title: Strategies for classifying patients based on office, home, and ambulatory blood pressure measurement.
abstract: Hypertension guidelines propose home or ambulatory blood pressure monitoring as indispensable after office measurement. However, whether preference should be given to home or ambulatory monitoring remains undetermined. In 831 untreated outpatients (mean age, 50.6 years; 49.8% women), we measured office (3 visits), home (7 days), and 24-h ambulatory blood pressures. We applied hypertension guidelines for cross-classification of patients into normotension or white-coat, masked, or sustained hypertension. Based on office and home blood pressures, the prevalence of white-coat, masked, and sustained hypertension was 61 (10.3%), 166 (20.0%), and 162 (19.5%), respectively. Using daytime (from 8 am to 6 pm) instead of home blood pressure confirmed the cross-classification in 575 patients (69.2%), downgraded risk from masked hypertension to normotension (n=24) or from sustained to white-coat hypertension (n=9) in 33 (4.0%), but upgraded risk from normotension to masked hypertension (n=179) or from white-coat to sustained hypertension (n=44) in 223 (26.8%). Analyses based on 24-h ambulatory blood pressure were confirmatory. In adjusted analyses, both the urinary albumin-to-creatinine ratio (+20.6%; confidence interval, 4.4-39.3) and aortic pulse wave velocity (+0.30 m/s; confidence interval, 0.09-0.51) were higher in patients who moved up to a higher risk category. Both indexes of target organ damage and central augmentation index were positively associated (P≤0.048) with the odds of being reclassified. In conclusion, for reliably diagnosing hypertension and starting treatment, office measurement should be followed by ambulatory blood pressure monitoring. Using home instead of ambulatory monitoring misses the high-risk diagnoses of masked or sustained hypertension in over 25% of patients.
authors: From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (L.Z., Y.L., F.-F.W., Y.-Y.K., S.W., T.-Y.X., J.-G.W.); Studies Coordinating Centre, Research Unit Hypertension and Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., J.A.S.); and VitaK Research and Development, Maastricht University, Maastricht, The Netherlands (J.A.S.).
authors: Lu
authors: L
authors: Zhang
authors: From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (L.Z., Y.L., F.-F.W., Y.-Y.K., S.W., T.-Y.X., J.-G.W.); Studies Coordinating Centre, Research Unit Hypertension and Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., J.A.S.); and VitaK Research and Development, Maastricht University, Maastricht, The Netherlands (J.A.S.). liyanshcn@yahoo.com.
authors: Yan
authors: Y
authors: Li
authors: From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (L.Z., Y.L., F.-F.W., Y.-Y.K., S.W., T.-Y.X., J.-G.W.); Studies Coordinating Centre, Research Unit Hypertension and Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., J.A.S.); and VitaK Research and Development, Maastricht University, Maastricht, The Netherlands (J.A.S.).
authors: Fang-Fei
authors: FF
authors: Wei
authors: From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (L.Z., Y.L., F.-F.W., Y.-Y.K., S.W., T.-Y.X., J.-G.W.); Studies Coordinating Centre, Research Unit Hypertension and Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., J.A.S.); and VitaK Research and Development, Maastricht University, Maastricht, The Netherlands (J.A.S.).
authors: Lutgarde
authors: L
authors: Thijs
authors: From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (L.Z., Y.L., F.-F.W., Y.-Y.K., S.W., T.-Y.X., J.-G.W.); Studies Coordinating Centre, Research Unit Hypertension and Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., J.A.S.); and VitaK Research and Development, Maastricht University, Maastricht, The Netherlands (J.A.S.).
authors: Yuan-Yuan
authors: YY
authors: Kang
authors: From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (L.Z., Y.L., F.-F.W., Y.-Y.K., S.W., T.-Y.X., J.-G.W.); Studies Coordinating Centre, Research Unit Hypertension and Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., J.A.S.); and VitaK Research and Development, Maastricht University, Maastricht, The Netherlands (J.A.S.).
authors: Shuai
authors: S
authors: Wang
authors: From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (L.Z., Y.L., F.-F.W., Y.-Y.K., S.W., T.-Y.X., J.-G.W.); Studies Coordinating Centre, Research Unit Hypertension and Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., J.A.S.); and VitaK Research and Development, Maastricht University, Maastricht, The Netherlands (J.A.S.).
authors: Ting-Yan
authors: TY
authors: Xu
authors: From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (L.Z., Y.L., F.-F.W., Y.-Y.K., S.W., T.-Y.X., J.-G.W.); Studies Coordinating Centre, Research Unit Hypertension and Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., J.A.S.); and VitaK Research and Development, Maastricht University, Maastricht, The Netherlands (J.A.S.).
authors: Ji-Guang
authors: JG
authors: Wang
authors: From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (L.Z., Y.L., F.-F.W., Y.-Y.K., S.W., T.-Y.X., J.-G.W.); Studies Coordinating Centre, Research Unit Hypertension and Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., J.A.S.); and VitaK Research and Development, Maastricht University, Maastricht, The Netherlands (J.A.S.).
authors: Jan A
authors: JA
authors: Staessen
mesh_terms: D000368:Aged; D001795:Blood Pressure Determination / Q000379:methods*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis*; D016015:Logistic Models; D008297:Male; D059468:Masked Hypertension / Q000175:diagnosis; D008875:Middle Aged; D015999:Multivariate Analysis; D009819:Office Visits; D011786:Quality Control; D012648:Self Care / Q000379:methods*; D012720:Severity of Illness Index; D059466:White Coat Hypertension / Q000175:diagnosis
keywords: ambulatory blood pressure; clinical science; hypertension