg (ICH1) or <130/80 mmHg (ICH2). Sensitivity, specificity, positive likelihood ratio (LR+), odds ratio (OR), error rate, predictive values, κ values and 95% confidence interval were calculated for each possible cut-off point for ICH1 and ICH2.
  
  
  RESULTS
  One thousand eight hundred and seven patients (29.2%) and 960 patients (15.5%) met ICH1 and ICH2 criteria, respectively. The 24-h BP cut-off points that best predict ICH1 and ICH2 are less than 132/82 mmHg (sensitivity: 93.6%, specificity: 94.3%, LR+: 16.6, OR: 1367.1, error rate: 5.9, κ 0.86) and less than 127/77 mmHg (sensitivity: 90.8%, specificity: 97.4%, LR+: 34.6, OR: 1041.5, error rate: 3.6,κ 0.86), respectively. These values achieved the best balance of sensitivity and specificity, together with the highest values of LR+ and OR and the lowest error rate.
  
  
  CONCLUSIONS
  The 24-h BP cut-off point that best predicts the daytime criterion of less than 135/85 and less than 130/80 mmHg are 132/82 and 127/77 mmHg, respectively. These 24-h cut-off points may add value to ambulatory blood pressure monitoring for both diagnostic and management future decisions.
authors.affiliation: La Mina Primary Care Center, University of Barcelona, CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN, Instituto de Salud Carlos III), Spain. 23561evb@comb.cat
authors.forename: Ernest
authors.initials: E
authors.lastname: Vinyoles
authors.forename: Teresa
authors.initials: T
authors.lastname: Rodriguez-Blanco
authors.forename: Alejandro
authors.initials: A
authors.lastname: de la Sierra
authors.forename: Angela
authors.initials: A
authors.lastname: Felip
authors.forename: José R
authors.initials: JR
authors.lastname: Banegas
authors.forename: Juan J
authors.initials: JJ
authors.lastname: de la Cruz
authors.forename: Manuel
authors.initials: M
authors.lastname: Gorostidi
authors.forename: Javier
authors.initials: J
authors.lastname: Sobrino
authors.forename: Julián
authors.initials: J
authors.lastname: Segura
authors.forename: Alex
authors.initials: A
authors.lastname: Roca-Cusachs
authors.forename: Luís M
authors.initials: LM
authors.lastname: Ruilope
mesh_terms: D000328:Adult; D018660:Blood Pressure Monitoring, Ambulatory; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000503:physiopathology; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity