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Clinical practice of ambulatory versus home blood pressure monitoring in hypertensive patients

Paolasso, Jorge A.; Crespo, Florencia; Arias, Viviana; Moreyra, Eduardo A.; Volmaro, Ariel; Orías, Marcelo; Moreyra, Eduardo Jr

doi: 10.1097/MBP.0000000000000138
Clinical Methods and Pathophysiology
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Objectives This study aimed to analyze whether blood pressure (BP) measurement is concordant between ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM), and determine whether the decision on treatment changes is similar on the basis of information provided by both methods.

Methods Treated hypertensive patients were studied with ABPM and HBPM to evaluate therapeutic efficacy and/or diagnose resistant hypertension (HTN). Modification of pharmacological treatment was decided on the basis of pre-established criteria; therefore, the number of therapeutic changes between both techniques was compared.

Results A total of 200 patients were included. The average daytime ABPM systolic blood pressure (SBP) was 136±16 compared with 136±15 (P=1) with HBPM; the average diurnal diastolic blood pressure (DBP) was 83±12 and 81±9, respectively (P=0.06). The concordance between both methods was very good for SBP [r=0.85; Bland–Altman 0.2 (95% confidence interval 0.9–1.4 mmHg)], and good for the DBP [r=0.77; Bland–Altman 1.8 (95% confidence interval 0.8–2.8 mmHg)]. Both methods were in agreement that HTN was controlled in 68 patients and that it was not controlled in 90 patients, that is, they were concordant in 158 patients (79%, κ=0.6). More patients required changes with ABPM than HBPM (149 vs. 99 patients, P<0.0001)

Conclusion There were no significant differences in the measurement of diurnal SBP and DBP between both methods. The concordance to determine proper control of HTN was 79%. There was a significant difference in the decision to modify the treatment in favor of the ABPM.

Department of Internal Medicine, Division of Cardiology, Sanatorio Allende, Córdoba (Capital), Argentina

Correspondence to Eduardo Moreyra Jr, MD, FACC, Department of Internal Medicine, Division of Cardiology, Sanatorio Allende, Obispo Oro 42, 5000 Córdoba (Capital), Argentina Tel: +54 9 351 590 9614; fax: +54 351 426 9212; e-mail: eddie.moreyra@gmail.com

Received February 24, 2015

Received in revised form April 29, 2015

Accepted May 20, 2015

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