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Accuracy of telemedical home blood pressure measurement in the diagnosis of hypertension

Journal of Human Hypertension volume 17, pages 549–554 (2003)Cite this article

Abstract

This study was conducted to compare the accuracy of clinic blood pressure (CBP) and telemedical home blood pressure (HBP) measurement in the diagnosis of hypertension in primary care. The study subjects were 411 patients with average CBP ⩾140 mmHg systolic or ⩾90 mmHg diastolic, who performed telemedical HBP measurement (5 days, four times daily) and ambulatory blood pressure (ABP) monitoring in random order. Main outcome measure was the agreement of CBP and HBP with daytime ABP. CBP was much higher than daytime ABP and average HBP (P<0.001) with no difference between the latter two. The correlation between CBP and ABP was weak (systolic: r=0.499, diastolic: r=0.543), whereas strong correlations existed between HBP and ABP (systolic: r=0.847, diastolic: r=0.812). A progressive improvement in the strength of the linear regression between average HBP of single days and ABP was obtained from day 1 to day 4, with no further benefit obtained on the fifth day. The HBP readings taken at noon and in the afternoon showed significantly stronger correlations with ABP than the blood pressures measured in the morning and in the evening. In conclusion, the accuracy of telemedical HBP measurement was substantially better than that of CBP in the diagnosis of hypertension in primary care. HBP most accurately reflected ABP on the fourth day of monitoring, and the readings at noon and in the afternoon seemed to be most accurate.

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References

  1. Appel LJ, Stason WB . Ambulatory blood pressure monitoring and blood pressure self-measurement in the diagnosis and management of hypertension. Ann Intern Med 1993; 118: 867–882.

    Article  CAS  PubMed  Google Scholar 

  2. Tsuji I et al. Proposal of reference values for home blood pressure measurement. Prognostic criteria based on a prospective observation of the general population in Ohasama, Japan. Am J Hypertens 1997; 10: 409–418.

    CAS  PubMed  Google Scholar 

  3. Ohkubo T et al. Home blood pressure measurement has a stronger predictive power for mortality than does screening blood pressure measurement: a population-based observation in Ohasama, Japan. J Hypertens 1998; 16: 971–975.

    Article  CAS  Google Scholar 

  4. Kleinert HD et al. What is the value of home blood pressure measurement in patients with mild hypertension? Hypertension 1984; 6: 574–578.

    Article  CAS  PubMed  Google Scholar 

  5. Julius S et al. ‘White coat’ versus ‘sustained’ borderline hypertension in Tecumseh, Michigan. Hypertension 1990; 16: 617–623.

    Article  CAS  PubMed  Google Scholar 

  6. Johnson AL et al. Self-recording of blood pressure in the management of hypertension. Can Med Assoc 1978; 119: 1034–1039.

    CAS  Google Scholar 

  7. Nessman DG, Carnahan JE, Nugent CA . Increasing compliance. Patient-operated hypertension groups. Arch Intern Med 1980; 140: 1427–1430.

    Article  CAS  PubMed  Google Scholar 

  8. Friedman RH et al. A telecommunications system for monitoring and counselling patients with hypertension. Impact on medication adherence and blood pressure control. Am J Hypertens 1996; 9: 285–292.

    Article  CAS  PubMed  Google Scholar 

  9. Pickering TG, for an American Society of Hypertension Ad Hoc Panel. Recommendations for the use of home (self) and ambulatory blood pressure monitoring. Am J Hypertens 1995; 9: 1–11.

    Article  Google Scholar 

  10. The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med 1997; 157: 2413–2446.

  11. Guidelines Subcommittee. 1999 World Health Organization — International Society of Hypertension guidelines for the management of hypertension. J Hypertens 1999; 17: 151–183.

  12. Asmar R, Zanchetti A, 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 Hypertens 2000; 18: 493–508.

    Article  CAS  Google Scholar 

  13. Reims H, Fossum E, Kjeldsen SE, Julius S . Home blood pressure monitoring. Current knowledge and directions for future research. Blood Press 2001; 10: 271–287.

    Article  CAS  PubMed  Google Scholar 

  14. Millar-Craig MW, Bishop CN, Raftery EB . Circadian variation of blood pressure. Lancet 1978; 795–797.

    Article  Google Scholar 

  15. Imai Y et al. Characteristics of blood pressure measured at home in the morning and in the evening: the Ohasama study. J Hypertens 1999; 17: 889–898.

    Article  CAS  PubMed  Google Scholar 

  16. Bondmass M et al. The effect of home monitoring and telemangement on blood pressure control among African Americans. Telemed J 2000; 6: 15–23.

    Article  Google Scholar 

  17. Rogers MAM et al. Home monitoring service improves mean arterial pressure in patients with essential hypertension. Ann Intern Med 2001; 134: 1024–1032.

    Article  CAS  PubMed  Google Scholar 

  18. Palatini P et al. Validation of the A&D TM-2430 device for ambulatory blood pressure monitoring and evaluation of performance according to subjects' characteristics. Blood Press Monit 1998; 3: 255–260.

    CAS  PubMed  Google Scholar 

  19. O'Brien E et al. Blood pressure measuring devices: recommendations of the European Society of Hypertension. BMJ 2001; 322: 531–536.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. O'Brien E et al. Use and interpretation of ambulatory blood pressure monitoring: recommendations of the British Hypertension Society. BMJ 2000; 320: 1128–1134.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Peixoto Filho AJ, Mansor GA, White WB . Effects of actual versus arbitrary awake and sleep times on analysis of 24-h blood pressure. Am J Hypertens 1995; 8: 676–680.

    Article  CAS  PubMed  Google Scholar 

  22. Stergiou GS, Voutsa AV, Achimastos AD, Mountokalakis TD . Home self-monitoring of blood pressure. Is fully automated oscillometric technique as good as conventional stethoscopic technique? Am J Hypertens 1997; 10: 428–433.

    CAS  PubMed  Google Scholar 

  23. Stergiou GS, Skeva II, Zourbaki AS, Mountokalakis TD . Self-monitoring of blood pressure at home: how many measurements are needed? J Hypertens 1998; 16: 725–731.

    Article  CAS  PubMed  Google Scholar 

  24. Stergiou GS et al. Diagnosis of hypertension using home or ambulatory blood pressure monitoring: comparison with the conventional strategy based on repeated clinic blood pressure measurements. J Hypertens 2000; 18: 1745–1751.

    Article  CAS  PubMed  Google Scholar 

  25. Stergiou GS et al. Home monitoring of blood pressure: limited value in general practice. J Hum Hypertens 1996; 10: 219–223.

    CAS  PubMed  Google Scholar 

  26. Ragot S, Genès N, Vaur L, Herpin D . Comparison of three blood pressure measurement methods for the evaluation of two antihypertensive drugs: feasibility, agreement and reproducibility of blood pressure response. Am J Hypertens 2000; 13: 632–639.

    Article  CAS  Google Scholar 

  27. Little P et al. Comparison of agreement between different measures of blood pressure in primary care and daytime ambulatory blood pressure. BMJ 2002; 325: 254.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Sakuma M et al. Reproducibility of home blood pressure measurements over a 1-year period. Am J Hypertens 1997; 10: 798–803.

    Article  CAS  Google Scholar 

  29. Mengden T et al. Reliability of reporting self-measured blood pressure values by hypertensive patients. Am J Hypertens 1998; 11: 1413–1417.

    Article  CAS  PubMed  Google Scholar 

  30. Nordmann A et al. Reliability of patients measuring blood pressure at home: prospective observational study. BMJ 1999; 319: 1172.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Nordmann A et al. Comparison of self-reported home blood pressure measurements with automatically stored values and ambulatory blood pressure. Blood Pressure 2000; 9: 200–205.

    Article  CAS  PubMed  Google Scholar 

  32. Johnson KA, Partsch DJ, Rippole LL, McVey DM . Reliability of self-reported blood pressure measurements. Arch Intern Med 1999; 159: 2589–2693.

    Google Scholar 

  33. Little P et al. Comparison of acceptability of and preferences for different methods of measuring blood pressure in primary care. BMJ 2002; 325: 258–259.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The study was supported by grants from Ringkjoebing County. The authors thank laboratory technicians Lisbeth Mikkelsen, Henriette Hedelund Vorup Simonsen, Anne Mette Ravn Torstensen, Susan Milton Rasmussen and Anne Jaritz-Nielsen for their excellent technical assistance. The general practitioners Lars Dudal Madsen, Niels Christian Bendtsen, Allan Raft, Christian Thomsen, Susanne Schovsbo, Bent Conrad Pedersen, Marianne Pedersen, Poul Erik Hven, Benny Funk Johannessen, Peder Kirkegaard, Asger Thomsen, Ole Krogsøe, Bruno Christensen, Pia Herltoft, Jens Jørgen Quistgaard and Henrik Termansen are thanked for trustingly recruiting patients from primary care.

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Authors and Affiliations

  1. Department of Medicine, Holstebro Hospital and Aarhus University, Holstebro, Denmark

    D S Møller, A Dideriksen & E B Pedersen

  2. Bang & Olufsen Medicom, Struer, Holstebro, Denmark

    S Sørensen

  3. Section of General Practitioners, Holstebro, Denmark

    L D Madsen

Authors
  1. D S Møller
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  2. A Dideriksen
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  3. S Sørensen
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  4. L D Madsen
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Correspondence to D S Møller.

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Møller, D., Dideriksen, A., Sørensen, S. et al. Accuracy of telemedical home blood pressure measurement in the diagnosis of hypertension. J Hum Hypertens 17, 549–554 (2003). https://doi.org/10.1038/sj.jhh.1001584

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