This study compared home (HBP) versus ambulatory (ABP) blood pressure (BP) monitoring in terms of agreement in the diagnosis of hypertension and their association with preclinical organ damage in young individuals.
Apparently healthy subjects aged 6–26 years referred for elevated BP or healthy volunteers were subjected to: (i) 24 h ABP monitoring (20-min intervals) and 7-day HBP monitoring (duplicate morning and evening measurements) using validated upper-arm cuff oscillometric devices, (ii) left ventricular mass index (LVMI) determination (echocardiography); (iii) common carotid intima-media thickness (IMT) measurement (ultrasonography), (iv) pulse wave velocity (PWV) measurement.
A total of 218 young subjects (mean age 14.4 ± 4.3 years; 152 males) were analyzed (201 had LVMI measurement, 127 IMT and 113 PWV). 24 h ABP was 121.5 ± 11.7/68.6 ± 7.3 (systolic/diastolic, mmHg) and HBP 122.1 ± 12.6/70.8 ± 8.1. 28% of the subjects had hypertension based on HBP and 31% based on 24 h ABP (agreement 84%, kappa 0.61, p < 0.01). LVMI was correlated with systolic BP (coefficient r = 0.37/0.35/0.37 for 24 h/day/night ABP, and 0.33 for HBP; all p < 0.01). IMT was correlated with systolic BP (r = 0.36/0.36/0.34 for 24 h/day/night ABP, and 0.37 for HBP; all p < 0.01). PWV was closely associated with systolic BP (r = 0.49/0.48/0.46 for 24 h/day/night ABP, and 0.47 for HBP; all p < 0.01). In multivariate stepwise regression analysis (age, gender, body mass index [BMI], systolic HBP, 24 h/day/night systolic ABP as independent variables), LVMI was determined (R2 = 0.28) by BMI and nighttime systolic ABP, IMT (R2 = 0.17) by systolic HBP and male gender, and PWV (R2 = 0.36) by systolic 24 h ABP and age.
In young individuals there is reasonable agreement between HBP and ABP measurements in diagnosing hypertension and similar associations with indices of preclinical target-organ damage.
1Hypertension Center STRIDE -7, Third University Department of Medicine, Sotiria Hospital, Athens, Greece
2 Department of Cardiology, P. & A. Kyriakou Children Hospital, Athens, Greece
3First Department of Pediatrics, P. & A. Kyriakou Children Hospital, Athens, Greece