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Predictors of the Home-Clinic Blood Pressure Difference: A Systematic Review and Meta-Analysis

James P Sheppard1, Ben Fletcher2, Paramjit Gill3

  • 1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; james.sheppard@phc.ox.ac.uk.

American Journal of Hypertension
|September 25, 2015
PubMed

Insights

Predicting blood pressure differences between home and clinic is crucial for accurate hypertension diagnosis. Masked hypertension is linked to male sex, higher BMI, smoking, and elevated clinic BP, while female sex predicts white coat hypertension.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Clinical Prediction Models

Background:

  • Discrepancies between home and clinic blood pressure (BP) readings, known as white coat hypertension and masked hypertension, can lead to misdiagnosis and suboptimal hypertension management.
  • Identifying predictors of these BP differences is essential for accurate patient assessment.

Purpose of the Study:

  • To systematically review the literature and identify key predictors of the difference between home and clinic blood pressure measurements.
  • To establish factors associated with masked hypertension and white coat hypertension.

Main Methods:

  • A systematic literature review was performed using a MEDLINE search strategy across six databases.
  • Data from 70 eligible studies, encompassing 86,167 patients, were analyzed using random-effects meta-analysis.
  • Odds ratios (ORs) were extracted to quantify associations between patient characteristics and BP differences.

Main Results:

  • Sixty significant predictors of the home-clinic BP difference were identified.
  • Masked hypertension was associated with male sex (OR 1.47), higher body mass index (BMI) (OR 1.07 per kg/m²), current smoking (OR 1.32), and higher systolic clinic BP (OR 1.10).
  • Female sex was the sole significant predictor of white coat hypertension (OR 3.38).

Conclusions:

  • Common patient characteristics effectively predict home-clinic BP differences, particularly for masked hypertension.
  • These predictors offer potential for developing a clinical tool to identify patients with masked or white coat hypertension in practice.
Abstract

Keywords:
ambulatory blood pressure monitoringhypertensionmasked hypertensionprimary carewhite coat hypertension.

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