Ross D. Feldman, MD
What is the accuracy of clinic blood pressure measurement (CBPM) and home BP measurement (HBPM) compared with ambulatory BP monitoring (ABPM) for diagnosing hypertension?
Included studies compared CBPM and/or HBPM with ABPM in adults, reported data that could be extracted into 2 x 2 tables, and clearly defined BP thresholds for diagnosing hypertension. Studies of pregnant or hospitalized patients or those receiving treatment for hypertension were excluded unless data were reported separately for those groups. Outcomes were sensitivity, specificity, and likelihood ratios.
MEDLINE, EMBASE/Excerpta Medica, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Medion, Aggressive Research Intelligence Facility database, and Turning Research Into Practice database (all to May 2010); and reference lists were searched for relevant studies. Experts and investigators were contacted. 20 studies (n = 5863, mean age 49 y, mean 57% women) met the selection criteria: 14 evaluated CBPM, 3 HBPM, and 3 both. Only 11 of 20 studies used validated devices for all methods of monitoring. 7 studies used a 135/85-mm Hg daytime ABPM threshold and a 140/90-mm Hg CBPM threshold to diagnose hypertension, and 3 used a 135/85-mm Hg threshold for both ABPM and HBPM.
Using an ABPM threshold of 135/85 mm Hg as the reference standard for diagnosing hypertension, pooled analysis showed that CBPM with a threshold of 140/90 mm Hg had mean 75% sensitivity and specificity, and HBPM with a threshold of 135/85 mm Hg had mean 86% sensitivity and 62% specificity (Table).
Home and clinic blood pressure measurements have insufficient sensitivity and specificity compared with ambulatory blood pressure monitoring to be used as single diagnostic tests for diagnosing hypertension in adults.
*Diagnostic terms defined in Glossary. The gold standard was ambulatory BP monitoring (diagnostic cutpoint = 135/85 mm Hg).
†Data provided by author.
Feldman RD. Review: Home and clinic BP have limited accuracy compared with ambulatory BP for diagnosing hypertension. Ann Intern Med. ;155:JC6–10. doi: 10.7326/0003-4819-155-12-201112200-02010
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Published: Ann Intern Med. 2011;155(12):JC6-10.
Cardiology, Coronary Risk Factors, Hypertension, Nephrology.
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