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Ambulatory versus home blood pressure monitoring

frequency and determinants of blood pressure difference and diagnostic disagreement

Ntineri, Angelikia; Niiranen, Teemu J.b,c,d; McManus, Richard J.e; Lindroos, Annikab,c; Jula, Anttib; Schwartz, Clairee; Kollias, Anastasiosa; Andreadis, Emmanuel A.f; Stergiou, George S.a

doi: 10.1097/HJH.0000000000002148
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Objectives: Out-of-office blood pressure evaluation assessed using ambulatory (ABP) or home (HBP) monitoring is currently recommended for hypertension management. We evaluated the frequency and determinants of diagnostic disagreement between ABP and HBP measurements.

Methods: Cross-sectional data from 1971 participants (mean age 53.8 ± 11.4 years, 52.6% men, 32% treated) from Greece, Finland and the United Kingdom were analyzed. The diagnostic disagreement between HBP and daytime ABP was regarded as certain when (i) the two methods diagnosed a different blood pressure phenotype, (ii) the absolute HBP–ABP difference was more than 10/5 mmHg (systolic/diastolic) and (iii) ABP and HBP had a more than 5 mmHg difference from the respective hypertension threshold.

Results: In 1574 participants (79.9%), there was agreement between HBP and ABP in diagnosing hypertensive phenotypes (kappa 0.70). Of the remaining 397 participants (20.1%) with diagnostic disagreement, 95 had clinically irrelevant HBP–ABP differences, which reduced the disagreement to 15.3%. When cases with ABP and/or HBP differing ≤5 mmHg from the respective hypertension threshold were excluded, the certain disagreement between the two methods was reduced to 8.2%. Significant determinants of the HBP–ABP difference were age, sex, study center, BMI, cardiovascular disease history, office hypertension and antihypertensive treatment. Antihypertensive drug treatment, alcohol consumption and office normotension independently increased the odds of diagnostic disagreement.

Conclusion: These data suggest that there is considerable diagnostic agreement between HBP and ABP, and that these methods are interchangeable for clinical decisions in most patients. However, considerable disagreement between the two methods occurs in an appreciable minority, most likely due to methodological and patient-related factors.

aHypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece

bNational Institute for Health and Welfare, Turku, Finland

cDepartment of Internal Medicine, University of Turku, Turku, Finland

dDivision of Medicine, Turku University Hospital, Turku, Finland

eGreen Templeton College & Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK

fHypertension and Cardiovascular Disease Prevention Center, Evangelismos General Hospital, Athens, Greece

Correspondence to George S. Stergiou, MD, FRCP, Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, 152 Mesogion Avenue, Athens 11527, Greece. Tel: +30 2107763117; fax: +30 2107719981; e-mail: stergiougs@gmail.com

Received 18 December, 2018

Revised 11 April, 2019

Accepted 17 April, 2019

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