Diagnostic performance of clinic and home blood pressure measurements compared with ambulatory blood pressure: a systema
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RESEARCH ARTICLE
Diagnostic performance of clinic and home blood pressure measurements compared with ambulatory blood pressure: a systematic review and meta‑analysis Auttakiat Karnjanapiboonwong1, Thunyarat Anothaisintawee1,2,5* , Usa Chaikledkaew1,6, Charungthai Dejthevaporn3, John Attia4 and Ammarin Thakkinstian5
Abstract Background: Clinic blood pressure measurement (CBPM) is currently the most commonly used form of screening for hypertension, however it might have a problem detecting white coat hypertension (WCHT) and masked hypertension (MHT). Home blood pressure measurement (HBPM) may be an alternative, but its diagnostic performance is inconclusive relative to CBPM. Therefore, this systematic review aimed to estimate the performance of CBPM and HBPM compared with ambulatory blood pressure measurement(ABPM) and to pool prevalence of WCHT and MHT. Methods: Medline, Scopus, Cochrane Central Register of Controlled Trials and WHO’s International Clinical Trials Registry Platform databases were searched up to 23rd January 2020. Studies having diagnostic tests as CBPM or HBPM with reference standard as ABPM, reporting sensitivity and specificity of both tests and/or proportion of WCHT or MHT were eligible. Diagnostic performance of CBPM and HBPM were pooled using bivariate mixed-effect regression model. Random effect model was applied to pool prevalence of WCHT and MHT. Results: Fifty-eight studies were eligible. Pooled sensitivity, specificity, and diagnostic odds ratio (DOR) of CBPM, when using 24-h ABPM as the reference standard, were 74% (95% CI: 65–82%), 79% (95% CI: 69%, 87%), and 11.11 (95% CI: 6.82, 14.20), respectively. Pooled prevalence of WCHT and MHT were 0.24 (95% CI 0.19, 0.29) and 0.29 (95% CI 0.20, 0.38). Pooled sensitivity, specificity, and DOR of HBPM were 71% (95% CI 61%, 80%), 82% (95% CI 77%, 87%), and 11.60 (95% CI 8.98, 15.13), respectively. Conclusions: Diagnostic performances of HBPM were slightly higher than CBPM. However, the prevalence of MHT was high in negative CBPM and some persons with normal HBPM had elevated BP from 24-h ABPM. Therefore, ABPM is still necessary for confirming the diagnosis of HT. Keywords: Clinic blood pressure measurement, Home blood pressure measurement, diagnostic performance, Hypertension, Systematic review, Meta-analysis
*Correspondence: [email protected] 2 Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rachathevi, Bangkok 10400, Thailand Full list of author information is available at the end of the article
Background Screening for hypertension (HT) is an important strategy for prevention of cardiovascular diseases (CVD). Currently, several approaches are being used for measuring blood pressure (BP) including office or clinic blood pressure measurement (CBPM) and out-off office blood pressure measurement (i.e. ambulatory blood pressure
© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which
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