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Inconsistent Control Status of Office, Home, and Ambulatory Blood Pressure All Taken Using the Same Device: The
Kazuomi Kario1, Satoshi Hoshide1, Naoko Tomitani1
1Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
Insights
Discrepancies in blood pressure (BP) readings between clinic and home measurements can occur. Using a single, validated device for office, home, and ambulatory BP monitoring helps ensure consistent BP control classification.
Area of Science:
- Cardiology
- Hypertension Management
- Medical Device Validation
Background:
- Discrepancies between office and out-of-office blood pressure (BP) readings, known as white-coat hypertension or masked hypertension, may stem from using different BP monitoring devices.
- This study addresses the consistency of BP control classification across various measurement settings.
Purpose of the Study:
- To evaluate the consistency in classifying blood pressure (BP) control (well-controlled vs. uncontrolled) using office, home, and ambulatory BP measurements.
- To assess the impact of using a single, validated "all-in-one" BP monitoring device on BP classification consistency.
Main Methods:
- The HI-JAMP study involved 2,322 hypertensive patients treated with antihypertensive drugs.
- Patients underwent office BP measurements, followed by 24-hour ambulatory BP monitoring (ABPM) and 5-day home BP monitoring (HBPM) using a validated device.
Main Results:
- Patients with consistent well-controlled BP in office and home settings (n=970) largely showed well-controlled 24-hour BP (83.3%).
- Patients with consistent uncontrolled BP in office and home settings (n=579) predominantly had uncontrolled 24-hour BP (80.9%).
- Among 803 patients with inconsistent office vs. home BP control, 46.1% showed conflicting out-of-office BP control status between ABPM and HBPM.
Conclusions:
- Combined assessment of office and home BP is valuable in clinical practice.
- For patients with conflicting office and home BP classifications, complementary use of home BP monitoring (HBPM) and ambulatory BP monitoring (ABPM) is recommended.
Background:
Inconsistencies between the office and out-of-office blood pressure (BP) values (described as white-coat hypertension or masked hypertension) may be attributable in part to differences in the BP monitoring devices used.
Methods:
We studied consistency in the classification of BP control (well-controlled BP vs. uncontrolled BP) among office, home, and ambulatory BPs by using a validated "all-in-one" BP monitoring device. In the nationwide, general practitioner-based multicenter HI-JAMP study, 2,322 hypertensive patients treated with antihypertensive drugs underwent office BP measurements and 24-hour ambulatory BP monitoring (ABPM), consecutively followed by 5-day home BP monitoring (HBPM), for a total of seven BP measurement days.
Results:
Using the thresholds of the JSH2019 and ESC2018 guidelines, the patients with consistent classification of well-controlled status in the office (<140 mmHg) and home systolic BP (SBP) (<135 mmHg) (n = 970) also tended to have well-controlled 24-hour SBP (<130 mmHg) (n = 808, 83.3%). The patients with the consistent classification of uncontrolled status in office and home SBP (n = 579) also tended to have uncontrolled 24-hour SBP (n = 444, 80.9%). Among the patients with inconsistent classifications of office and home BP control (n = 803), 46.1% had inconsistent ABPM-vs.-HBPM out-of-office BP control status. When the 2017 ACC/AHA thresholds were applied as an alternative, the results were essentially the same.
Conclusions:
The combined assessment of the office and home BP is useful in clinical practice. Especially for patients whose office BP classification and home BP classification conflict, the complementary clinical use of both HBPM and ABPM might be recommended.
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