Related Experiment Video
Updated: Jan 4, 2026
Tilt Testing with Combined Lower Body Negative Pressure: a "Gold Standard" for Measuring Orthostatic Tolerance
Published on: March 21, 2013
Which out-of-office measurement technique should be used for diagnosing hypertension in prehypertensives?
Şükrü Ulusoy1, Gülsüm Özkan2, Mustafa Arıcı3
1Department of Nephrology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey.
Insights
For prehypertensive individuals, 24-hour ambulatory blood pressure monitoring (24-h ABPM) is superior for early hypertension detection. This method identifies hypertension more frequently and sooner than home blood pressure monitoring (HBPM).
Area of Science:
- Cardiology
- Hypertension Research
- Preventive Medicine
Background:
- Current hypertension diagnosis relies on office blood pressure (BP), with out-of-office measurements recommended for confirmation.
- Limited data exist on out-of-office BP measurement utility for diagnosing hypertension in prehypertensive individuals.
- Prehypertension represents a critical window for early intervention to prevent cardiovascular disease.
Purpose of the Study:
- To determine which out-of-office BP measurement technique detects hypertension development earlier and more frequently in prehypertensive patients.
- To compare the diagnostic yield of 24-hour ambulatory BP monitoring (24-h ABPM) versus home BP monitoring (HBPM) in this population.
Main Methods:
- Prospective observational study including 207 prehypertensive patients from the Cappadocia cohort.
- Office BP measurements, 24-h ABPM, and weekly home BP monitoring (HBPM) were conducted over ~2 years.
- Data analyzed to identify incident hypertension, masked hypertension, and white coat hypertension.
Main Results:
- Hypertension was diagnosed in 25.6% of subjects; masked hypertension in 11.1%.
- Office plus 24-h ABPM yielded significantly more hypertension diagnoses (p < 0.001) compared to other combinations.
- 24-h ABPM detected hypertension earlier and more frequently in this high-risk prehypertensive group.
Conclusions:
- 24-hour ambulatory BP monitoring is a valuable tool for confirming hypertension in prehypertensive patients.
- Implementing 24-h ABPM can lead to earlier and more frequent diagnosis of hypertension in individuals at high risk.
- This study highlights the importance of out-of-office BP monitoring for comprehensive hypertension management.
Abstract:
Hypertension (HT) is diagnosed with high office blood pressure (BP), although confirmation with the addition of out-of-office measurements is currently recommended. However, insufficient data are available concerning the use of out-of-office BP measurement techniques for the diagnosis of HT in the prehypertensive population. The aim of the present study was to determine which out-of-office measurements yielded earlier and more frequent detection of development of HT in prehypertensive patients. Two hundred seven prehypertensive patients under monitoring in the Cappadocia cohort were included in the study. Office BP was measured five times at 1-min intervals, followed by 24-h ambulatory BP monitoring (24-h ABPM). Home BP measurement (HBPM) was performed five times, at the same times in the morning and evening, at 1-min intervals for 1 week. The same procedure was carried out at 4-6-month intervals for ~2 years. HT was diagnosed in 25.6% of subjects, masked HT in 11.1%, and white coat HT in 2.9%, while 23.7% remained prehypertensive and 36.7% became normotensive. Briefly, 56.6% of the patients with HT were diagnosed with office plus 24-h ABPM, 13.2% with office plus HBPM, and 30.2% with office plus HBPM and 24-h ABPM. Office with 24-h ABPM yielded statistically significantly more diagnoses (p < 0.001). In conclusion, our prospective observational study evaluated the usefulness of out-of-office BP measurements in confirming diagnosis of HT in prehypertensive patients. The findings show that 24-h ABPM detected HT earlier and more frequently in this high-risk population.
Related Concept Videos
01:30Hypertension III: Clinical Manifestations and Diagnostic Studies
01:28Special considerations while measuring blood pressure
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
01:23Assessment of blood pressure in brachial artery(two-step method)
01:17Measurement of Blood Pressure
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
01:21Sites for measruring blood pressure
The Brachial Artery: Primary Site for Blood Pressure Measurement