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Clinic Blood Pressure Underestimates Ambulatory Blood Pressure in an Untreated Employer-Based US Population: Results

Joseph E Schwartz¹, Matthew M Burg², Daichi Shimbo²

¹From Center for Behavioral Cardiovascular Health (J.E.S., D.S., S.G., T.G.P.) and Department of Psychiatry (R.S.), Columbia University Medical Center, New York, NY; Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY (J.E.S., T.Y., S.G.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (M.M.B.); USC Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA (J.E.B., A.A.S.); and Department of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan (J.I.). joseph.schwartz@stonybrookmedicine.edu.

|December 7, 2016

Summary

Ambulatory blood pressure (ABP) is often higher than clinic blood pressure (CBP), challenging the common belief it

Area of Science:

Cardiology
Hypertension Research
Preventive Medicine

Background:

Ambulatory blood pressure (ABP) is a superior predictor of cardiovascular risk compared to clinic blood pressure (CBP).
A common misconception suggests ABP is typically lower than CBP.
The relationship between CBP-ABP difference and age in the US population remained unexamined.

Purpose of the Study:

To investigate the relationship between clinic blood pressure (CBP) and ambulatory blood pressure (ABP) in healthy US adults.
To examine the age-related differences in the CBP-ABP gradient.
To determine the prevalence of masked hypertension defined by ABP in individuals with normal CBP.

Main Methods:

888 healthy adults underwent 3 clinic BP assessments and 24-hour ABP monitoring.
Comparison of CBP, awake ABP (aABP), and CBP-aABP difference across demographics.
Locally weighted scatterplot smoothing modeled BP measures against age and BMI.
Prevalence of white-coat and masked hypertension was assessed.

Main Results:

Average awake ABP (123.0/77.4 mmHg) was higher than average CBP (116.0/75.4 mmHg).
ABP exceeded CBP by >10 mmHg more frequently than vice versa, particularly in younger adults with normal BMI.
Masked hypertension was identified in 15.7% of individuals with nonelevated CBP.

Conclusions:

Contrary to popular belief, ABP is not consistently lower than CBP in healthy individuals.
A significant portion of healthy individuals with normal CBP exhibit masked hypertension.
Understanding CBP-aABP gradients can guide physicians in utilizing 24-hour ABP to diagnose masked hypertension.

Keywords:

blood pressure blood pressure monitoring, ambulatory masked hypertension

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