Office blood pressure measurement versus ambulatory blood pressure monitoring for detecting undiagnosed hypertension in an apparently healthy Mexican adult cohort: complementary central hemodynamic and arterial stiffness assessment

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Undiagnosed hypertension (n=151). Intervention: Office blood pressure measurement vs. Composite 24-hour ambulatory blood pressure monitoring (ABPM). Primary outcome: Detection of previously undiagnosed hypertension (sensitivity of office BP vs composite ABPM reference standard) (Sensitivity 37.9%, Specificity 96.7%, Kappa 0.42, 95% CI 22.7-56.0).

Q: What does this research mean for the field?

Office blood pressure measurement substantially underestimates hypertension prevalence compared to composite ambulatory blood pressure monitoring, demonstrating low sensitivity and failing to detect masked and nighttime hypertension. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Julia Berenice Ramírez-González; Shubhang Sharma-Sharma; Ricardo Arturo Osorio-Juárez; Jaime Galindo-Uribe; Gerardo Payró-Ramírez; Diana J. Reyes-Antonio; Berenice Hernández-Franco; Itzel Martínez-Nevarez; Ricardo Arturo Méndez-Cobos; Juana K. Rodríguez-García; Reyna Lizette Pacheco-Domínguez

doi:10.3389/fcvm.2026.1977185

November 5, 2026Frontiers in Cardiovascular MedicineOpen Access

Office blood pressure measurement versus ambulatory blood pressure monitoring for detecting undiagnosed hypertension in an apparently healthy Mexican adult cohort: complementary central hemodynamic and arterial stiffness assessment

View Full Paper

Ask AI

Bookmark

Share

Key result

Office BP misses over half of hypertension cases vs composite 24-hour ABPM, with ~38% sensitivity.

Sensitivity 37.9%, Specificity 96.7%, Kappa 0.42
95% CI 22.7-56.0
n=151

Why the study?

Office blood pressure measurement is limited by blood pressure variability and white-coat or masked hypertension, whereas ambulatory blood pressure monitoring (ABPM) provides a more comprehensive assessment alongside complementary central aortic pressure and arterial stiffness parameters.

Does office blood pressure measurement accurately detect previously undiagnosed hypertension compared with 24-hour composite ambulatory blood pressure monitoring in apparently healthy Mexican adults?

Key Points

To evaluate the diagnostic performance of office blood pressure measurement against composite ambulatory blood pressure monitoring (ABPM) for identifying undiagnosed hypertension, and to characterize vascular stiffness and circadian blood pressure patterns.
Cross-sectional analytical study of 151 adults without a prior hypertension diagnosis in Mexico.
Participants underwent office blood pressure measurement, 24-hour ABPM, and noninvasive assessment of central aortic pressure (CAP) and arterial stiffness.
Composite ABPM hypertension was defined as 24-hour blood pressure >130/80 mmHg, daytime blood pressure >135/85 mmHg, or nighttime blood pressure >120/70 mmHg.
Office blood pressure identified hypertension in 15 participants (9.9%), whereas composite ABPM detected hypertension in 29 participants (19.2%).
Office blood pressure measurement demonstrated a sensitivity of 37.9% and a specificity of 96.7% for detecting composite ABPM hypertension.
Masked hypertension was present in 18 participants (11.9%), white-coat hypertension in 4 (2.6%), and nighttime hypertension in 29 (19.2%), while elevated pulse wave velocity (>10 m/s) was observed in 9 (6.0%).

Study Design

Type

Cross-Sectional (n=151)

Multicenter

Yes

Structured PICO

Does office blood pressure measurement accurately detect previously undiagnosed hypertension compared with 24-hour composite ambulatory blood pressure monitoring in apparently healthy Mexican adults?

P

Population

151 Mexican institutional adults aged 18-69 years (mean age 42.3 years, 67.5% female) without previously diagnosed hypertension or known cardiovascular or renal disease evaluated cross-sectionally over 24 hours.

E

Exposure

Office blood pressure measurement (index test) using a WelchAllyn wall-mounted aneroid sphygmomanometer (Model: WA7670-01) in the sitting position on the left arm after 5 minutes of rest (mean of 3 measurements at 3-minute intervals; office hypertension defined as ≥140/90 mmHg), plus noninvasive assessment of central aortic pressure (CAP) and arterial stiffness parameters using TensioMed ArterioGraph.

C

Comparator

24-hour ambulatory blood pressure monitoring (ABPM; reference standard) using validated Spacelabs OnTrak devices (Model: 90227) with measurements every 15 minutes during daytime and every 30 minutes during nighttime (composite ABPM hypertension defined as 24-hour BP >130/80 mmHg, daytime BP >135/85 mmHg, or nighttime BP >120/70 mmHg).

O

Outcome

Diagnostic performance (sensitivity, specificity, positive predictive value, negative predictive value, accuracy, likelihood ratios, AUC, and Cohen's kappa agreement) of office blood pressure measurement for detecting previously undiagnosed hypertension using composite ABPM hypertension as the reference standard.surrogate

Main Result

Effect estimate: Sensitivity 37.9%, Specificity 96.7%, Kappa 0.42 (95% CI 22.7-56.0)

Absolute Event Rate: 9.9% vs 19.2%

Office blood pressure measurement had low sensitivity (37.9%) and underestimated hypertension prevalence by nearly half compared to 24-hour ABPM (9.9% vs 19.2%), missing substantial rates of masked (11.9%) and nighttime (19.2%) hypertension in apparently healthy Mexican adults.

Limitations

Cross-sectional design precludes causal inference and assessment of longitudinal prognostic value
Convenience sampling of institutional employees and medical students limits generalizability to the general Mexican adult population
High prevalence of overweight and obesity among apparently healthy participants
Lack of formal independent validation status for the specific wall-mounted aneroid sphygmomanometer model used
Absence of direct measures of target-organ damage or longitudinal cardiovascular outcomes
Small number of participants with elevated pulse wave velocity (n=9) limited statistical power for subgroup and ROC analyses
No formal a priori sample-size calculation or correction for multiple testing
Convenience sampling strategy of institutional employees and medical students, not representative of the overall Mexican adult population
Formal independent validation status for the specific aneroid sphygmomanometer model (WA7670-01) was not available
Specific proprietary algorithm and reference population used to generate vascular age were not available
Small number of participants with elevated PWV >10 m/s (n = 9), precluding multivariable logistic regression due to risk of overfitting and sparse-data bias
No formal a priori sample-size calculation or correction for multiple testing was performed

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Office BP's low sensitivity cautions against sole reliance for ruling out hypertension; leaves open ABPM's role in screening undiagnosed adults.

Abstract

Background Office blood pressure measurement is widely used for hypertension screening, but its diagnostic performance is limited by blood pressure variability and white-coat or masked hypertension. Ambulatory blood pressure monitoring (ABPM) provides a more comprehensive assessment, including nighttime blood pressure and circadian patterns. Central aortic pressure (CAP) and arterial stiffness parameters may provide complementary information on vascular hemodynamics. Objectives To evaluate the diagnostic performance of office blood pressure measurement for detecting previously undiagnosed hypertension using composite ABPM as the reference standard, and to describe ABPM-derived phenotypes, circadian blood pressure patterns, and central hemodynamic and arterial stiffness parameters. Methods This cross-sectional analytical study included 151 adults without a previous diagnosis of hypertension. Participants underwent office blood pressure measurement, 24-hour ABPM, and noninvasive assessment of CAP and arterial stiffness. Composite ABPM hypertension was defined as 24-hour blood pressure >130/80 mmHg, daytime blood pressure >135/85 mmHg, or nighttime blood pressure >120/70 mmHg. Results Office blood pressure measurement identified hypertension in 15 participants (9.9%), whereas composite ABPM identified hypertension in 29 (19.2%). Masked hypertension was observed in 18 participants (11.9%) and white-coat hypertension in 4 (2.6%). Nighttime hypertension was present in 29 participants (19.2%). Office blood pressure measurement showed low sensitivity (37.9%) and high specificity (96.7%) for composite ABPM hypertension. The dipper phenotype was observed in 80 participants (53.0%), non-dipper in 59 (39.1%), riser in 6 (4.0%), and extreme dipper in 6 (4.0%). Mean CAP was 120.7 ± 20.4 mmHg, and elevated pulse wave velocity >10 m/s was observed in 9 participants (6.0%). Conclusion Office blood pressure measurement underestimated the prevalence of hypertension compared with composite ABPM. ABPM identified masked, nighttime, and circadian blood pressure abnormalities that were not detected by office measurements. CAP, AIx, and PWV provided complementary exploratory information on central hemodynamic and arterial stiffness markers.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Ramírez-González et al. (2026) conducted a cross-sectional in Undiagnosed hypertension (n=151). Office blood pressure measurement vs. Composite 24-hour ambulatory blood pressure monitoring (ABPM) was evaluated on Detection of previously undiagnosed hypertension (sensitivity of office BP vs composite ABPM reference standard) (Sensitivity 37.9%, Specificity 96.7%, Kappa 0.42, 95% CI 22.7-56.0). Office blood pressure measurement underestimated hypertension prevalence (9.9% vs 19.2%), showing 37.9% sensitivity and 96.7% specificity compared with composite 24-hour ABPM.

synapsesocial.com/papers/6aee6bd871a7594806220bee https://doi.org/10.3389/fcvm.2026.1977185

View Full Paper

Ask AI

Bookmark

Share

Office blood pressure measurement versus ambulatory blood pressure monitoring for detecting undiagnosed hypertension in an apparently healthy Mexican adult cohort: complementary central hemodynamic and arterial stiffness assessment

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Office blood pressure measurement versus ambulatory blood pressure monitoring for detecting undiagnosed hypertension in an apparently healthy Mexican adult cohort: complementary central hemodynamic and arterial stiffness assessment

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading