Format

Send to

Choose Destination
Hypertension. 2015 Jun;65(6):1258-65. doi: 10.1161/HYPERTENSIONAHA.114.05038. Epub 2015 Apr 13.

Strategies for classifying patients based on office, home, and ambulatory blood pressure measurement.

Author information

1
From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (L.Z., Y.L., F.-F.W., Y.-Y.K., S.W., T.-Y.X., J.-G.W.); Studies Coordinating Centre, Research Unit Hypertension and Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., J.A.S.); and VitaK Research and Development, Maastricht University, Maastricht, The Netherlands (J.A.S.).
2
From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (L.Z., Y.L., F.-F.W., Y.-Y.K., S.W., T.-Y.X., J.-G.W.); Studies Coordinating Centre, Research Unit Hypertension and Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., J.A.S.); and VitaK Research and Development, Maastricht University, Maastricht, The Netherlands (J.A.S.). liyanshcn@yahoo.com.

Abstract

Hypertension guidelines propose home or ambulatory blood pressure monitoring as indispensable after office measurement. However, whether preference should be given to home or ambulatory monitoring remains undetermined. In 831 untreated outpatients (mean age, 50.6 years; 49.8% women), we measured office (3 visits), home (7 days), and 24-h ambulatory blood pressures. We applied hypertension guidelines for cross-classification of patients into normotension or white-coat, masked, or sustained hypertension. Based on office and home blood pressures, the prevalence of white-coat, masked, and sustained hypertension was 61 (10.3%), 166 (20.0%), and 162 (19.5%), respectively. Using daytime (from 8 am to 6 pm) instead of home blood pressure confirmed the cross-classification in 575 patients (69.2%), downgraded risk from masked hypertension to normotension (n=24) or from sustained to white-coat hypertension (n=9) in 33 (4.0%), but upgraded risk from normotension to masked hypertension (n=179) or from white-coat to sustained hypertension (n=44) in 223 (26.8%). Analyses based on 24-h ambulatory blood pressure were confirmatory. In adjusted analyses, both the urinary albumin-to-creatinine ratio (+20.6%; confidence interval, 4.4-39.3) and aortic pulse wave velocity (+0.30 m/s; confidence interval, 0.09-0.51) were higher in patients who moved up to a higher risk category. Both indexes of target organ damage and central augmentation index were positively associated (P≤0.048) with the odds of being reclassified. In conclusion, for reliably diagnosing hypertension and starting treatment, office measurement should be followed by ambulatory blood pressure monitoring. Using home instead of ambulatory monitoring misses the high-risk diagnoses of masked or sustained hypertension in over 25% of patients.

KEYWORDS:

ambulatory blood pressure; clinical science; hypertension

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Atypon
Loading ...
Support Center