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Agreement Between Guideline Thresholds Using an "All-in-One" Device to Measure Office, Home, and Ambulatory Blood
Kazuomi Kario1, Naoko Tomitani1, Satoshi Hoshide1
1Division of Cardiovascular Medicine, Department of Medicine Jichi Medical University School of Medicine Tochigi Japan.
Insights
This study determined equivalent blood pressure (BP) thresholds for office, home, and ambulatory measurements. Home BP monitoring closely aligns with daytime ambulatory BP, offering a reliable alternative for hypertension management.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Measurement Science
Background:
- Blood pressure (BP) thresholds for hypertension diagnosis and management differ across measurement types (office, home, ambulatory) and guidelines.
- Variability in BP thresholds complicates consistent hypertension care.
- The HI-JAMP study aimed to clarify these discrepancies using a validated device.
Purpose of the Study:
- To determine corresponding office, home, and ambulatory BP thresholds.
- To compare BP thresholds derived from different measurement methods.
- To provide evidence for harmonizing hypertension management guidelines.
Main Methods:
- Analysis of baseline data from 2322 treated hypertensive patients in the HI-JAMP prospective study.
- Utilized a validated
- all-in-one
- BP monitoring device for office, 24-hour ambulatory, and 5-day home BP monitoring.
- Employed Deming regression to establish equivalent BP thresholds between measurement types.
Main Results:
- Equivalent thresholds were calculated for office, 24-hour ambulatory, daytime ambulatory, nighttime ambulatory, and morning-evening average home BP.
- Morning-evening average home systolic BP (SBP) and daytime ambulatory SBP showed strong correlation (r=0.627), with home SBP closely mirroring daytime ambulatory SBP.
- Specific equivalent values were provided for office SBP of 120 and 140 mmHg across other measurement types.
Conclusions:
- Ambulatory and home BP thresholds derived in this analysis align with existing hypertension guidelines.
- The strong similarity between home BP and daytime ambulatory BP thresholds is a clinically significant finding.
- These findings support the use of home BP monitoring as a reliable indicator for hypertension management.
Background:
Blood pressure (BP) thresholds for diagnosing and managing hypertension vary for office, home, and ambulatory readings, and between guideline documents. This analysis determined corresponding office, home, and ambulatory BP thresholds using baseline data from the HI-JAMP (Home-Activity Information and Communication Technology-Based Japan Ambulatory Blood Pressure Monitoring Prospective) study, which used a validated "all-in-one" BP monitoring device.
Methods And Results:
Data from 2322 treated patients with hypertension who underwent office BP measurement, then 24-hour ambulatory BP monitoring, then home BP monitoring for 5 days were analyzed. Corresponding BP thresholds for office, home, and ambulatory measurements were determined using Deming regression. Values equivalent to office systolic BP (SBP) of 120 and 140 mm Hg were as follows: 115.9 and 127.7 mm Hg for 24-hour ambulatory SBP; 120.8 and 134.0 mm Hg for daytime ambulatory SBP; 104.9 and 117.9 mm Hg for nighttime ambulatory SBP; and 122.0 and 134.2 mm Hg for morning-evening average home SBP. Deming regression showed that morning-evening average home SBP and daytime ambulatory SBP were almost the same (home SBP=0.99×daytime ambulatory SBP+0.27 mm Hg; r=0.627). Morning-evening average home SBP values of 120 and 135 mm Hg were equivalent to daytime ambulatory SBP values of 119.1 and 133.9 mm Hg, respectively. A home SBP threshold of 130 mm Hg corresponded to 24-hour and nighttime ambulatory SBP values of 123.5 and 113.6 mm Hg, whereas a home SBP threshold of 135 mm Hg corresponded to 24-hour and nighttime ambulatory SBP values of 128.0 and 119.2 mm Hg.
Conclusions:
Ambulatory and home BP thresholds in this analysis were similar to those proposed by existing guidelines. The similarity between the home BP and daytime ambulatory BP thresholds was a clinically relevant finding.
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