Clinic blood pressure measurements versus ambulatory blood pressure monitoring

ABSTRACT

To compare clinic [office] blood pressure [BP] measurement and ambulatory blood pressure monitoring [ABPM] in the clinical evaluation of hypertensive subjects. Hundred middle aged and pharmacologically untreated hypertensive subjects were studied [80 men and 20 women]. All subjects were referred fro m outpatient clinic in Farwania Hospital with BP greater than 140/90 mmHg. Resting ECG and echocardiography were done to assess left ventricular hypertrophy [LVH]. In order to exclude patients with ischemia an exercise ECG was done. Ambulatory blood pressure was recorded with an auscultatory device. There was a non -significant difference between the three clinical sessions in the measurement of the office systolic and diastolic BPreadings, [P= NS]. There was no significant intra-recording variation between the first and the second ABPM recordings when considering awake Aly M Hegazy, Bader AAbdel Kader Department of Medicine, Farwania Hospital, Kuwait and asleep maximum SBP, minimum systolic BP, maximum diastolic BP and minimum diastolic BP [P = NS]. Stepwise logistic analysis showed that ambulatory sleeptime and 24-hour systolic blood pressure had a significant relation to the presence of left ventricular hypertrophy [P < 0.05]. There was a good agreement between clinic BP readings and ambulatory daytime systolic and diastolic BP recordings as there was a good distribution of values between upper and lower limits of a g reement [mean +/- 2SD]. There was a significant c o r relation between office systolic BPreadings and awake systolic ABPM recordings [r = 0.954, P < 0.01]. Measured by non-physicians, clinic BP is as reliable as ambulatory BP monitoring in the clinical evaluation of untreated hypertensive patients. Asleep ABP, 24-hour ambulatory BP and daytime systolic BP variability were also shown to be good indicators of left ventricular hypertrophy