Relative effectiveness of clinic and home blood pressure monitoring compared with ambulatory blood pressure monitoring in diagnosis of hypertension: systematic review

Abstract

Objective To determine the relative accuracy of clinic measurements and home blood pressure monitoring compared with ambulatory blood pressure monitoring as a reference standard for the diagnosis of hypertension.Design Systematic review with meta-analysis with hierarchical summary receiver operating characteristic models. Methodological quality was appraised, including evidence of validation of blood pressure measurement equipment.

Inter-arm blood pressure differences compared with ambulatory monitoring: a manifestation of the ‘white-coat’ effect?

“…[13][14][15][16][17][18] Ambulatory blood pressure monitoring (ABPM) is typically used where there is uncertainty in diagnosis, resistance to treatment, irregular or diurnal variation, or concerns about variability and 'whitecoat' effect. [19][20][21] A systematic review 22 and modelling study 23 found that using ambulatory monitoring as a diagnostic strategy for hypertension after an initial raised reading in the clinic would reduce misdiagnosis and save costs, and this is now recommended by the National Institute for Health and Clinical Excellence (NICE) for the routine diagnosis of hypertension. 2 The relationship between inter-arm differences in blood pressure and mean daytime blood pressure measured by ABPM has not been reported previously.…”

Questionable link between normo- to microalbuminuria and home-measured blood pressure variability in hypertension

“…24 Furthermore, recently published systematic reviews have shown that ambulatory BP monitoring is superior to home BP monitoring and clinic BP measurements in terms of diagnostic accuracy and cost effectiveness, even in a primary care setting. 25,26 The hypothesis that home BP variability favors the development of renal deterioration in hypertension is appealing. However, further studies are warranted to explore the prognostic potential of home BP variability.…”

Wytyczne ESH/ESC dotyczące postępowania w nadciśnieniu tętniczym w 2013 roku

“…W ramach początkowej oceny chorego HBPM może być bardziej odpowiednie w podstawowej opiece zdrowotnej, natomiast ABPM w opiece specjalistycznej. Wskazane jest jednak, aby graniczne lub nieprawidłowe wyniki HBPM potwierdzać za pomocą ABPM [122], które obecnie uważa się za referencyjną metodę oceny BP poza warunkami klinicznymi, mającą również dodatkową zaletę w postaci dostarczania informacji na temat BP w nocy. Ponadto większość pacjentów -jeżeli nie wszyscy -powinna być zaznajomiona z samodzielnymi pomiarami BP w celu optymalizacji dalszej obserwacji w trakcie leczenia, do czego HBPM nadaje się lepiej niż ABPM.…”