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

Journal of Human Hypertension volume 26, pages 696–700 (2012)Cite this article

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Abstract

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 ⩾3 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 ⩾135/85 mm Hg (systolic and/or diastolic) for HBP and awake ABP and ⩾140/90 mm Hg for clinic blood pressure. Among 73 subjects on ⩾3 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.

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References

  1. Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD et al. Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension 2008; 51: 1403–1419.

    Article  CAS  PubMed  Google Scholar 

  2. Redon J, Campos C, Narciso ML, Rodicio JL, Pascual JM, Ruilope LM . Prognostic value of ambulatory blood pressure monitoring in refractory hypertension: a prospective study. Hypertension 1998; 31: 712–718.

    Article  CAS  PubMed  Google Scholar 

  3. Brown MA, Buddle ML, Martin A . Is resistant hypertension really resistant? Am J Hypertens 2001; 14: 1263–1269.

    Article  CAS  PubMed  Google Scholar 

  4. Pickering TG . Extending the reach of ambulatory blood pressure monitoring: masked and resistant hypertension. Am J Hypertens 2005; 18: 1385–1387.

    Article  PubMed  Google Scholar 

  5. Salles GF, Cardoso CR, Muxfeldt ES . Prognostic influence of office and ambulatory blood pressures in resistant hypertension. Arch Intern Med 2008; 168: 2340–2346.

    Article  PubMed  Google Scholar 

  6. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G et al. 2007 guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007; 25: 1105–1187.

    Article  CAS  PubMed  Google Scholar 

  7. Stergiou GS, Siontis KC, Ioannidis JP . Home blood pressure as a cardiovascular outcome predictor: it's time to take this method seriously. Hypertension 2010; 55: 1301–1303.

    Article  CAS  PubMed  Google Scholar 

  8. Parati G, Stergiou GS, Asmar R, Bilo G, de Leeuw P, Imai Y et al. European Society of Hypertension guidelines for blood pressure monitoring at home: a summary report of the second international consensus conference on home blood pressure monitoring. J Hypertens 2008; 26: 1505–1526.

    Article  CAS  PubMed  Google Scholar 

  9. Stergiou GS, Bliziotis IA . Home blood pressure monitoring in the diagnosis and treatment of hypertension: a systematic review. Am J Hypertens 2011; 24: 123–134.

    Article  PubMed  Google Scholar 

  10. Stergiou GS, Salgami EV, Tzamouranis DG, Roussias LG . Masked hypertension assessed by ambulatory blood pressure versus home blood pressure monitoring: is it the same phenomenon? Am J Hypertens 2005; 18: 772–778.

    Article  PubMed  Google Scholar 

  11. Stergiou GS, Nasothimiou EG, Roussias LG . Morning hypertension assessed by home or ambulatory monitoring: different aspects of the same phenomenon? J Hypertens 2010; 28: 1846–1853.

    Article  CAS  PubMed  Google Scholar 

  12. Stergiou GS, Parati G . The optimal schedule for self-monitoring of blood pressure by patients at home. J Hypertens 2007; 25: 1992–1997.

    Article  CAS  PubMed  Google Scholar 

  13. dabls Educational Trust. Devices for blood pressure measurement. 2011. http://www.dableducational.org(accessed June 2011).

  14. O′Brien E, Mee F, Atkins N, O′Malley K . Accuracy of the spacelabs 90207 determined by to the British Hypertension Society Protocol. J Hypertens 1991; 9 (suppl 5): S25–S31.

    Google Scholar 

  15. Baumgart P, Kamp J . Accuracy of the spacelabs medical 90217 ambulatory blood pressure monitor. Blood Press Monit 1998; 3: 303–307.

    CAS  PubMed  Google Scholar 

  16. O’Brien E, Petrie J, Littler W, de Swiet M, Padfield PL, Altman DG et al. An outline of the revised British Hypertension Society protocol for the evaluation of blood pressure measuring devices. J Hypertens 1993; 11: 677–679.

    Article  PubMed  Google Scholar 

  17. Stergiou GS, Nasothimiou EG, Omboni S, De la Sierra A, Ruilope IM, Parati G . Diagnostic accuracy of home blood pressure monitoring: the MEDIT HABP study (Mediterranean home vs Ambulatory BP). J Hypertens 2011 29 (e suppl A): e 83.

    Article  Google Scholar 

  18. Stergiou GS, Baibas NM, Gantzarou AP, Skeva II, Kalkana CB, Roussias LG et al. Reproducibility of home, ambulatory, and clinic blood pressure: implications for the design of trials for the assessment of antihypertensive drug efficacy. Am J Hypertens 2002; 15: 101–104.

    Article  PubMed  Google Scholar 

  19. Muxfeldt ES, Bloch KV, Nogueira AR, Salles GF . Twenty-four hour ambulatory blood pressure monitoring pattern of resistant hypertension. Blood Press Monit 2003; 8: 181–185.

    Article  PubMed  Google Scholar 

  20. Oliveras A, Armario P, Hernández-Del Rey R, Arroyo JA, Poch E, Larrousse M et al. Urinary albumin excretion is associated with true resistant hypertension. J Hum Hypertens 2010; 24: 27–33.

    Article  CAS  PubMed  Google Scholar 

  21. Muxfeldt ES, Bloch KV, Nogueira Ada R, Salles GF . True resistant hypertension: is it possible to be recognized in the office? Am J Hypertens 2005; 18: 1534–1540.

    Article  PubMed  Google Scholar 

  22. Pierdomenico SD, Lapenna D, Bucci A, Di Tommaso R, Di Mascio R, Manente BM et al. Cardiovascular outcome in treated hypertensive patients with responder, masked, false resistant, and true resistant hypertension. Am J Hypertens 2005; 18: 1422–1428.

    Article  PubMed  Google Scholar 

  23. Oikawa T, Obara T, Ohkubo T, Kikuya M, Asayama K, Metoki H et al. Characteristics of resistant hypertension determined by self-measured blood pressure at home and office blood pressure measurements: the J-HOME study. J Hypertens 2006; 24: 1737–1743.

    Article  CAS  PubMed  Google Scholar 

  24. Marui FR, Bombig MT, Francisco YA, Thalenberg JM, Fonseca FA, Souza DD et al. Assessment of resistant hypertension with home blood pressure monitoring. Arq Bras Cardiol 2010; 95: 536–540.

    Article  PubMed  Google Scholar 

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Acknowledgements

The home devices used in the study were provided by G Leoussis IS, Athens, Greece.

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Authors and Affiliations

  1. Third University Department of Medicine, Hypertension Center, Sotiria Hospital, Athens, Greece

    E G Nasothimiou, D Tzamouranis, L G Roussias & G S Stergiou

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  1. E G Nasothimiou
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  2. D Tzamouranis
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  3. L G Roussias
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  4. G S Stergiou
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Correspondence to G S Stergiou.

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The authors declare no conflict of interest.

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This paper was presented at the 20th European Society of Hypertension Meeting, Oslo, 2010.

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Nasothimiou, E., Tzamouranis, D., Roussias, L. et al. Home versus ambulatory blood pressure monitoring in the diagnosis of clinic resistant and true resistant hypertension. J Hum Hypertens 26, 696–700 (2012). https://doi.org/10.1038/jhh.2011.98

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