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Accuracy of self-monitored blood pressure for diagnosing hypertension in primary care

Nunan, Davida,b; Thompson, Matthewb,c; Heneghan, Carl J.a,b; Perera, Rafaela,b; McManus, Richard J.a,b; Ward, Alisona,b

doi: 10.1097/HJH.0000000000000489

Objective: To assess the diagnostic accuracy of recommendations for self-monitoring blood pressure (BP) for diagnosing hypertension in primary care.

Methods: Two hundred and forty-seven consecutive participants with raised (≥130 mmHg systolic) BP measured by their general practitioner from four primary care practices in the United Kingdom underwent 28 days of self-monitoring followed by 24-h ambulatory BP monitoring (ABPM). Diagnostic accuracy of the first 7 days of self-monitored BP (minimum 4 days, discarding readings on day 1) in detecting hypertension with ambulatory blood pressure was taken as reference.

Results: Two hundred and three participants were included, 109 (53.7%) of whom were diagnosed with hypertension using daytime ambulatory BP. The average of days 2–7 self-monitored BP correctly classified 150 of 203 participants [sensitivity 93.6%, 95% confidence interval (CI) 87.2–97.4%; specificity 51.1%, 95% CI 40.5–61.5%). However, the average of days 2–5 self-monitoring correctly classified 152 of 203 participants due to better specificity (53.2%, 95% CI 42.6–63.6%). In sensitivity analysis, diagnostic accuracy was not improved by inclusion of readings beyond day 5, and inclusion of readings taken on day 1 had no impact on diagnostic accuracy. Self-monitoring in the clinic was more accurate than readings taken by the general practitioner, but not self-monitoring outside of the clinic.

Conclusion: Hypertension can be ruled out in the majority of patients with elevated clinic BP using the average of the first 5 consecutive days of self-monitored BP, supporting lower limits for self-monitoring readings in current guidelines. Performing readings beyond day 5 and including readings taken on the first day had no clinical impact on diagnostic accuracy.

aNuffield Department of Primary Care Health Sciences, University of Oxford

bNational Institute for Health Research School for Primary Care Research, Oxford, UK

cDepartment of Family Medicine, University of Washington, Seattle, Washington, USA

Correspondence to David Nunan, PhD, Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK. Tel: +44 1865 617938; e-mail:

Abbreviations: ABPM, ambulatory blood pressure monitoring; BP, blood pressure; GP, general practitioner

Received 16 May, 2014

Revised 14 November, 2014

Accepted 14 November, 2014

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