Background Home blood pressure measurement has gained increasing importance for the management of hypertensive patients. The aim of our study was to compare levels of clinic (CBP), ambulatory (ABP), and home blood pressure (HBP) measurements, and their relationships with various indexes of target organ damage in I–II grade essential hypertension.
Design and methods Thirty-eight essential hypertensives underwent evaluation of clinic, ambulatory and home blood pressures. Each patient recorded HBP for 2 days with a digital BP monitor three times daily, the first time on the same day during which ABP monitoring was simultaneously performed. Moreover, in all subjects electrocardiogram recording, echocardiographic study, microalbuminuria assay and fundus oculi examination were obtained.
Results The average HBPs obtained on the first day, in particular systolic values, were quite similar to mean daytime ambulatory BP recorded on the same day. Clinic BP, both systolic and diastolic, showed no significant correlation with left ventricular mass index (LVMI) and with albumin excretion rate (AER), whereas a correlation barely significant was observed with an index of global target organ damage (GTODi), including cardiac, renal and retinal parameters. On the contrary, home blood pressures, especially those recorded on the second day, correlated significantly, and more tightly than clinic BP, with LVMI, AER and GTODi.
Conclusions Our study seems to justify the adoption of home BP monitoring in the management of hypertensive patients, as a useful complement to clinical readings, and may provide additional prognostic information.
ManciaGBertinieriGGrassiGParatiGPomidossiGFerrariAEffects of blood pressure measurement by the doctor on patient's blood pressure and heart rate. Lancet1983; ii:695–698.
2.
PickeringTGJamesGDBoddieCHarshifieldGABlackSLaraghJ.How common is white coat hypertension? JAMA1988; 259:225–228.
3.
ManciaGParatiGPomidossiGGrassiGZanchettiA.Alerting reaction and rise in blood pressure during measurement by physician and nurse. Hypertension1987; 9:209–215.
4.
SokolowMWerdegarDKaimHKHinmanAT.Relationship between level of blood pressure measured casually and by portable recorders and severity of complications in essential hypertension. Circulation1966; 34:279–298.
5.
RowlandsDBGloverDRIrelandMAMcLeayRAStallardTJWatsonRDAssessment of left ventricular mass and its response to antihypertensive treatment. Lancet1982; i:467–470.
6.
DrayerJIMWeberMADe YoungJL.BP as determinant of cardiac left ventricular mass. Arch Intern Med1983; 143:90–92.
7.
DevereuxRPickeringTGHarshfieldGAKleinertHDDenbyLClarkLLeft ventricular hypertrophy in patients with hypertension: Importance of blood pressure response to regularly recurrent stress. Circulation1983; 68:470–476.
8.
ParatiGPomidossiGAlbiniFMalaspinaDManciaG.Relationship of 24-hour blood pressure mean and variability to severity of target-organ damage in hypertension. J Hypertens1987; 5:93–98.
9.
VerdecchiaPSchillaciGGuerrieriMGatteschiCBenemioGBoldriniFCircadian blood pressure changes and left ventricular hypertrophy in essential hypertension. Circulation1990; 81:528–536.
10.
CerasolaGD'IgnotoGCottoneSNardiEGrassoLZingoneFBlood pressure pattern importance in the development of left ventricular hypertrophy in hypertension. G Ital Cardiol1991; 21:389–394.
11.
ManciaGZanchettiAAgabiti-RoseiEBenemioGDe CesarisRFogariRFor the SAMPLE Study Group: Ambulatory blood pressure is superior to clinic blood pressure in predicting treatment-induced regression of left ventricular hypertrophy. Circulation1997; 95:1464–1470.
12.
AsmarRGBrunelPCPannierBMLacolleyPJSafarME.Arterial distensibility and ambulatory blood pressure monitoring in essential hypertension. Am J Cardiol1988; 61:1066–1070.
13.
ZanchettiABondMGHennigMNeissAManciaGDal PalùCOn behalf of the ELSA investigators. Risk factors associated with alterations in carotid intima-media thickness in hypertension: Baseline data from the European Lacidipine Study on Atherosclerosis. J Hypertens1998; 16:949–961.
14.
CerasolaGCottoneSNardiED'IgnotoGVolpeVMulèGWhite-coat hypertension and cardiovascular risk. J Cardiovasc Risk1995; 2:545–549.
15.
ShimadaKKawamotoAMatsubayashiKOzawaT.Silent cerebrovascular disease in the elderly: Correlation with ambulatory pressure. Hypertension1990; 16:692–699.
16.
CerasolaGCottoneSMulèGNardiEManganoMTAndronicoGMicroalbuminuria, renal dysfunction and cardiovascular complication in essential hypertension. J Hypertens1996; 14:915–920.
17.
PerloffDSokolowMCowanRMJusterRP.Prognostic value of ambulatory blood pressure measurements: Further analyses. J Hypertens1989; 7:S3–S10.
18.
VerdecchiaPPorcellatiCSchillaciGBorgioniCCiucciABattistelliMAmbulatory blood pressure an independent predictor of prognosis in essential hypertension. Hypertension1994; 24:793–801.
19.
OhkuboTImaiYTsujiINagaiKWatanabeNMinamiNPrediction of mortality by ambulatory blood pressure monitoring versus screening blood pressure measurements: A pilot study in Ohasama. J Hypertens1997; 15:357–364.
20.
StaessenJAThijsLFagardRO'BrienETClementDde LeeuwPWFor the Systolic Hypertension in Europe Trial Investigators: Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension. JAMA1999; 282:539–546.
21.
JamesGDPickeringTGYeLSHarshfieldGSRivaSLaraghJH.The reproducibility of average ambulatory, home, and clinic pressures. Hypertension1988; 11:545–549.
22.
MejiaADJuliusKAJonesKAShorkNJKneisleyJ.The Tecumseh Blood Pressure Study: Normative data on blood pressure self-determination. Arch Intern Med1990; 150:1209–1213.
23.
de GaudemarisRChauNPMallionJM, For the Groupe de la Mesure, French Society of Hypertension. Home blood pressure: Variability, comparison with office readings and proposal for reference values. J Hypertens1994; 12:831–838.
24.
NesbittSDAmerenaJVGrantEJamersonKALuHWederAHome blood pressure as a predictor of future blood pressure stability in borderline hypertension. The Tecumseh Study. Am J Hypertens1997; 10:1270–1280.
25.
PadfieldPLStewartMJGoughK.The role of self-measurement of blood pressure in the management of hypertension. Blood Press Monit1996; 1 (suppl 2):S15–S18.
26.
IbrahimMMTaraziRCDustanHPGiffordRW.Electrocardiogram in evaluation of resistance to antihypertensive therapy. Arch Intern Med1977; 137:1125–1129.
27.
KleinertHDHarshifieldGAPickeringTGDevereuxRBSullivanPAMarionRMWhat is the value of home blood pressure measurement in patients with mild hypertension? Hypertension1984; 6:574–578.
28.
AbeHYokouchiMNagataSAshidaTYoshimiHKawanoYRelation of office and home blood pressure to left ventricular hypertrophy and performance in patients with hypertension. High Blood Press1992; 1:279–285.
29.
OhkuboTImaiYTsujiINagaiKKatoJKikukiNHome blood pressure measurement has a stronger power for mortality than does screening blood pressure measurement: A population-based observation in Ohasama, Japan. J Hypertens1998; 16:971–975.
30.
RaveKBenderRHeiseTSawickiPT.Value of blood pressure self-monitoring as a predictor of progression of diabetic nephropathy. J Hypertens1999; 17:597–601.
31.
MufundaJSparksBChifambaJDawkaCMatengaJAAdamsJMComparison of the Omron HEM-713C automated blood pressure monitor with a standard ausculatory method using a mercury manometer. Cent Afr J Med1996; 42:230–232.
32.
CooperRPurasASTracyJKaufmanJAsuzuMOrdunezPMufundaJSparksH, Evaluation of an electronic blood presssure device for epidemiologic studies. Blood Press Monit1997; 2: 35–40.
33.
SahnDJDeMariaAKissloJWeimanA.The Committee on M-mode Standardization of The American Society of Echocardiography. Circulation1978; 58:1072–1073.
34.
DevereuxRBReichekN.Echocardiografic determination of left ventricular mass in man. Anatomic validation of the method. Circulation1977; 55:613–618.
35.
FrattolaAParatiGCuspidiCAlbiniFManciaG.Prognostic value of 24-hour blood pressure variability. J Hypertens1993; 11:1133–1137.
36.
StrasserT.Self-measurement of blood pressure: A statement by the World Hypertension League. J Hypertens1988; 6:257–261.
37.
PickeringT, For an American Society of Hypertension Ad Hoc Panel. Recommendations for the use of home (self) and ambulatory blood pressure monitoring. Am J Hypertens1996; 9: 1–11.
38.
The Sixth Report of The Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNCVI).Arch Intern Med1997; 157: 2413–2446.
39.
World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension.J Hypertens1999; 17: 151–183.
40.
AsmarRZanchettiA, On behalf of the Organizing Committee and participants. Guidelines for the use of self-blood pressure monitoring: A summary report of the first international consensus conference. J Hypertens2000; 18: 493–508.
41.
AymanDGoldshineAD.Blood pressure determination by patients with essential hypertension: I. The difference between clinic and home readings before treatment. Am J Med Sci1940; 200:465–474.
42.
ManciaGSegaRBraviCDe VitoGValagussaFCesanaGAmbulatory blood pressure normality: Results from the PAMELA study. J Hypertens1995; 13:1377–1390.
43.
StergiouGSSkevaIIZourbakiASMountokalakisTD.Self-monitoring of blood pressure: How many measurements are needed? J Hypertens1998; 16:725–731.
44.
IulaAPuukkaPKarankoA.Multiple clinic and home blood pressure measurements versus ambulatory blood pressure monitoring. Hypertension1999; 34:261–266.
