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The role of blood pressure variability in misdiagnosed clinic hypertension.
MedLine Citation:
PMID:  21068739     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Blood pressure (BP) assessment may be vulnerable to bias by increased BP variability. Uncertainty in determining BP control is inherent to the clinic setting. We analyzed a registry of 3949 patients referred for ambulatory BP monitoring. The difference between clinic and ambulatory readings was plotted against ambulatory BP variability, assessed by standard deviation. In addition, BP variability of patients with clinic and awake ambulatory hypertension was compared with that of patients with controlled BP and sustained hypertension, respectively. The average clinic-ambulatory systolic BP difference was 5±17/3±9 mm Hg. Patients with >10-mm Hg systolic difference had higher systolic ambulatory BP standard deviation (14.9±4.2 mm Hg) compared to patients with a difference of 0 to 10-mm Hg (standard deviation 12.5±3.7 mm Hg). Patients with masking (negative clinic-ambulatory BP difference) also had comparatively higher standard deviation (14.4±4.9 mm Hg P<0.0001). Greater ambulatory BP variability carried increased risk for both false diagnosis of hypertension (odds ratio (OR): 2.09, 95% confidence interval (CI): 1.58-2.76), and missed clinic diagnosis of hypertension (OR: 1.86, 95% confidence interval: 1.48-2.33). The former was more striking in women, in whom high variability carried greater odds for false diagnosis of hypertension (OR: 2.76, 95% confidence interval: 1.96-3.89). Thus, clinic misjudgment of BP control may stem in part from high BP variability. Women with high BP variability are more susceptible to hypertension misdiagnosis. It is possible that high BP variability contributes to the increased cardiovascular risk related to both masked hypertension and white coat hypertension.
Authors:
Amos Cahan; Iddo Z Ben-Dov; Judith Mekler; Michael Bursztyn
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Publication Detail:
Type:  Journal Article     Date:  2010-11-11
Journal Detail:
Title:  Hypertension research : official journal of the Japanese Society of Hypertension     Volume:  34     ISSN:  1348-4214     ISO Abbreviation:  Hypertens. Res.     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-02-07     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9307690     Medline TA:  Hypertens Res     Country:  England    
Other Details:
Languages:  eng     Pagination:  187-92     Citation Subset:  IM    
Affiliation:
Hypertension Unit, Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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