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Diagnostic agreement of masked uncontrolled hypertension detected by ambulatory blood pressure and home blood pressure measured by an all-in-one BP monitoring device: The HI–JAMP study

Hypertension Research volume 46, pages 157–164 (2023)Cite this article

Abstract

Masked hypertension is defined by office blood pressure (BP) in the controlled-BP range while out-of-office BP measured by ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM) is in the uncontrolled range. However, diagnosis of masked hypertension may differ if assessed by different out-of-office BP indices. This study aims to investigate the diagnostic agreement of masked uncontrolled hypertension (MUHT) detected by ABPM indices (ABPM-MUHT) and HBPM indices (HBPM-MUHT) using the same all-in-one device (TM2441; A&D Company). The present study enrolled a total of 2322 treated hypertensive patients (males 53.2%, average age 69.2 ± 11.5 years) from the Home-Activity ICT-based Japan Ambulatory Blood Pressure Monitoring Prospective (HI-JAMP) Study, who consecutively underwent office BP monitoring, 24-h ABPM (at 30-min intervals), and 5-day HBPM (twice each morning and evening) using the same device. When out-of-office BP control status was assessed only by 24-h average SBP or by the average of morning and evening SBP, the diagnostic agreement of MUHT detected by ABPM and HBPM was 29.7% among the 445 patients with any type of MUHT. When out-of-office BP indices in each time-window were simultaneously assessed, the diagnostic agreement increased to 40–45.7%. Our results indicated the importance of assessing BPs at various times of day, especially morning hours, for perfect hypertension management. Diagnosis of masked hypertension only by an averaged BP index, without considering specific time-windows, might underestimate cardiovascular risk.

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Acknowledgements

The authors thank all nurses and physicians of the participating centers for their excellent cooperation and help. The authors also thank Ms. Noriko Harada, Ms. Tomoko Shiga, and Ms. Tomoko Morimoto for their assistance with study coordination and data management, and Mr. Nobuhiko Yasui and Mr. Toshiyuki Kiuchi for their valuable advice.

Funding

This study was financially supported in part by A&D Co., Ltd., by Otsuka Medical Devices Co., Ltd., and by a grant from the Foundation for the Development of the Community (Tochigi).

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  1. Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan

    Naoko Tomitani, Satoshi Hoshide & Kazuomi Kario

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  1. Naoko Tomitani
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  2. Satoshi Hoshide
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  3. Kazuomi Kario
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On behalf of the HI-JAMP study investigators

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Correspondence to Kazuomi Kario.

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KK has received research grants from Omron Healthcare Co., Ltd., A&D Co., Ltd., and Fukuda Denshi Co., Ltd. M. The other authors report no conflicts.

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Tomitani, N., Hoshide, S., Kario, K. et al. Diagnostic agreement of masked uncontrolled hypertension detected by ambulatory blood pressure and home blood pressure measured by an all-in-one BP monitoring device: The HI–JAMP study. Hypertens Res 46, 157–164 (2023). https://doi.org/10.1038/s41440-022-01073-1

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