Clinic, Home, and Kiosk Blood Pressure Measurements for Diagnosing Hypertension: a Randomized Diagnostic Study

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....

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Bibliographic Details
Published in:Journal of general internal medicine : JGIM 2022-09, Vol.37 (12), p.2948-2956
Main Authors: Green, Beverly B, Anderson, Melissa L, Cook, Andrea J, Ehrlich, Kelly, Hall, Yoshio N, Hsu, Clarissa, Joseph, Dwayne, Klasnja, Predrag, Margolis, Karen L, McClure, Jennifer B, Munson, Sean A, Thompson, Mathew J
Format: Article
Language:English
Subjects:
Antihypertensives
Blood pressure
Confidence intervals
Daytime
Diagnosis
Diagnostic systems
Health care
Hypertension
Internal Medicine
Medical diagnosis
Medicine
Medicine & Public Health
Minority & ethnic groups
Monitoring
Original Research
Primary care
Randomization
Sensitivity
Telemedicine
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Summary: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
ISSN:0884-8734
1525-1497
DOI:10.1007/s11606-022-07400-z