Home blood pressure self-monitoring: diagnostic performance in white-coat hypertension

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Abstract
Objective To determine the diagnostic performance of home blood pressure self-monitoring in white-coat hypertension using a 3-day reading program. Material and methods One hundred and ninety nontreated patients recently diagnosed with mild–moderate hypertension, selected consecutively at four primary healthcare centers in the city of Barcelona, were included. Each patient underwent morning and night home blood pressure self-monitoring with readings in triplicate for three consecutive days, followed by 24-h ambulatory blood pressure monitoring. The normality cut-off point value for home blood pressure self-monitoring and daytime ambulatory blood pressure monitoring was 135/85 mmHg. Results Sixty-three patients were diagnosed with white-coat hypertension with home blood pressure self-monitoring (34.8%; 95% confidence interval: 27.9–42.2) and 74 with ambulatory blood pressure monitoring (41.6%; 95% confidence interval: 33.7–48.4). No statistically significant differences were observed between home blood pressure self-monitoring values and those of diurnal ambulatory blood pressure monitoring [137.4 (14.3)/82.1 (8.3) mmHg vs. 134.8 (11.3)/81.3 (9.5) mmHg]. Home blood pressure self-monitoring diagnostic performance parameters were sensitivity 50.0% (95% confidence interval: 38.3–61.7), specificity 75.7% (95% confidence interval: 66.3–83.2), positive and negative predictive values 58.7% (95% confidence interval: 45.6–70.8) and 68.6% (95% confidence interval: 59.4–76.7), respectively, and positive and negative probability coefficients 2.05 and 0.66, respectively. Analysis of different normality cut-off points using a receiver operating characteristic curve failed to produce significant improvement in the diagnostic performance of home blood pressure self-monitoring. Conclusions The diagnostic accuracy of a 3-day home blood pressure self-monitoring reading program in white-coat hypertension was poor. Ambulatory blood pressure monitoring continues to be the test of choice for this indication.

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