Reproducibility of home, ambulatory, and clinic blood pressure: implications for the design of trials for the assessment of antihypertensive drug efficacy

Stergiou, George S.; Baibas, N. M.; Gantzarou, Alexandra P.; Skeva, Irini I.; Kalkana, Chrysa B.; Roussias, Leonidas G.; Mountokalakis, Theodore D.

doi:10.1016/s0895-7061(01)02324-x

Cited by 238 publications

(105 citation statements)

References 15 publications

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“…17 By taking ABP as the reference method, the sensitivity, specificity, and positive and negative predictive values of HBP in detecting sustained hypertension were 88%, 85%, and 83% and 90%, respectively, white coat hypertension were 55%, 93%, and 66% and 90%, respectively, and masked hypertension were 57%, 93%, and 50% and 95%, respectively. 17 Given that the diagnostic disagreement between ABP and HBP can be attributed, at least in part, to their imperfect reproducibility, 18 these findings suggest that these two methods might be regarded as interchangeable in the diagnosis of hypertension.…”

Section: Discussionmentioning

confidence: 99%

Home versus ambulatory blood pressure monitoring in the diagnosis of clinic resistant and true resistant hypertension

et al. 2011

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Ambulatory blood pressure (ABP) monitoring is recommended as a standard method for the evaluation of resistant hypertension (RH). This study assessed the diagnostic value of home blood pressure (HBP) monitoring in RH. Subjects on stable treatment with X3 antihypertensive drugs were included. Clinic RH (CRH) was defined as elevated clinic blood pressure and true RH (TRH) as elevated ABP. The diagnosis of CRH was verified by ABP and HBP monitoring. The diagnostic value of HBP was assessed by taking ABP as reference method. Threshold for hypertension diagnosis was X135/85 mm Hg (systolic and/or diastolic) for HBP and awake ABP and X140/90 mm Hg for clinic blood pressure. Among 73 subjects on X3 antihypertensive drugs, 44 (60%) had CRH and 40 (55%) TRH. There was agreement between ABP and HBP in diagnosing CRH in 82% of the cases (26 subjects (59%) with CRH and 10 (23%) without CRH; kappa 0.59). Regarding the diagnosis of TRH, there was agreement between ABP and HBP in 74% of the cases (36 subjects (49%) with TRH and 18 (25%) without TRH; kappa 0.46). The sensitivity, specificity, and positive and negative predictive values of HBP in detecting CRH were 93%, 63%, and 81% and 83%, respectively, and TRH were 90%, 55%, and 71%, and 82%, respectively (ABP taken as reference method). These data suggest that HBP is a reliable alternative to ABP in the evaluation of RH. These methods are necessary in both uncontrolled and controlled subjects on triple therapy to detect the white coat phenomenon and also masked RH. Although the exact prevalence of RH is unknown, clinical trials suggest that it affects 20 --30% of participants 1 and is related with worse prognosis than subjects with controlled hypertension. 1,2 Studies have shown that a significant white-coat effect is as common in patients with RH as in the general hypertensive population, with prevalence ranging from 20 to 30%. 1,3 Furthermore, using only conventional clinic blood pressure (CBP) measurements as follow-up method, patients with masked RH 4 cannot be detected, antihypertensive treatment is not up-titrated and blood pressure (BP) control is not achieved. Several studies have shown that ambulatory BP (ABP) is superior to clinical measurements in predicting hypertension-induced target-organ damage and cardiovascular events in patients with RH. 2,5 Therefore, current guidelines recommend ABP monitoring as a standard method for the evaluation of RH. 1,6 Home BP (HBP) monitoring has also been shown to predict cardiovascular events better than clinical measurements 7,8 and several studies have reported similar ability of HBP with ABP in diagnosing white coat, masked and sustained hypertension. 9 Previous studies have also shown that HBP and ABP monitoring are interchangeable diagnostic methods, not only in untreated but also in treated hypertensives. 9 --11 However, in patients with RH, although the clinical utility of ABP has been documented, to date the usefulness of HBP monitoring has not been investigated.This study assessed the diagnostic value of HBP monitoring...

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Section: Discussionmentioning

confidence: 99%

Home versus ambulatory blood pressure monitoring in the diagnosis of clinic resistant and true resistant hypertension

et al. 2011

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“…Short-term studies that attempted to define the optimal home BP monitoring schedule on the basis of its reproducibility and stability have concluded that a 3-day home BP monitoring schedule with duplicate morning and evening measurements and after excluding readings of the initial day is the minimum requirement. 14,24,35,36 As home BP monitoring is easily accepted by users and has relatively low cost, the European Society of Hypertension recommends an average of more readings to be obtained in clinical practice (7 days and exclude the first one) than the statistically minimum reliable schedule. 1,4 Although the above short-term data are important to ensure that the optimal home BP monitoring schedule accurately represents the usual level of BP of an individual at home, the ability of the proposed schedule to predict cardiovascular risk is of paramount importance.…”

Section: Study Limitationsmentioning

confidence: 99%

The optimal home blood pressure monitoring schedule based on the Didima outcome study

et al. 2009

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This study investigated the optimal schedule for home blood pressure (HBP) monitoring that has the greatest prognostic ability and provides the most reliable assessment of HBP. The Didima study assessed the value of HBP (duplicate morning and evening measurements, 3 days) in predicting cardiovascular events in the general population (662 adults, 8.2±0.2 years followup). Criteria for the optimal monitoring schedule were stabilization of mean HBP, its variability (standard deviation (s.d.)) and hazard ratios (HRs) of cardiovascular events per 1 mm Hg HBP increase. By averaging more readings (1-12), there was a progressive decline in average HBP and its s.d. and increase in HR, with most of these benefits achieved on the second day (8 readings) and little additional benefit obtained on the third day (12 readings). The first day gave higher and more unstable HBP values (higher s.d.) with less prognostic ability (lower HR). The first HBP readings per occasion gave higher values but with similar prognostic ability as the second readings taken 1 min later. There was little difference in average HBP between morning and evening readings with no prognostic superiority of morning readings. In conclusion, by averaging more readings the average HBP and its variability are reduced and the prognostic ability improved. Any aspect of HBP monitoring (first or second readings, morning or evening) has similar prognostic ability. The first day gives higher and unstable values with lower prognostic ability and should be better discarded. These data validate the HBP monitoring schedule proposed by the European Society of Hypertension.

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“…However, although the present study included a small number of subjects, its power was increased, first because a crossover design (where all patients are exposed to all treatments) was employed, 9 and, second, by using ABP monitoring that is known to have superior reproducibility than clinic BP measurements. 10 Nevertheless, the possibility of a type 2 error cannot be ruled out in our investigation.…”

mentioning

confidence: 73%

Association of renin–angiotensin system gene polymorphisms with antihypertensive responses to angiotensin-converting enzyme inhibition or angiotensin receptor blockade

et al. 2005

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Reproducibility of home, ambulatory, and clinic blood pressure: implications for the design of trials for the assessment of antihypertensive drug efficacy

Cited by 238 publications

References 15 publications

Home versus ambulatory blood pressure monitoring in the diagnosis of clinic resistant and true resistant hypertension

Home versus ambulatory blood pressure monitoring in the diagnosis of clinic resistant and true resistant hypertension

The optimal home blood pressure monitoring schedule based on the Didima outcome study

Association of renin–angiotensin system gene polymorphisms with antihypertensive responses to angiotensin-converting enzyme inhibition or angiotensin receptor blockade

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