[Efficiency between the different measurement patterns of home blood pressure monitoring in the follow-up of hypertensive patients in primary care]

Abstract

Objective: To identify the most efficient measurement pattern of home blood pressure monitoring (HBPM) for the follow-up of hypertensive patients in primary care.

Design: Validation study of a diagnostic test.

Setting: Primary care team in Murcia, Spain.

Population: One hundred and fifty three hypertensive patients younger than 80 years who met the inclusion criteria, who used HBPM and ambulatory blood pressure monitoring.

Main measurements: Performing HBPM for 24hours. The HBPM protocol consisted of recording 2 measurements in the morning and 2 in the evening for 7 days. With the records obtained, the different HBPM patterns were established (7, 6, 5, 4, 3 days). The ROC curves were used for the analysis, together with the correlation coefficients and the Bland-Altman plots.

Results: The best areas under the curve for the systolic pressure of the different HBPM patterns corresponded to the 4-day pattern: 0.837 (0.77-0.90); and the 3 day one: 0.834 (0.77-0.90). As for diastolic pressure, the 7-day pattern had an area under the curve of 0.889 (0.84-0.94); followed by the 3 and 4 days patterns, which had the same statistical result both: 0.834 (0.83-0.94). There were no significant differences between correlation coefficients for systolic and diastolic blood pressures. The 3-day pattern showed a lower dispersion in the Bland-Altman plots.

Conclusion: The 3 days HBPM pattern is proposed for the follow-up of the hypertensive patient, since it does not have an inferior efficiency to the other patterns.

Keywords: Atención primaria; Automonitorización presión arterial; Cardiovascular risk; Home blood pressure monitoring; Primary care; Riesgo cardiovascular.

Diagrama de flujo con esquema del estudio.

Figura 1

Proceso de depuración y obtención de pacientes con ambos métodos válidos para inclusión en estudio.

Figura 2

Arriba: comparación curvas presión arterial sistólica de los diferentes patrones de medición de la automonitorización de la presión arterial y de la determinación de la presión arterial en consulta, tomando como gold estándar la monitorización ambulatoria de 24 hs. Debajo, sus homónimas diastólicas.

Figura 3

a. Diagramas de Bland-Altman de los diferentes patrones de medición de la presión arterial sistólica de la AMPA con respecto a la MAPA de 24 h. b. Diagramas de Bland-Altman de los diferentes patrones de medición de la presión arterial diastólica de la AMPA con respecto a la MAPA de 24 h.