Validity and Applicability of a New Recording Method for Hypertension

• Published in: Revista española de cardiología (English ed.) 2014-09, Vol.67 (9), p.717-723
• Main Authors: Mas-Heredia, Minerva, Molés-Moliner, Eloisa, González-de Paz, Luis, Kostov, Belchin, Ortiz-Molina, Jacinto, Mauri-Vázquez, Vanesa, Menacho-Pascual, Ignacio, Cararach-Salami, Daniel, Sierra-Benito, Cristina, Sisó-Almirall, Antoni
• Format: Article
• Language: English
• Subjects: Ambulatory blood pressure monitoring; Atención primaria; Blood Pressure Determination - methods; Blood Pressure Monitoring, Ambulatory; Female; Hipertensión de bata blanca; Humans; Hypertension - diagnosis; Male; Middle Aged; Monitorización ambulatoria de la presión arterial; Primary care; White coat hypertension
• ISSN: 1885-5857; 1885-5857
• DOI: 10.1016/j.rec.2013.12.017

Blood pressure measurement methods and conditions are determinants of hypertension diagnosis. A recent British guideline recommends systematic 24-h ambulatory blood pressure monitoring. However, these devices are not available at all health centers and they can only be used by 1 patient per day. The aim of this study was to test a new blood pressure recording method to see if it gave the same diagnostic results as 24-h blood pressure monitoring. One-hour blood pressure monitoring under routine clinical practice conditions was compared with standard method of day time recording by analyzing the coefficient of correlation and Bland-Altman plots. The Kappa index was used to calculate degree of agreement. Method sensitivity and specificity were also analyzed. Of the 102 participants, 89 (87.3%) obtained the same diagnosis regardless of method, with high between-method agreement (κ= 0.81; 95% confidence interval, 0.71-0.91). We observed robust correlations between diastolic (r=0.85) and systolic blood pressure (r=0.76) readings. Sensitivity and specificity for the new method for diagnosing white coat hypertension were 85.2% (95% confidence interval 67.5%-94.1%) and 92% (95% confidence interval, 83.6%-96.3%), respectively. One-hour blood pressure monitoring is a valid and reliable method for diagnosing hypertension and for classifying hypertension subpopulations, especially in white coat hypertension and refractory hypertension. This also leads to a more productive use of monitoring instruments. El diagnóstico de la hipertensión arterial se asocia al método de medición y las condiciones en que esta se realiza. La reciente guía británica recomienda el uso sistemático de monitorización ambulatoria de la presión arterial durante 24h. Sin embargo, no todos los centros de salud disponen de dispositivos, y su uso queda restringido a 1 paciente/día. Analizamos si un nuevo método de registro de la presión arterial permite diagnosticar del mismo modo que con la monitorización de la presión arterial de 24 h. Evaluación de un nuevo método de registro de hipertensión arterial consistente en monitorizar la presión arterial durante 1h en condiciones de práctica clínica habitual. Se comparó con los registros diurnos de la prueba estándar utilizando el coeficiente de correlación y Bland-Altman plots. Se calculó el índice kappa de concordancia y la sensibilidad y la especificidad del método. De los 102 participantes, 89 (87,3%) obtuvieron el mismo diagnóstico con uno y otro méto