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Clinic, Home, and Kiosk Blood Pressure Measurements for Diagnosing Hypertension: a Randomized Diagnostic Study
Beverly B Green1,2, Melissa L Anderson3, Andrea J Cook3
1Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA. Bev.B.Green@kp.org.
Insights
Home blood pressure (BP) monitoring accurately aids in diagnosing hypertension, showing no significant difference compared to ambulatory BP monitoring (ABPM). Clinic BP measurements were less sensitive for hypertension diagnosis.
Area of Science:
- Cardiovascular Medicine
- Diagnostic Accuracy
- Primary Care
Background:
- The US Preventive Services Task Force recommends ambulatory BP monitoring (ABPM) or home BP monitoring for new hypertension diagnoses.
- Accurate blood pressure (BP) measurement is crucial for timely hypertension diagnosis and management.
Purpose of the Study:
- To compare the diagnostic accuracy of clinic, home, and kiosk-based BP measurements against ABPM for diagnosing hypertension.
- To evaluate the utility of different BP monitoring methods in primary care settings.
Main Methods:
- A diagnostic study involved 510 participants aged 18-85 with elevated clinic BP, randomized into clinic, home, or kiosk BP monitoring groups.
- All participants underwent 24-hour ambulatory BP monitoring (ABPM) at 3 weeks for comparison.
- Primary outcome was the difference in mean systolic BP between ABPM and other methods; secondary outcomes included diastolic BP differences, sensitivity, and specificity.
Main Results:
- Home BP monitoring showed no significant difference in mean systolic BP compared to daytime ABPM (-0.1 mmHg, P=.92).
- Clinic BP measurements yielded significantly lower systolic BP (-4.7 mmHg, P<.001) and diastolic BP (-7.2 mmHg, P<.001) versus ABPM.
- Kiosk BP measurements resulted in significantly higher systolic BP (9.5 mmHg, P<.001) and diastolic BP (5.0 mmHg, P<.001) compared to ABPM.
Conclusions:
- Home BP monitoring is a reliable method for diagnosing hypertension, aligning closely with ABPM results.
- Clinic BP measurements demonstrated low sensitivity for hypertension detection.
- Findings support the integration of home BP monitoring into routine practice for accurate hypertension diagnosis.
Background:
The US Preventive Services Task Force recommends blood pressure (BP) measurements using 24-h ambulatory monitoring (ABPM) or home BP monitoring before making a new hypertension diagnosis.
Objective:
Compare clinic-, home-, and kiosk-based BP measurement to ABPM for diagnosing hypertension.
Design, Setting, And Participants:
Diagnostic study in 12 Washington State primary care centers, with participants aged 18-85 years without diagnosed hypertension or prescribed antihypertensive medications, with elevated BP in clinic.
Interventions:
Randomization into one of three diagnostic regimens: (1) clinic (usual care follow-up BPs); (2) home (duplicate BPs twice daily for 5 days); or (3) kiosk (triplicate BPs on 3 days). All participants completed ABPM at 3 weeks.
Main Measures:
Primary outcome was difference between ABPM daytime and clinic, home, and kiosk mean systolic BP. Differences in diastolic BP, sensitivity, and specificity were secondary outcomes.
Key Results:
Five hundred ten participants (mean age 58.7 years, 80.2% white) with 434 (85.1%) included in primary analyses. Compared to daytime ABPM, adjusted mean differences in systolic BP were clinic (-4.7mmHg [95% confidence interval -7.3, -2.2]; P<.001); home (-0.1mmHg [-1.6, 1.5];P=.92); and kiosk (9.5mmHg [7.5, 11.6];P<.001). Differences for diastolic BP were clinic (-7.2mmHg [-8.8, -5.5]; P<.001); home (-0.4mmHg [-1.4, 0.7];P=.52); and kiosk (5.0mmHg [3.8, 6.2]; P<.001). Sensitivities for clinic, home, and kiosk compared to ABPM were 31.1% (95% confidence interval, 22.9, 40.6), 82.2% (73.8, 88.4), and 96.0% (90.0, 98.5), and specificities 79.5% (64.0, 89.4), 53.3% (38.9, 67.2), and 28.2% (16.4, 44.1), respectively.
Limitations:
Single health care organization and limited race/ethnicity representation.
Conclusions:
Compared to ABPM, mean BP was significantly lower for clinic, significantly higher for kiosk, and without significant differences for home. Clinic BP measurements had low sensitivity for detecting hypertension. Findings support utility of home BP monitoring for making a new diagnosis of hypertension.
Trial Registration:
ClinicalTrials.gov NCT03130257 https://clinicaltrials.gov/ct2/show/NCT03130257.
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