Self-measured home blood pressure in predicting ambulatory hypertension

• Published in: American journal of hypertension Vol. 17; no. 11; pp. 1017 - 1022
• Main Authors: Mansoor, George A., White, William B.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2004; Oxford University Press; Elsevier Science
• Subjects: Adult; ambulatory blood pressure; Arterial hypertension; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Blood Pressure - physiology; Blood Pressure Determination; Blood Pressure Monitoring, Ambulatory - methods; Cardiology. Vascular system; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Cross-Sectional Studies; Female; Fundamental and applied biological sciences. Psychology; Hemodynamics. Rheology; Humans; Hypertension - diagnosis; Male; Medical sciences; Middle Aged; Predictive Value of Tests; Prospective Studies; Self Care; self-measurement of blood pressure; Vertebrates: cardiovascular system; Arterial hypertension; self-measurement of blood pressure; ambulatory blood pressure; Hypertension; Cardiovascular disease; Arterial pressure; Blood pressure; Ambulatory; Pressure measurement
• ISSN: 0895-7061; 1879-1905; 1941-7225
• DOI: 10.1016/j.amjhyper.2004.06.015

Physicians are commonly uncertain whether a person with office blood pressure (BP) around 140/90 mm Hg actually has hypertension. This is primarily because of BP variability. One approach is to perform self-measured home BP and determine if home BP is elevated. There is a general agreement that if home BP is ≥135/85 mm Hg, then antihypertensive therapy may be commenced. However, some persons with home BP below this cut-off will have ambulatory hypertension. We therefore prospectively study the role of home BP in predicting ambulatory hypertension in persons with stage 1 and borderline hypertension. We studied in a cross-sectional way home and ambulatory BP in a group of 48 patients with at least two elevated office BP readings. The group was free of antihypertensive drug therapy for at least 4 weeks and performed 7 days of standardized self-BP measurements at home. We examined the relationships of the three BP methods and also defined a threshold (using receiver operating curves) for home BP that captures 80% of ambulatory hypertensives (awake BP ≥135/85 mm Hg). Office systolic BP (145 ± 13 mm Hg) was significantly higher than awake (139 ± 12 mm Hg, P = .013) and home (132 ± 11 mm Hg, P < .001) BP. Office diastolic BP (88 ± 4 mm Hg) was higher than home diastolic BP (80 ± 8 mm Hg, P < .001) but not different from awake diastolic BP (88 ± 8 mm Hg, P = .10). Home BP had a higher correlation (compared with office BP) with ambulatory BP. The home BP-based white coat effect correlated with ambulatory BP-based white coat effect ( r = 0.83, P = .001 for systolic BP; r = 0.68, P = .001 for diastolic BP). The threshold for home BP of 80% sensitivity in capturing ambulatory hypertension was 125/76 mm Hg. Our preliminary data suggest that a lower self-monitored home BP threshold should be used (to exclude ambulatory hypertension) in patients with borderline office hypertension.