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Limited (6-h) ambulatory blood pressure monitoring is a valid replacement for the office blood pressure by trained nurse clinician in the diagnosis of hypertension

Graves, John W.a; Nash, Carol A.a; Grill, Diane E.b; Bailey, Kent R.b; Sheps, Sheldon G.a

doi: 10.1097/01.mbp.0000170920.47788.ed
Clinical Methods and Pathophysiology
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Objective To assess the ability of limited ambulatory blood pressure monitoring as a valid replacement for office blood pressure measurement done to American Heart Association criteria in diagnosing hypertension.

Methods In all, 105 adults, who had been referred for limited ambulatory blood pressure monitoring, participated in the study. Limited ambulatory blood pressure monitoring consisted of 6 h of blood pressure measurement while ambulatory at the Mayo Clinic, using a SpaceLabs 90207 (SpaceLabs Medical, Issaquah, Washington, USA) collecting six readings per hour for the period of observation. The study participants gave consent for three additional consecutive office blood pressure measurements, using a validated aneroid device, done to American Heart Association criteria, by a single hypertension nurse specialist.

Results Mean systolic blood pressure by limited ambulatory blood pressure monitoring was 137.9±14.2 mmHg and for the nurse, 137.9±20.1 mmHg. Mean diastolic blood pressure by limited ambulatory blood pressure monitoring was 81.5±9.7 mmHg and for the nurse, 74.3±11.9 mmHg. The intermethod difference for systolic blood pressure was 0.03±12.5 mmHg and diastolic blood pressure, –7.2±8.0 mmHg. Using <140/90 as criteria factor, limited ambulatory blood pressure monitoring and the trained nurse agreed 77% of the time on whether the patient was hypertensive. This agreement increased to 81% if the participant's referral blood pressure was ≥140/90.

Conclusions Limited ambulatory blood pressure monitoring is an excellent replacement for office blood pressure, done to American Heart Association criteria, in diagnosing hypertension. This avoids issues of variability introduced by the observers, such as digit preference and bias, and increases reproducibility of blood pressure measurements. The appropriate normal value for limited ambulatory blood pressure monitoring is <140/90 mmHg compared with <135/85 mmHg used in 24-h ambulatory blood pressure monitoring.

aDivision of Nephrology and Hypertension

bDepartment of Biostatistics, Mayo Clinic School of Medicine, Rochester, Minnesota, USA

Correspondence and requests for reprints to John W. Graves, M.D., F.A.C.P., Division of Nephrology and Hypertension, Mayo Clinic School of Medicine, 200 First Street SW, Rochester, MN 55905, USA

Tel: +1 507 284 2007; fax: +1 507 284 1161;

e-mail: Graves.john@mayo.edu

Received 24 June 2004 Revised 13 March 2005 Accepted 16 March 2005

© 2005 Lippincott Williams & Wilkins, Inc.