Key result
In a large Indian primary care population, there was a contradiction between office and ambulatory blood pressure measurements in 31.3% of patients, with 19.3% having masked hypertension and 12.0% having white coat hypertension.
Why the study?
The study was conducted to evaluate differences between office blood pressure measurement and ambulatory blood pressure measurement in a large primary care Indian population.
Does 24-hour ambulatory blood pressure measurement improve the accuracy of hypertension diagnosis compared to office blood pressure measurement in Indian primary care patients?
Cross-Sectional (n=27,472)
Yes
Does 24-hour ambulatory blood pressure measurement improve the accuracy of hypertension diagnosis compared to office blood pressure measurement in Indian primary care patients?
Relying solely on office blood pressure measurement leads to a misdiagnosis in approximately one-third of Indian primary care patients, highlighting the critical role of ABPM in routine hypertension management.
The present paper reports differences between office blood pressure (BP) measurement (OBPM) and ambulatory blood pressure measurement (ABPM) in a large multi-centre Indian all comers' population visiting primary care physicians. ABPM and OBPM data from 27,472 subjects (aged 51 ± 14 years, males 68.2%, treated 45.5%) were analysed and compared. Patients were classified based on the following hypertension thresholds: systolic BP (SBP) ≥ 140 and/or diastolic BP (DBP) ≥90 mmHg for OBPM, and SBP ≥ 130 and/or DBP ≥ 80 mmHg for 24-h ABPM, and SBP ≥ 120 and/or DBP ≥ 70 mmHg for night-time ABPM and SBP ≥ 135 and/or DBP ≥ 85 mmHg for daytime ABPM, all together. White coat hypertension (WCH) was seen in 12.0% (n = 3304), masked hypertension (MH) in 19.3% (n = 5293) and 55.5% (n = 15,246) had sustained hypertension. Isolated night-time hypertension (INH) was diagnosed in 11.9% (n = 3256). Untreated subjects had MH relatively more often than treated subjects (23.0% vs. 14.8%, p < 0.0001; respectively). Females had higher relative risk (RR) of having WCH than males (RR 1.16 [CI 95, 1.07-1.25], p < 0.0001). Whereas, males had higher RR of MH than females (RR 1.09 [CI 95, 1.02-1.17] p < 0.01). INH subjects had lower average systolic and diastolic dipping percentages (0.7 ± 6.6/ 2.2 ± 7.9 vs. 9.0 ± 7.3/11.9 ± 8.5, p < 0.001) than those without INH. In conclusion, for diagnosis of hypertension there was a contradiction between OBPM and ABPM in approximately one-third of all patients, and a substantial number of patients had INH. Using ABPM in routine hypertension management can lead to a reduction in burden and associated costs for Indian healthcare.
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Kaul et al. (2019) conducted a cross-sectional in Hypertension (n=27,472). Ambulatory blood pressure measurement (ABPM) vs. Office blood pressure measurement (OBPM) was evaluated on Contradiction in hypertension diagnosis between OBPM and ABPM. In a large Indian primary care population, there was a contradiction between office and ambulatory blood pressure measurements in 31.3% of patients, with 19.3% having masked hypertension and 12.0% having white coat hypertension.
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