Central pressures and central hemodynamic values in white coat hypertensives are closer to those of normotensives than to those of controlled hypertensives for similar age, gender, and 24-h and nocturnal blood pressures

Effect of white-coat hypertension on arterial stiffness: A meta-analysis

BACKGROUND

White-coat hypertension (WCH) is a debatable risk factor of cardio-cerebrovascular diseases and the current study results on the association between WCH and arterial stiffness are inconsistent. The aim was to investigate the effect of WCH on arterial stiffness using meta-analysis.

METHODS

Based on prespecified search strategies and inclusion criteria, Medline, Embase, Web Of Science, Cochrane Library, and BioSciences Information Service Preview databases were reviewed. A total of 20 studies involving 1538 WCH patients and 3582 normotensives (NT) were included. Literatures were screened for data extraction and quality assessment. Overall analysis and subgroup analysis were conducted in RevMan version 5.3 and Stata version 14.0 software.

RESULTS

Overall analysis showed that carotid-femoral pulse wave velocity (cf-PWV) was significantly higher in WCH group than in the NT group (P < .00001, 95% CI: 0.79-3.26). Subgroup analysis showed that in adults, cf-PWV was significantly higher in the WCH patients than in the NT subjects (P<.001, 95% CI: 0.46-0.87), while in juveniles, cf-PWV was comparable between the WCH group and the NT group (P = .25, 95% CI: -0.39 to 0.61).

CONCLUSION

This meta-analysis showed that WCH may increase arterial stiffness in adult population.

Evaluating the impact of measurement uncertainty in blood pressure measurement on hypertension diagnosis

BACKGROUND AND OBJECTIVE

The sphygmomanometer is a well-known device used widely for blood pressure (BP)measurement in primary cares to diagnose hypertension. It is also vastly used by patients to monitor BP for medication. Deviations in measurement might affect significantly the diagnosis. For example, a hypertensive patient might be diagnosed as normal and consequently not receive proper treatment or a healthy patient might be diagnosed as hypertensive and may receive treatment for a nonexistent disease. A measurement has two components, the error and the measurement uncertainty, both affecting the interpretation of the results yielded by the sphygmomanometer. As the impact of measurement uncertainty has not been considered properly, the present study aims to evaluate how it influences the misdiagnosis of hypertension.

MATERIALS AND METHODS

A theoretical approach is applied, using two samples from the literature, simulating how the measurement uncertainty affects the diagnosis of a sample with known BP for a sphygmomanometer indicating the threshold pressures of diagnosis. We also carried out a study evaluating how the number of measurements taken affects the probability of misdiagnosis.

RESULTS

For one of the samples, the results show an increase in misdiagnosis of 227% for diastolic pressure and 225% for systolic pressure, considering the threshold of 90 and 140 mmHg, for a measurement error of -5 mmHg when considering a ±5 mmHg uncertainty in comparison with when it is disregarded. The probability of a correct diagnosis also converges to over 98% for four measurements taken.

CONCLUSION

The significant impact of misdiagnosis is an indicator of the importance of considering the uncertainties as a component to medical decision. The number of measurements taken also plays a major role in hypertension diagnosis.