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Self-measured versus ambulatory blood pressure in the diagnosis of hypertension

Hond, Elly Dena; Celis, Hildea; Fagard, Roberta; Keary, Louisc; Leeman, Marcd; O'Brien, Eoinc; Vandenhoven, Guyb; Staessen, Jan Aaon behalf of the THOP investigators

Original papers: Blood pressure measurement
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Objective We examined to what extent self-measurement of blood pressure at home (HBP) can be an alternative to ambulatory monitoring (ABP) to diagnose white-coat hypertension.

Methods In 247 untreated patients, we compared the white-coat effects obtained by HBP and ABP. The thresholds to diagnose hypertension were ≥ 140/≥ 90 mmHg for conventional blood pressure (CBP) and ≥ 135/≥ 85 mmHg for daytime ABP and HBP.

Results Mean systolic/diastolic CBP, HBP and ABP were 155.4/100.0, 143.1/91.5 and 148.1/95.0 mmHg, respectively. The white-coat effect was 5.0/3.5 mmHg larger on HBP compared with ABP (12.3/8.6 versus 7.2/5.0 mmHg; P< 0.001). The correlation coefficients between the white-coat effects based on HBP and ABP were 0.74 systolic and 0.60 diastolic (P< 0.001). With ABP as a reference, the specificity of HBP to detect white-coat hypertension was 88.6%, and the sensitivity was 68.4%.

Conclusion Our findings are in line with the recommendations of the ASH Ad Hoc Panel that recommends HBP for screening while ABP has a better prognostic accuracy.

aStudy Coordinating Centre, Hypertension and Cardiovascular Rehabilitation Unit, Department of Molecular and Cardiovascular Research, Katholieke Universiteit Leuven, Leuven, Belgium, bAstraZeneca NV/SA, Brussels, Belgium, cBlood Pressure Unit and ADAPT Centre, Beaumont Hospital, Dublin 9, Ireland and dHypertension Unit, University Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium.

Sponsorship: The THOP trial is conducted under the auspices of the Belgian Hypertension Committee and is financially supported by AstraZeneca NV/SA (Brussels, Belgium). AstraZeneca (Brussels, Belgium) and Pfizer Corporation (Brussels, Belgium) donated the study medications.

See editorial commentary page 677

Correspondence to Elly Den Hond, PhD, Study Coordinating Centre, Hypertension Unit, University Hospital, Herestraat 49, B-3000 Leuven, Belgium. Tel: +32 16 34 5764; fax: +32 16 34 5763; e-mail: elly.denhond@med.kuleuven.ac.be

Requests for reprints to Jan A. Staessen, MD, PhD, Studiecoördinatiecentrum, Laboratorium Hypertensie, Gebouw Onderwijs en Navorsing, Herestraat 49, B-3000 Leuven, Belgium. Tel: +32 16 34 7104; fax: +32 16 34 7106; e-mail: jan.staessen@med.kuleuven.ac.be

Received 18 March 2002 Revised 18 December 2002 Accepted 7 January 2003

© 2003 Lippincott Williams & Wilkins, Inc.