[Predictive factors of hypertension in patients with diagnostic doubts of persistent hypertension]

[Home blood pressure self-monitoring. Influence of the mean calculation used on the diagnosis of white-coat hypertension]

OBJECTIVE

To describe the variations in the diagnosis performance of home blood pressure self-monitoring (hBPSM) with different methods for mean calculation, in order to diagnose white-coat hypertension (WCH).

DESIGN

Multi-centre, descriptive, and comparative study to assess the diagnosis performance of a test method.

SETTING

Four primary health care centres.

PARTICIPANTS

A total of 157 recently-diagnosed, untreated patients with mild-moderate hypertension took part in the study.

METHODS

The results obtained with hBPSM (3 consecutive days with readings in triplicate, morning-night) were compared with a "gold standard" out-patient blood pressure reading (OutBP).

RESULTS

Systolic and diastolic BP values of the first day and first reading (morning-night) were higher than the remaining days and readings (linear trend P< .001). Results in hBPSM diagnostic performance using all readings to calculate the mean were: sensitivity (S), 47.6%; specificity (Sp), 77.4%; positive and negative predictive values (PPV and NPV), 58.8% and 68.6%, with positive and negative probability coefficients (PPC and NPC), 2.10 and 0.67. When readings with greater patient alarm reaction (first day and first reading, morning-night) were removed, greater values of S (61.9%) were obtained, albeit at expense of an excessive loss in Sp (64.5%) and without improvement in PPC (1.74).

CONCLUSIONS

The diagnostic performance of hBPSM in WCH was low and failed to improve with the use of different systems to calculate mean BP.

[Effectiveness of self-monitoring of blood pressure in white coat hypertension diagnosis. Rationale and design]

OBJECTIVE

To assess the effectiveness of blood pressure self-monitoring at home in front of 24-h blood pressure ambulatory measurement in isolated clinical hypertension diagnosis.

DESIGN

Comparative study of repeated measurements of self-monitoring home BP and 24-h ambulatory BP measurement in a hypertensive patients sample. SETTING AND SUBJECTS TO STUDY: Mild-moderate essential hypertensive patients newly diagnosed or previously diagnosed in which suspect isolated clinical hypertension (BP>140/90 mm Hg in clinical setting repeatedly). It needs a sample of 182 hypertensive patients seen at urban primary health care.

PRINCIPAL MEASUREMENTS

We compute the isolated clinical hypertension prevalence, the sensibility, specificity and positive and negative predictive values, with 95% confidence intervals.

DISCUSSION

Prove the effectiveness of blood pressure self-monitoring at home in insolated clinical hypertension diagnosis, can involve an important cost saving for health care system as in hypertensive patient management (medicines and office visits), as in diagnosis equipment.