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Accuracy of home versus ambulatory blood pressure monitoring in the diagnosis of white-coat and masked hypertension

Kang, Yuan-Yuana; Li, Yana; Huang, Qi-Fanga; Song, Jiea; Shan, Xiao-Lia; Dou, Yub; Xu, Xin-Juanc; Chen, Shou-Hongd; Wang, Ji-Guanga

doi: 10.1097/HJH.0000000000000596

Background: We investigated accuracy of home blood pressure (BP) monitoring in the diagnosis of white-coat and masked hypertension in comparison with ambulatory BP monitoring.

Methods: Our study participants were enrolled in the China Ambulatory and Home BP Registry, and underwent clinic, home, and 24-h ambulatory BP measurements. We defined white-coat hypertension as an elevated clinic SBP/DBP (≥140/90 mmHg) and a normal 24-h ambulatory (<130/80 mmHg) or home SBP/DBP (<135/85 mmHg), and masked hypertension as a normal clinic SBP/DBP (<140/90 mmHg) and an elevated 24-h ambulatory (≥130/80 mmHg) or home SBP/DBP (≥135/85 mmHg).

Results: In untreated patients (n = 573), the prevalence of white-coat hypertension (13.1 vs. 19.9%), masked hypertension (17.8 vs. 13.1%), and sustained hypertension (46.4 vs. 39.6%) significantly (P ≤ 0.02) differed between 24-h ambulatory and home BP monitoring. In treated patients (n = 1201), only the prevalence of masked hypertension differed significantly (18.7 vs. 14.5%; P = 0.005). Regardless of the treatment status, home compared with 24-h ambulatory BP had low sensitivity (range 47–74%), but high specificity (86–94%), and accordingly low positive (41–87%), but high negative predictive values (80–94%), and had moderate diagnostic agreement (82–85%) and Kappa statistic (0.41–0.66). In untreated and treated patients, age advancing was associated with a higher prevalence of white-coat hypertension and a lower prevalence of masked hypertension defined by 24-h ambulatory (P ≤ 0.03) but not home BP (P ≥ 0.10).

Conclusion: Home BP monitoring has high specificity, but low sensitivity in the diagnosis of white-coat and masked hypertension, and may therefore behave as a complementary to, but not a replacement of, ambulatory BP monitoring.

aCentre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai

bDepartment of Cardiology, Jiangsu Provincial Authorities Hospital, Nanjing, Jiangsu

cDepartment of Hypertension, The First Affiliated Hospital of Xinjiang Medical University, Urumuqi, Xinjiang

dDepartment of Cardiology, Lianyungang Hospital of Chinese Medicine, Lianyungang, Jiangsu, China

Correspondence to Ji-Guang Wang, MD, PhD, The Shanghai Institute of Hypertension, Ruijin 2nd Road 197, Shanghai 200025, China. Tel: +86 21 64370045 ext 610911; fax: +86 21 64662193; e-mail:

Abbreviations: BMI, body mass index; CI, confidence interval

Received 27 January, 2015

Revised 9 March, 2015

Accepted 9 March, 2015

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