3C.09: STRATEGIES FOR CLASSIFYING XXXX BASED ON OFFICE, HOME AND AMBULATORY BLOOD PRESSURE MEASUREMENT.

@entity1 @entity101 @entity20166 @entity8176 @entity1011 @entity44950 @entity15032
OBJECTIVE: @entity101 guidelines propose home ( @entity20166 ) or ambulatory ( @entity15032 ) blood pressure monitoring as indispensable after office measurement ( @entity44950 ). However, whether preference should be given to @entity20166 or @entity15032 remains undetermined. DESIGN AND METHOD: We recruited 831 consecutive @entity1 (mean age, 50.6 years; 49.8% @entity1 ) referred for @entity15032 monitoring to our clinic, if they had never taken (   90%) or had discontinued antihypertensive medication for at least 2 weeks (   10%). SpaceLabs 90217 monitors were programed to obtain 24-h @entity15032 recordings. @entity44950 was measured at three visits at 1 week intervals using the Omron HEM-7051 device. @entity1 were requested to measure their @entity20166 three times in the morning and three times in the evening at 1 minute intervals during 7 consecutive days. We applied @entity101 guidelines for cross-classification of @entity1 based on @entity44950 , @entity20166 and @entity15032 into normotension (NT) or white-coat (WCH), masked ( @entity8176 ) or sustained (SH) @entity101 . Aortic pulse wave velocity was measured by the SphygmoCor system and a first-morning urine sample was collected for the measurement of urinary albumin-to- @entity1011 ratio. RESULTS: Based on @entity44950 and @entity20166 , the prevalence of NT, WCH, @entity8176 and SH was 442 (53.2%), 61 (10.3%), 166 (20.0%) and 162 (19.5%), respectively. Using daytime @entity15032 (30 readings from 8 AM to 6 PM) instead of @entity20166 , confirmed the cross-classification based on @entity44950 and @entity20166 in 575 @entity1 (69.2%), downgraded risk from @entity8176 to NT (n=24) or from SH to WCH (n=9) in 33 (4.0%), but upgraded risk from NT to @entity8176 (n=179) or from WCH to SH (n=44) in 223 (26.8%). Analyses based on 24h @entity15032 were confirmatory. In adjusted analyses, both the urinary albumin-to- @entity1011 ratio (+20.6%; CI, 4.4-39.3) and aortic pulse wave velocity (+0.30m/s; CI, 0.09-0.51) were higher in @entity1 who moved up to a higher risk category. Both indexes of target organ damage were positively associated (P<0.008) with the odds of being reclassified. CONCLUSIONS: For reliably diagnosing @entity101 and starting treatment, @entity44950 should be followed by @entity15032 monitoring. Using @entity20166 instead of @entity15032 misses the high-risk diagnoses of @entity8176 or SH in over 25% of @entity1 .
