Multiple clinic and home blood pressure measurements versus ambulatory blood pressure monitoring

To compare multiple clinic and home blood pressure (BP) measurements and am bulatory BP monitoring in the clinical evaluation of hypertension, we studi ed 239 middle-aged pharmacologically untreated hypertensive men and women w ho were referred to the study from the primary healthcare provider. Ambulat ory BP monitoring was successfully completed for 233 patients. Clinic BP wa s measured by a trained nurse with a mercury sphygmomanometer and averaged over 4 duplicate measures. Self-recorded home BP was measured with a semiau tomatic oscillometric device twice every morning and twice every evening on 7 consecutive days. Ambulatory BP was recorded with an auscultatory device . Two-dimensionally controlled M-mode echocardiography was successfully per formed on 232 patients. Twenty-four-hour urinary albumin was determined by nephelometry. Clinic BP was 144.5+/-12.6/94.5+/-7.4 mm Hg, home BP (the mea n of 14 self-recorded measures) was 138.9+/-+13.1/92.9+/-8.6 mm Hg, home mo rning BP (the mean of the first 4 duplicate morning measures) was 137.1+/-1 3.7/92.4+/-9.2 mm Hg, daytime ambulatory BP was 148.3+/-13.9/91.9+/-7.8 mm Hg, nighttime ambulatory BP was 125.5+/-16.4/75.6+/-8.9 mm HE, and 24-hour ambulatory BP was 141.7+/-14.0/87.2+/-7.6 mm Hg. Pearson correlation coeffi cients of clinic, home, home morning, and daytime ambulatory BPs to albumin uria and to the characteristics of the left ventricle were nearly equal. In multivariate regression analyses, 36% (P<0.0001) of the cross-sectional va riation in left ventricular mass index was attributed to gender and home mo rning systolic BP in models that originally included age, gender, and clini c, self-measured home morning, and ambulatory daytime, nighttime, and 24-ho ur systolic and diastolic BPs. We concluded that carefully controlled nonph ysician-measured clinic and self-measured home BPs, when averaged over 4 du plicate measurements, are as reliable as ambulatory BP monitoring in the cl inical evaluation of untreated hypertension.