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

Abstract

Background Clinic blood pressure measurement (CBPM) is currently the most commonly used form of screening for hypertension, however it might have a problem detecting white coat hypertension (WCHT) and masked hypertension (MHT). Home blood pressure measurement (HBPM) may be an alternative, but its diagnostic performance is inconclusive relative to CBPM. Therefore, this systematic review aimed to estimate the performance of CBPM and HBPM compared with ambulatory blood pressure measurement(ABPM) and to pool prevalence of WCHT and MHT. Methods Medline, Scopus, Cochrane Central Register of Controlled Trials and WHO's International Clinical Trials Registry Platform databases were searched up to 23rd January 2020. Studies having diagnostic tests as CBPM or HBPM with reference standard as ABPM, reporting sensitivity and specificity of both tests and/or proportion of WCHT or MHT 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 WCHT and MHT. Results Fifty-eight studies were eligible. Pooled sensitivity, specificity, and diagnostic odds ratio (DOR) of CBPM, when using 24-h ABPM as the reference standard, were 74% (95% CI: 65–82%), 79% (95% CI: 69%, 87%), and 11.11 (95% CI: 6.82, 14.20), respectively. Pooled prevalence of WCHT and MHT were 0.24 (95% CI 0.19, 0.29) and 0.29 (95% CI 0.20, 0.38). Pooled sensitivity, specificity, and DOR of HBPM were 71% (95% CI 61%, 80%), 82% (95% CI 77%, 87%), and 11.60 (95% CI 8.98, 15.13), respectively. Conclusions Diagnostic performances of HBPM were slightly higher than CBPM. However, the prevalence of MHT was high in negative CBPM and some persons with normal HBPM had elevated BP from 24-h ABPM. Therefore, ABPM is still necessary for confirming the diagnosis of HT.

Diagnostic accuracy of mercurial versus digital blood pressure measurement devices: a systematic review and meta-analysis

“…Our analysis suggests that digital blood pressure monitoring had equal accuracy with mercury sphygmomanometer. Our findings corroborate the studies that reported that digital blood pressure monitoring should be used for proper and better management of hypertension 12 , 13 . We reemphasize the fact that for correct estimation of blood pressure, mercury sphygmomanometers are considered the gold standard, with the comparability of measurement accuracy, found that digital blood pressure monitoring is almost as accurate as mercury sphygmomanometer.…”

Comparison of intraoperative arterial blood pressure lability during general anaesthesia in masked, uncontrolled hypertensive and adequately controlled hypertensive patients: a prospective observational study

“…Our study found a significantly higher SBP and MAP lability in the masked hypertensive patients during the intraoperative and immediate postop erative periods as measured by SD and ln (VAR), and higher SBP lability during the intraoperative period as measured by ARV and TARV, compared to the corresponding values in adequately controlled hypertensive patients. This increased lability implies that not only are masked uncontrolled hypertensive patients at increased risk of future cardiovascu lar events and vital organ damage [16] but also at risk of difficult intraoperative BP management and perioperative cardiovascular complications. This is consistent with the previously reported findings of increased risk of postoperative complications asso ciated with intraoperative BP variability [4,12].…”

“…In our study, we used a percentage of BP readings lying outside the range of ± 20% of baseline level of SBP, MAP, and DBP, respectively, to provide an estimate of the magnitude of BP lability. However, A B in the outofrange method to measure individual periope rative BP lability, the home BP is considered to be the more usual setting value and more predic tive of target organ damage [16,27]. Unlike the estimation of lability using the out ofrange approach, using SD, and therefore also ln(VAR), is independent of any baseline value, so it is commonly used to measure consecutive changes in the BP of each patient without timing consider ations [7].…”

Diagnóstico. Criterios de seguimiento, control y derivación

“…Para el diagnóstico de la HTA debemos disponer de al menos 2 o más medidas de la PA en consulta (PAC) elevadas, obtenidas en visitas de días distintos, pero dado que la PAC se correlaciona poco con el riesgo de morbimortalidad futura, sería recomendable confirmar este diagnóstico con al menos una determinación de PA fuera de ella, preferiblemente mediante monitorización ambulatoria de la PA (MAPA) de 24 horas (6) con el objetivo de poder descartar así HTA nocturna (5-9), HTA de bata blanca o HTA enmascarada (10).…”