title: Is home blood pressure monitoring useful in the management of patients with resistant hypertension?
abstract: BACKGROUND
  Ambulatory blood pressure (BP) monitoring (ABPM) is a cornerstone in resistant hypertension (RHT) management. However, it has higher cost and lower patients' acceptance than home BP monitoring (HBPM). Our objective was to evaluate HBPM usefulness in the management of patients with RHT.
  
  
  METHODS
  A total of 240 patients were submitted to 24-hour ABPM and 5-day HBPM (triplicate morning and evening measurements). Patients with uncontrolled office BP (≥140/90mm Hg) were classified as true RHT (daytime or home BP ≥135/85mm Hg) or white-coat RHT (daytime or home BP <135/85mm Hg), and patients with controlled office BP were classified as masked RHT (daytime or home BP ≥135/85mm Hg) or controlled RHT (daytime or home BP <135/85mm Hg). Sensitivity, specificity, predictive values, and likelihood ratios for HBPM were calculated. Agreement between the procedures was evaluated using kappa coefficients and the Bland-Altman method.
  
  
  RESULTS
  Mean office BP was 157±26/84±16mm Hg, mean daytime BP was 134±18/77±13mm Hg, and mean home BP was 143±20/76±14mm Hg. The ABPM and HBPM diagnoses were 35% and 48%, respectively, for true RHT; 36% and 23%, respectively, for white-coat RHT; 7% and 17%, respectively, for masked RHT; and 22% and 13%, respectively, for controlled RHT. HBPM overestimated systolic BP by 8.8 (95% confidence interval (CI) = 6.8-10.7) mm Hg and diastolic BP by 0.2 (95% CI = -1.0 to 1.4) mm Hg. The specificity, sensitivity, and positive and negative predictive values of HBPM in detecting controlled ambulatory BP were 91%, 55%, 89%, and 59%.
  
  
  CONCLUSIONS
  HBPM presented good agreement with ABPM and can be used as a complementary method in the follow-up of resistant hypertensive patients, particularly in those with controlled ambulatory BPs.
authors.affiliation: Department of Internal Medicine, University Hospital Clementino Fraga Filho, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Muxfeldt
authors.affiliation: Department of Internal Medicine, University Hospital Clementino Fraga Filho, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Guilherme S
authors.initials: GS
authors.lastname: Barros
authors.affiliation: Department of Internal Medicine, University Hospital Clementino Fraga Filho, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Bianca B
authors.initials: BB
authors.lastname: Viegas
authors.affiliation: Department of Internal Medicine, University Hospital Clementino Fraga Filho, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Fernanda O
authors.initials: FO
authors.lastname: Carlos
authors.affiliation: Department of Internal Medicine, University Hospital Clementino Fraga Filho, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. gilsalles@hucff.ufrj.br.
authors.forename: Gil F
authors.initials: GF
authors.lastname: Salles
mesh_terms: D000368:Aged; D001795:Blood Pressure Determination; D018660:Blood Pressure Monitoring, Ambulatory; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D019468:Disease Management; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D059468:Masked Hypertension / Q000175:diagnosis / Q000188:drug therapy*; D008875:Middle Aged; D012680:Sensitivity and Specificity; D017211:Treatment Failure; D059466:White Coat Hypertension / Q000175:diagnosis / Q000188:drug therapy*
keywords: ambulatory blood pressure monitoring; blood pressure; home blood pressure monitoring; hypertension; resistant hypertension.