Abstract
Background
The diagnosis of hypertension is difficult when faced with several different blood pressure measurements in an individual. Using the average of several office measurements is recommended, although considerable uncertainty remains. Twenty-four-hour ambulatory monitoring is often considered the gold standard, but self-monitoring of blood pressure has been proposed as a superior method.
Aim
Determination of within-individual variability of blood pressure measured in the office, by ambulatory monitoring, and by a week of self-monitoring.
Design of study
Retrospective analysis of a clinical trial of 163 subjects.
Method
Within-patient variability of office and ambulatory blood pressure was determined from measurements at 0 and 6 weeks. Subjects had performed self-monitoring of blood pressure twice each morning and evening, for at least 6 weeks; variability was determined from the means of week 1 and week 6.
Results
The within-individual coefficients of variation (CVs) for systolic blood pressure were: office, 8.6%; ambulatory, 5.5%; self, 4.2%. Equivalent values for diastolic blood pressure were 8.6%, 4.9%, and 3.9%. CVs tended to be lower with longer self-monitoring duration, and higher with longer intervals between self-monitoring.
Conclusion
Office blood pressure is impractical for precise assessment, as 10-13 measurements are required to give the accuracy required for rational titration of antihypertensive drugs. Twenty-four-hour ambulatory monitoring is better than a single office measurement, but considerable uncertainty remains around the. estimate. A week of self-monitoring appears to be the most accurate method of measuring blood pressure, but remains imperfect. Further research may identify superior self-monitoring schedules. Given the inherent accuracy in blood pressure measurement, the importance of considering overall cardiovascular risk is emphasised.
Original language | English |
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Pages (from-to) | 675-680 |
Number of pages | 6 |
Journal | British Journal of General Practice |
Volume | 60 |
Issue number | 578 |
DOIs | |
Publication status | Published - 1 Sept 2010 |
Keywords
- home
- blood pressure
- hypertension
- self
- blood pressure monitoring
- ambulatory