Abstract: | BackgroundThe importance of measuring blood pressure before morning micturition and in the
afternoon, while working, is yet to be established in relation to the accuracy of
home blood pressure monitoring (HBPM). Objective: To compare two HBPM protocols,
considering 24-hour ambulatory blood pressure monitoring (wakefulness ABPM) as
gold-standard and measurements taken before morning micturition (BM) and in the
afternoon (AM), for the best diagnosis of systemic arterial hypertension (SAH),
and their association with prognostic markers.MethodsAfter undergoing 24-hour wakefulness ABPM, 158 participants (84 women) were
randomized for 3- or 5-day HBPM. Two variations of the 3-day protocol were
considered: with measurements taken before morning micturition and in the
afternoon (BM+AM); and with post-morning-micturition and evening measurements
(PM+EM). All patients underwent echocardiography (for left ventricular hypertrophy
- LVH) and urinary albumin measurement (for microalbuminuria - MAU).ResultKappa statistic for the diagnosis of SAH between wakefulness-ABPM and standard
3-day HBPM, 3-day HBPM (BM+AM) and (PM+EM), and 5-day HBPM were 0.660, 0.638,
0.348 and 0.387, respectively. The values of sensitivity of (BM+AM) versus (PM+EM)
were 82.6% × 71%, respectively, and of specificity, 84.8% × 74%, respectively. The
positive and negative predictive values were 69.1% × 40% and 92.2% × 91.2%,
respectively. The comparisons of intraclass correlations for the diagnosis of LVH
and MAU between (BM+AM) and (PM+EM) were 0.782 × 0.474 and 0.511 × 0.276,
respectively.Conclusions The 3 day-HBPM protocol including measurements taken before morning micturition
and during work in the afternoon showed the best agreement with SAH diagnosis and
the best association with prognostic markers. |