Threshold for diagnosing hypertension by automated office blood pressure using random sample population data

J Hypertens. 2016 Nov;34(11):2180-6. doi: 10.1097/HJH.0000000000001076.

Abstract

Objective: Manual office blood pressure (BP) is still recommended for diagnosing hypertension. However, its predictive value is decreased by errors in measurement technique and the white-coat effect. The errors can be eliminated by automated office BP (AOBP) measurement taking multiple readings with the participant resting quietly alone. Therefore, use of AOBP in clinical practice requires a threshold value for hypertension diagnosis. The aim of the present study was to determine an AOBP threshold corresponding to the 140/90 mmHg manual office BP using data from a large random population sample.

Methods: In 2145 participants (mean age 47.3 ± 11.3 years) randomly selected from a Brno population aged 25-64 years, BP was measured using manual mercury and automated office sphygmomanometers.

Results: Manual SBP (mean difference 6.39 ± 9.76 mmHg) and DBP (mean difference 2.50 ± 6.54 mmHg) were higher than the automated BP. According to polynomial regression, automated systole of 131.06 (95% confidence interval 130.43-131.70) and diastole of 85.43 (95% confidence interval 85.03-85.82) corresponded to the manual BP of 140/90 mmHg. Using this cut-off, the white-coat hypertension was present in 24% of participants with elevated manual BP, whereas 10% had masked hypertension and 11% masked uncontrolled hypertension. In individuals with masked uncontrolled hypertension, only AOBP was associated with the urinary albumin-creatinine ratio, whereas there was no association with manual BP.

Conclusion: AOBP of 131/85 mmHg corresponds to the manual BP of 140/90 mmHg. This value may be used as a threshold for diagnosing hypertension using AOBP. However, outcome-driven studies are required to confirm this threshold.

MeSH terms

  • Adult
  • Algorithms
  • Blood Pressure Determination / instrumentation
  • Blood Pressure Determination / methods*
  • Blood Pressure*
  • Female
  • Humans
  • Hypertension / diagnosis*
  • Male
  • Masked Hypertension / diagnosis
  • Middle Aged
  • Predictive Value of Tests
  • Reference Values
  • Sphygmomanometers
  • White Coat Hypertension / diagnosis