Diagnostic performance of clinic and home blood pressure measurements compared with ambulatory blood pressure: a systematic review and meta-analysis

Abstract

Background This systematic review aimed to estimate the performance of clinic(CBPM) and home blood pressure measurements(HBPM) compared with ambulatory blood pressure measurement(ABPM) and to pool prevalence of white coat and masked hypertension.Methods Medline and Scopus databases were searched up to 11th June 2018. Studies having diagnostic test as CBPM or HBPM, reference standard as ABPM, and reported sensitivity and specificity of either or both tests and/or proportion of white coat or masked hypertension were eligible. Diagnostic performance of CBPM and HBPM were pooled using bivariate mixed-effect regression model. Random effect model was applied to pool prevalence of white coat and masked hypertension.Results Forty-six studies were eligible. Pooled sensitivity, specificity, and diagnostic odds ratio of CBPM were 66%(95%CI:58%-73%), 83%(95%CI:75%-89%), and 9.75(95%CI:6.45-14.74), respectively. Pooled prevalence of white coat and masked hypertension were 31%(95%CI:26%-35%) and 25%(95%CI:22%-28%). Pooled sensitivity, specificity, and diagnostic odds ratio of HBPM were 71%(95%CI:58%-80%), 84%(95%CI:73%-91%), and 12.47(95%CI:6.13-25.37), respectively. Pooled prevalence of white coat and masked hypertension were 19%(95%CI:10%-27%) and 31%(95%CI:10%-52%).Conclusions Diagnostic performances of HBPM were slightly higher than performance of CBPM. However, prevalence of masked hypertension was high in both negative CBPM and HBPM. Therefore, ABPM is still necessary for hypertension diagnosis, especially in people suspected with masked hypertension.