1-hr method detects hypertension in undiagnosed patients

A recent study has shown the validity and reliability of 1-hr automated blood pressure (BP) measurement for the diagnosis of hypertension in undiagnosed patients. The accuracy of this method allows the detection of both white-coat and masked hypertension.

In this study, the investigators enrolled patients requiring a hypertension diagnostic test, who then underwent ambulatory BP monitoring, 1-hr automated office BP measurement, office BP measurement, and home BP monitoring. Hypertension prevalence and subtypes were calculated.

The investigators compared mean values of ambulatory BP monitoring with those of the 1-hr automated office BP measurement using the correlation coefficient and Bland‒Altman graphs. They calculated the Kappa concordance index, sensitivity, specificity, and diagnostic accuracy, and established the diagnostic threshold of the 1-hr measurement using the area under the receiver operating characteristic curve.

A total of 562 participants were included, of whom 438 (87.6 percent) completed the four diagnostic methods. The 1-hr method had a sensitivity of 76.6 percent (95 percent confidence interval [CI], 71.1‒81.5), a specificity of 64.8 percent (95 percent CI, 57‒72.1), and the best diagnostic accuracy at 72.1 percent (95 percent CI, 67.7‒76.3) relative to the office and home measurements.

There were moderate-to-high associations between diastolic (r, 0.73) and systolic BP (r, 0.58) readings. The 1-hr method identified more patients as normotensive (24.4 percent) and fewer as having white-coat hypertension (13.3 percent). A diagnostic threshold of at least 133/83 mm Hg could improve the accuracy of the 1-hr method by 2.3 percent.

“To diagnose hypertension, the 1-h method or conventional home BP monitoring should be used rather than office measurements,” the investigators said.