Reproducibility of masked uncontrolled hypertension detected through home blood pressure monitoring

BAROCHINER, JESSICA; POSADAS MARTÍNEZ, MARÍA LOURDES; MARTÍNEZ, ROCÍO; GIUNTA, DIEGO

JOURNAL OF CLINICAL HYPERTENSION

WILEY-BLACKWELL PUBLISHING, INC

Año: 2019

1524-6175

Masked uncontrolled hypertension (MUCH) is an entity described in treated hyper‐tensive subjects, where office blood pressure (BP) is well controlled and out‐of‐of‐fice BP is elevated. It has been related to a higher cardiovascular risk. However, thereproducibility of MUCH has been scarcely studied. In this study, we aimed to de‐termine the reproducibility of MUCH detected through home blood pressure moni‐toring (HBPM). Two sets of measurements were performed in hypertensive adultsunder stable treatment with a 1‐week interval. Each set of measurements includedthree office BP readings and a 4‐day HBPM with duplicate readings in the morning,afternoon, and evening (the same validated oscillometric device was employed inboth settings). We determined the percentage of agreement regarding the presenceof MUCH in the two sets of measurements and quantified such agreement throughthe Cohen´s kappa coefficient (κ), its 95% confidence interval, and P value. We in‐cluded 105 patients (median age 58.6 [IQR 45.6‐67.2] years old, 53.4% men). MUCHprevalence on at least one occasion was 22.3% (95% CI: 15.2‐31.5). The reproduc‐ibility of MUCH was scant: κ = 0.19 (95% CI: 0.0002‐0.38), P = 0.02, due to the poorreproducibility of the office BP component of MUCH in comparison with the homeBP component: κ = 0.21 (95% CI: 0.03‐0.39), P = 0.01 vs κ = 0.48 (95% CI 0.29‐0.67),P < 0.001, respectively. In conclusion, the reproducibility of MUCH detected throughHBPM is minimal, mainly due to the poor reproducibility of office BP measurements.An HBPM‐based strategy for the management of patients with MUCH may be moreadequate in terms of cardiovascular morbidity and mortality.