Accuracy Of Home Versus Ambulatory Blood Pressure Monitoring In The Diagnosis Of White-coat And Masked Hypertension

Objective: We investigated accuracy of home blood pressure(BP)monitoring in the diagnosis of white-coat and masked hypertension in comparison with ambulatory BP monitoring.Methods: Our study participants were patients enrolled in the China Ambulatory and Home BP Registry,and underwent clinic,home,and 24-h ambulatory BP measurements.We defined white-coat hypertension as an elevated clinic systolic/diastolic BP(?140/90 mmHg)and a normal 24-h ambulatory(<130/80 mmHg)or home systolic/diastolic BP(<135/85 mmHg),and masked hypertension as a normal clinic systolic/diastolic BP(<140/90 mmHg)and an elevated 24-h ambulatory(130/80 mmHg)or home systolic/diastolic BP(135/85 mmHg).Results: In untreated patients(n=200),the prevalence of white-coat hypertension(10.0% vs.17.0%),masked hypertension(26.5% vs.14.5%)significantly(P?0.04)differed between 24-h ambulatory and home BP monitoring.In treated patients(n=867),the prevalence of masked hypertension(22.2% vs.16.4% P=0.002)but not white-coat hypertension(12.6% vs.11.9%,P=0.66)differed significantly.Regardless of the treatment status,home compared with 24-h ambulatory BP had low sensitivity(range 42–85%),but high specificity(91–98%),and accordingly low positive(50–95%),but high negative predictive values(82–98%).These two modalities had moderate diagnostic agreement(81–90%)and Kappa statistic(0.43–0.78).Conclusion: Home BP monitoring has high specificity,but low sensitivity in the diagnosis of white-coat and masked hypertension.It may behave as a complementary to,albeit not a replacement of,ambulatory BP monitoring.