Abstract: | BackgroundThe importance of measuring blood pressure before morning micturition and in theafternoon, while working, is yet to be established in relation to the accuracy ofhome blood pressure monitoring (HBPM). Objective: To compare two HBPM protocols,considering 24-hour ambulatory blood pressure monitoring (wakefulness ABPM) asgold-standard and measurements taken before morning micturition (BM) and in theafternoon (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) wererandomized for 3- or 5-day HBPM. Two variations of the 3-day protocol wereconsidered: with measurements taken before morning micturition and in theafternoon (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 standard3-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. Thepositive and negative predictive values were 69.1% × 40% and 92.2% × 91.2%,respectively. The comparisons of intraclass correlations for the diagnosis of LVHand 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 micturitionand during work in the afternoon showed the best agreement with SAH diagnosis andthe best association with prognostic markers. |