Ambulatory daytime blood pressure versus tonometric blood pressure measurements in the laboratory: effect of posture

Abstract

Objective To compare blood pressure (BP) in tonometric radial artery recordings during passive head-up tilt with ambulatory recordings and evaluate possible laboratory cutoff values for hypertension. Methods Laboratory BP and ambulatory BP were recorded in normotensive (n = 69), unmedicated hypertensive (n = 190), and medicated hypertensive (n = 151) subjects. Results Mean age was 50.2 years, BMI 27.7 kg/m2, ambulatory daytime BP 139/87 mmHg, and 276 were male (65%). As supine-to-upright changes in SBP ranged from −52 to +30 mmHg, and in DBP from -21 to +32 mmHg, the mean values of BP supine and upright measurements were compared with ambulatory BP. The mean(supine+upright) systolic laboratory BP was corresponding to ambulatory level (difference +1 mmHg), while mean(supine+upright) DBP was 4 mmHg lower (P < 0.05) than ambulatory value. Correlograms indicated that laboratory 136/82 mmHg corresponded to ambulatory 135/85 mmHg. When compared with ambulatory 135/85 mmHg, the sensitivity and specificity of laboratory 136/82 mmHg to define hypertension were 71.5% and 77.3% for SBP, and 71.7% and 72.8%, for DBP, respectively. The laboratory cutoff 136/82 mmHg classified 311/410 subjects similarly to ambulatory BP as normotensive or hypertensive, 68 were hypertensive only in ambulatory, while 31 were hypertensive only in laboratory measurements. Conclusion BP responses to upright posture were variable. When compared with ambulatory BP, mean(supine+upright) laboratory cutoff 136/82 mmHg classified 76% of subjects similarly as normotensive or hypertensive. In the remaining 24% the discordant results may be attributed to white-coat or masked hypertension, or higher physical activity during out-of-office recordings.

Blood Haemoglobin Concentration Is Directly and Independently Related with Pulse Wave Velocity, a Measure of Large Artery Stiffness

“…Thus, the average values of all haemodynamic variables during each minute of measurement represented a rather large number of individual values. Although some criticism regarding the reliability of the tonometric BP recording has been presented [64,65], we recently reported that the recorded BP values well corresponded to the level of ambulatory daytime BP among 410 participants [66]. While most of the present study subjects were devoid of medications with direct cardiovascular influences, also other medications used by the participants may have influenced the results.…”

Differences in heart rate responses to upright posture are associated with variations in the high-frequency power of heart rate variability

“…Criticism regarding the reliability of tonometric BP recordings has been published ( 50 , 51 ). Yet, we recently found that the tonometric BP values closely matched the ambulatory daytime BP in over 410 subjects ( 52 ). Changes in the hormonal profile during the menstrual cycle may also have affected the HRV results in the female participants ( 53 ).…”

Volume overload is a major characteristic in primary aldosteronism: a 3-year follow-up study

“…Central BP and pressure waves were also mathematically derived from the radial artery tonometric signal [ 23 ]. Criticism regarding the reliability of the tonometric BP recording has been presented [ 47 ], but we found that tonometric BP values in the laboratory well corresponded to ambulatory daytime BP [ 21 ].…”

“…The present analyses comprised 40 primary aldosteronism patients subjected to two separate haemodynamic recordings median 2.8 years apart. The 40 patients with essential hypertension and 40 normotensive controls were enrolled from occupational healthcare providers, personnel and patients treated at Tampere University Hospital, personnel of Tampere University, and clients of Varala Sports Institute during 2006–2019 [ 11 , 20 , 21 ]. These individuals were selected solely based on their age, sex, BMI, and available data from two separate haemodynamic recordings.…”