title: Relevance to home blood pressure monitoring protocol of blood pressure measurements taken before first- morning micturition and in the afternoon.
abstract: BACKGROUND
  The importance of measuring blood pressure before morning micturition and in the afternoon, while working, is yet to be established in relation to the accuracy of home blood pressure monitoring (HBPM).
  
  
  OBJECTIVE
  To compare two HBPM protocols, considering 24-hour ambulatory blood pressure monitoring (wakefulness ABPM) as gold-standard and measurements taken before morning micturition (BM) and in the afternoon (AM), for the best diagnosis of systemic arterial hypertension (SAH), and their association with prognostic markers.
  
  
  METHODS
  After undergoing 24-hour wakefulness ABPM, 158 participants (84 women) were randomized for 3- or 5-day HBPM. Two variations of the 3-day protocol were considered: with measurements taken before morning micturition and in the afternoon (BM+AM); and with post-morning-micturition and evening measurements (PM+EM). All patients underwent echocardiography (for left ventricular hypertrophy - LVH) and urinary albumin measurement (for microalbuminuria - MAU).
  
  
  RESULTS
  Kappa statistic for the diagnosis of SAH between wakefulness-ABPM and standard 3-day HBPM, 3-day HBPM (BM+AM) and (PM+EM), and 5-day HBPM were 0.660, 0.638, 0.348 and 0.387, respectively. The values of sensitivity of (BM+AM) versus (PM+EM) were 82.6% × 71%, respectively, and of specificity, 84.8% × 74%, respectively. The positive and negative predictive values were 69.1% × 40% and 92.2% × 91.2%, respectively. The comparisons of intraclass correlations for the diagnosis of LVH and MAU between (BM+AM) and (PM+EM) were 0.782 × 0.474 and 0.511 × 0.276, respectively.
  
  
  CONCLUSIONS
  The 3 day-HBPM protocol including measurements taken before morning micturition and during work in the afternoon showed the best agreement with SAH diagnosis and the best association with prognostic markers.
authors.affiliation: Hospital Universitário Lauro Wanderley, Universidade Federal da Paraíba, Brazil.
authors.forename: Antonio Eduardo Monteiro de
authors.initials: AE
authors.lastname: Almeida
authors.affiliation: Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Stein
authors.affiliation: Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: Miguel
authors.initials: M
authors.lastname: Gus
authors.affiliation: Statistic Departament, Universidade Federal da Paraíba, João Pessoa, PB, Brazil.
authors.forename: João Agnaldo
authors.initials: JA
authors.lastname: Nascimento
authors.affiliation: Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: Karlyse Claudino
authors.initials: KC
authors.lastname: Belli
authors.affiliation: Cardiology Departament, Faculdade de Medicina Nova Esperança, João Pessoa, PB, Brazil.
authors.forename: Jorge Rene Garcia
authors.initials: JR
authors.lastname: Arévalo
authors.affiliation: Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: Flávio Dani
authors.initials: FD
authors.lastname: Fuchs
authors.affiliation: Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: Jorge Pinto
authors.initials: JP
authors.lastname: Ribeiro
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000652:urine; D000704:Analysis of Variance; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods* / Q000592:standards; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis*; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012015:Reference Standards; D015203:Reproducibility of Results; D013997:Time Factors; D014463:Ultrasonography; D014554:Urination