title: How in-office and ambulatory BP monitoring compare: A systematic review and meta-analysis.
abstract: We performed a literature review and meta-analysis to ascertain the validity of office blood pressure (BP) measurement in a primary care setting, using ambulatory blood pressure measurement (ABPM) as a benchmark in the monitoring of hypertensive patients receiving treatment.
  
  
  
  We conducted a literature search for studies published up to December 2013 that included hypertensive patients receiving treatment in a primary care setting. We compared the mean office BP with readings obtained by ABPM. We summarized the diagnostic accuracy of office BP with respect to ABPM in terms of sensitivity, specificity, and positive and negative likelihood ratios (LR), with a 95% confidence interval (CI).
  
  
  
  Only 12 studies met the inclusion criteria and contained data to calculate the differences between the means of office and ambulatory BP measurements. Five were suitable for calculating sensitivity, specificity, and likelihood ratios, and 4 contained sufficient extractable data for meta-analysis. Compared with ABPM (thresholds of 140/90 mm Hg for office BP; 130/80 mmHg for ABPM) in diagnosing uncontrolled BP, office BP measurement had a sensitivity of 81.9% (95% CI, 74.8%-87%) and specificity of 41.1% (95% CI, 35.1%-48.4%). Positive LR was 1.35 (95% CI, 1.32-1.38), and the negative LR was 0.44 (95% CI, 0.37-0.53).
  
  
  
  Likelihood ratios show that isolated BP measurement in the office does not confirm or rule out the presence of poor BP control. Likelihood of underestimating or overestimating BP control is high when relying on in-office BP measurement alone.
authors.affiliation: Adormideras Primary Health Center, Xerencia de Xestión Integrada de A Coruña, SERGAS, A Coruña, Spain. Email: sergio.nelson.reino.gonzalez@sergas.es.
authors.forename: Sergio
authors.initials: S
authors.lastname: Reino-Gonzalez
authors.affiliation: Clinical Epidemiology and Biostatistics Research Group, Instituto de Investigación Biomédica de A Coruña, Complexo Hospitalario Universitario de A Coruña, SERGAS, Universidade da Coruña, Spain.
authors.forename: Salvador
authors.initials: S
authors.lastname: Pita-Fernández
authors.affiliation: Clinical Epidemiology and Biostatistics Research Group, Instituto de Investigación Biomédica de A Coruña, Complexo Hospitalario Universitario de A Coruña, SERGAS, Universidade da Coruña, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Seoane-Pillado
authors.affiliation: Clinical Epidemiology and Biostatistics Research Group, Instituto de Investigación Biomédica de A Coruña, Complexo Hospitalario Universitario de A Coruña, SERGAS, Universidade da Coruña, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: López-Calviño
authors.affiliation: Clinical Epidemiology and Biostatistics Research Group, Instituto de Investigación Biomédica de A Coruña, Complexo Hospitalario Universitario de A Coruña, SERGAS, Universidade da Coruña, Spain.
authors.forename: Sonia
authors.initials: S
authors.lastname: Pértega Díaz
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D001795:Blood Pressure Determination; D018660:Blood Pressure Monitoring, Ambulatory; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy*; D009819:Office Visits; D012648:Self Care
chemical_list: D000959:Antihypertensive Agents