Abstract 15741: Is Home Blood Pressure Monitoring Useful in Diagnosing Hypertension in Young Adults in Primary Care?

Abstract

Introduction: Recent guidelines have recommended out-of-office blood pressure (BP) measurement to improve the accuracy of the diagnosis of hypertension (HTN) but there are few studies evaluating its use in the younger population and in the scope of primary care. Objective: To assess the degree of agreement between office BP and Home Blood Pressure Monitoring (HBPM), evaluating their use in a young population assisted in primary care. Methods: This is a cross-sectional population study with adults between 20-50 years old registered in the Family Health Strategy. Sociodemographic, anthropometric data and cardiovascular risk factors were recorded. Office BP was the mean of 2 measurements and HBPM followed the 7-day protocol. HBPM < 135 x 85 mmHg and office BP < 140 x 90 mmHg were considered normal while dentifying the 4 phenotypes: Normotension (controlled office BP and HBPM); white-coat HTN (uncontrolled office BP and controlled HBPM); masked HTN (controlled office BP and uncontrolled HBPM) and sustained HTN (uncontrolled office BP and HBPM). Results: 475 individuals were included (male sex: 38%; mean age: 37.6 years ± 8.8 years) of which 93 (20%) had their diagnosis modified after HBPM (43 with white-coat and 47 with masked HTN). Through multiple logistics regression, male gender (OR 3.87: 95%CI 1.70-8.82) was independently correlated with white-coat HTN, while obesity and prehypertension increased the risk of masked HTN by 2 and 5.5 times respectively. Uncontrolled office BP had high specificity (89%) and low sensitivity (49%) for detecting sustained HTN, with a low concordance in the diagnosis of HTN (kappa=0.388). Among men with uncontrolled office BP, 55.6% had a diagnosis of white-coat HTN and among women, 37.1%. Conclusion: HBPM was a useful tool in the diagnosis of hypertension in a young and apparently healthy population in primary care, especially in those with uncontrolled office BP to identify white-coat HTN, and in those with high normal office BP, especially if they were male or obese, for early diagnosis of masked HTN.