Cited by 370Blood Pressure and Hypertension StudiesNon-Invasive Vital Sign MonitoringCardiovascular Health and Disease Prevention

Relative effectiveness of clinic and home blood pressure monitoring compared with ambulatory blood pressure monitoring in diagnosis of hypertension: systematic review

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Hodgkinson, J., Mant, J., Martin, U., Guo, B., Hobbs, F. D. R., Deeks, J. J., Heneghan, C., Roberts, N. +1 more·2011·BMJ

Abstract

OBJECTIVE: To determine the relative accuracy of clinic measurements and home blood pressure monitoring compared with ambulatory blood pressure monitoring as a reference standard for the diagnosis of hypertension. DESIGN: Systematic review with meta-analysis with hierarchical summary receiver operating characteristic models. Methodological quality was appraised, including evidence of validation of blood pressure measurement equipment. DATA SOURCES: Medline (from 1966), Embase (from 1980), Cochrane Database of Systematic Reviews, DARE, Medion, ARIF, and TRIP up to May 2010. Eligibility criteria for selecting studies Eligible studies examined diagnosis of hypertension in adults of all ages using home and/or clinic blood pressure measurement compared with those made using ambulatory monitoring that clearly defined thresholds to diagnose hypertension. RESULTS: The 20 eligible studies used various thresholds for the diagnosis of hypertension, and only seven studies (clinic) and three studies (home) could be directly compared with ambulatory monitoring. Compared with ambulatory monitoring thresholds of 135/85 mm Hg, clinic measurements over 140/90 mm Hg had mean sensitivity and specificity of 74.6% (95% confidence interval 60.7% to 84.8%) and 74.6% (47.9% to 90.4%), respectively, whereas home measurements over 135/85 mm Hg had mean sensitivity and specificity of 85.7% (78.0% to 91.0%) and 62.4% (48.0% to 75.0%). CONCLUSIONS: Neither clinic nor home measurement had sufficient sensitivity or specificity to be recommended as a single diagnostic test. If ambulatory monitoring is taken as the reference standard, then treatment decisions based on clinic or home blood pressure alone might result in substantial overdiagnosis. Ambulatory monitoring before the start of lifelong drug treatment might lead to more appropriate targeting of treatment, particularly around the diagnostic threshold.

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  • Blood pressure is usually lower in sleep than in wakefulness and has a characteristic surge after awakening.

    “BP is usually lower in sleep than in wakefulness and has a characteristic surge after awakening, drawing parallels with the daily pattern of adverse CV events (refs.94-97 and Figure 1).”

    From Role of the circadian system in cardiovascular disease (2018) · cites this paper as [97]

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Research works printed but not linked: 5

  1. Nordic Cochrane Centre. Review Manager (RevMan) [computer program]. Version 5.0. Cochrane Collaboration, 2008.
  2. Brueren MM, Dinant GJ, Schouten BJ, van-Ree JW. Hypertensiediagnostiek door de huisarts: metingen volgens de NHG-standaard vergeleken met ambulante bloeddrukmeting. Ned Tijdschr Geneeskd 1995;139:278-82.
  3. Denolle T. Comparaison et reproductibilite de 4 methodes de mesure indirect de la pression arterielle dans l'hypertension arterielle legere. Arch Mal Coeur Vaiss 1995;88:1165-70.
  4. Hoegholm A, Kristensen KS, Madsen NH, Svendsen TL. The frequency of white coat hypertension among patients with newly diagnosed hypertension. Cardiovasc Rev Rep 1994;15:55-61.
  5. Larkin KT, Schauss SL, Elnicki DM. Isolated clinic hypertension and normotension: false positives and false negatives in the assessment of hypertension. Blood Pressure Monit 1998;3:247-54.

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Authors
Hodgkinson, J., Mant, J., Martin, U., Guo, B., Hobbs, F. D. R., Deeks, J. J., Heneghan, C., Roberts, N., & McManus, R. J.
Affiliations
  • University of Birmingham (GB)
  • University of Cambridge (GB)
  • University of Oxford (GB)
Corresponding author
McManus, R. J.
Venue
BMJ
Publisher
BMJ
Published
2011-06-24
Volume
342
Issue
jun24 1
Pages
d3621-d3621
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
OpenAlex
W2014462481
Cited by
370
References
67
Citations by year
2026: 9 · 2025: 11 · 2024: 14 · 2023: 17 · 2022: 21 · 2021: 21 · 2020: 25 · 2019: 23 · 2018: 26 · 2017: 29 · 2016: 25 · 2015: 26 · 2014: 28 · 2013: 42 · 2012: 41
FWCI
6.65
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • HighWire Press Open Archive (submittedVersion)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
Funders
National Institute for Health and Care Research (CDF/01/017)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
Keywords
hypertension diagnosis, home blood pressure monitoring, clinic blood pressure measurement, ambulatory blood pressure monitoring, diagnostic accuracy, sensitivity and specificity, diagnostic thresholds, overdiagnosis
MeSH terms
Health Facilities, Home Care Services, Humans, Hypertension, Blood Pressure Monitoring, Ambulatory

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