Abstract

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.

Highlights

  • Supplementary information The online version of this article contains supplementary material, which is available to authorised users.Research Centre, Civil Hospital, Ahmedabad, India 6 PRS Hospital, Department of Cardiology, Killipalam, Trivandrum, IndiaIn India, cardiovascular disease (CVD) is the number one cause of mortality, causing over 2 million deaths covering more than a quarter of all deaths in 2015 [1]

  • office BP measurement (OBPM) values were significantly higher than daytime Ambulatory BP measurement (ABPM), 24-h ABPM and nighttime ABPM, respectively, both for systolic BP (SBP) and diastolic BP (DBP) (Fig. 1)

  • Considering that 24-h ABPM is superior to OBPM for diagnosing hypertension, the present study showed that from the 27,472 patients, 8597 patients (31.3%) would have been wrongly diagnosed if only OBPM was considered as common in current Indian primary care practice

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Summary

Introduction

Out-of-office BP monitoring offers specific advantages over OBPM, such as the possibility to obtain many measurements in a non-clinical setting This has proven to reduce the white coat effect that may lead to a reduction of unnecessary treatment and save costs for healthcare when ambulatory [8] or self BP measurement is performed [9]. For this reason, the National Institute for Health and Care Excellence (NICE) in the UK has recommended the use of ABPM for standard clinical practice and, recently, the JNC [10] and ESC [11] followed. The present study is aimed at investigating the prevalence of WCH, and MH and some other relevant parameters of ABPM for hypertension management in a large Indian all comers’ population visiting primary care physicians

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