The validity of a daytime ambulatory blood pressure to diagnose masked hypertension

Abstract

Masked hypertension (MH) is traditionally diagnosed with 24-hour ambulatory blood pressure monitoring (24-ABPM). This is relatively costly and could cause discomfort during the night. We studied the validity of daytime ABP (DT-ABPM) in young National Guard soldiers and determined the prevalence in comparison to the standard 24-ABPM. A prospective study of 196 soldiers aged 21-50 years, without a history of hypertension or antihypertensive medication use. Each participant was fitted with a 12h-ABPM. Patients were diagnosed with MH if the office blood pressure (OBP) was <140/90 mmHg and the average DT-ABPM was ≥135/85 mmHg. By pairing the average OBP with the 12 h-ABPM, the prevalence of MH was estimated as 18/196 (9.2%), the SBP MH (systolic blood pressure) of 8.2% and the DPB MH (diastolic blood pressure) of 3.1%. When we compared the daytime prevalence with the 24 h-ABPM, and the average OBP, the prevalence of MH was 29/196 (14.8%). No statistically significant difference was noted (kappa=0.74; 95% CI: 0.59 to 0.88). We conclude that DT-ABPM is a good method and convenient to detect MH, with no statistically significant difference when compared to the 24 h-ABPM. The prevalence of MH in young healthy soldiers was unexpectedly high.

Diagnostic Comparability and Interchangeability Between Daytime Ambulatory Blood Pressure Monitoring and 24-Hour Ambulatory Blood Pressure Monitoring in Detecting Masked Hypertension

“…Both BP methods eliminate observer bias and the white coat effect. However, DT-ABPM has a number of obvious advantages over 24-h ABPM: this technique eliminates sleep disturbance attributable to ABP monitoring, reduces patient discomfort, and maximizes patient acceptance [14][15]. Thus, DT-ABPM is a reliable alternative to the 24-h ABPM for patients who experience sleep disturbances and/or cannot endure performing the 24-h ABPM test in particular.…”

“…Of these, 196 patients were eligible for analysis. The inclusion criteria were: male soldiers, age between 21 and 50 years, no previous history of hypertension or not taking antihypertensive medications, and OBP < 140/90 mmHg as previously described [ 16 ]. The local Institutional Review Board (IRB) approved this study.…”

“…In the study by Viera et al, 70.2% of patients reported sleep disturbances, 19.6% unable to fall asleep, and 8.8% removed the ambulatory device during the night due to extreme sleep disturbance [6]. Recently, Ringrose et al indicated that 78% of their patients experienced sleep disturbance caused by the monitoring device [15]. These findings suggest that the technique may cause repeated discomfort and sleep disturbance and hence may not be appropriate for every patient.…”

“…The present study is a post hoc analysis of the database originally designed to compare the prevalence of MH as determined by DT-ABPM and 24-h ABPM [ 16 ]. However, the similarity of the prevalence rates does not necessarily mean the two BP methods are interchangeable in diagnosing/detecting MH.…”