Indicadores de hipertensión de bata blanca diagnosticada mediante automedida de la presión arterial domiciliaria / White-coat hypertension indicators diagnosed through self-measurement of blood pressure at home

No disponible

No disponible

[Home blood pressure self-monitoring. Influence of the mean calculation used on the diagnosis of white-coat hypertension]. / Automedida de la presión arterial domiciliaria. Influencia del sistema de cálculo de la media en el diagnóstico de la hipertensión de bata blanca.

OBJECTIVE: To describe the variations in the diagnosis performance of home blood pressure self-monitoring (hBPSM) with different methods for mean calculation, in order to diagnose white-coat hypertension (WCH). DESIGN: Multi-centre, descriptive, and comparative study to assess the diagnosis performance of a test method. SETTING: Four primary health care centres. PARTICIPANTS: A total of 157 recently-diagnosed, untreated patients with mild-moderate hypertension took part in the study. METHODS: The results obtained with hBPSM (3 consecutive days with readings in triplicate, morning-night) were compared with a "gold standard" out-patient blood pressure reading (OutBP). RESULTS: Systolic and diastolic BP values of the first day and first reading (morning-night) were higher than the remaining days and readings (linear trend P< .001). Results in hBPSM diagnostic performance using all readings to calculate the mean were: sensitivity (S), 47.6%; specificity (Sp), 77.4%; positive and negative predictive values (PPV and NPV), 58.8% and 68.6%, with positive and negative probability coefficients (PPC and NPC), 2.10 and 0.67. When readings with greater patient alarm reaction (first day and first reading, morning-night) were removed, greater values of S (61.9%) were obtained, albeit at expense of an excessive loss in Sp (64.5%) and without improvement in PPC (1.74). CONCLUSIONS: The diagnostic performance of hBPSM in WCH was low and failed to improve with the use of different systems to calculate mean BP.

Automedida de la presión arterial domiciliaria. Influencia del sistema de cálculo de la media en el diagnóstico de la hipertensión de bata blanca / Home blood pressure self-monitoring. Influence of the mean calculation used on the diagnosis of white-coat hypertension

Objetivo. Describir las variaciones que se producen en el rendimiento de la automedida de la presión arterial domiciliaria (AMPAd) al emplear diferentes sistemas para calcular la media, en el diagnóstico de la hipertensión de bata blanca (HBB). Diseño. Estudio multicéntrico, descriptivo y comparativo para evaluar el rendimiento diagnóstico de una prueba. Emplazamiento. Cuatro centros de atención primaria. Participantes. Se seleccionó a 157 pacientes con hipertensión leve-moderada, recién diagnosticados y sin tratamiento farmacológico, que presentaron las 18 lecturas de AMPAd. Métodos. A cada paciente se le realizó una AMPAd (3 días consecutivos con lecturas por triplicado mañana-noche) y una monitorización ambulatoria de la presión arterial (MAPA) empleado, como prueba de referencia. Resultados. Los valores de presión arterial sistólica y diastólica del primer día y de la primera lectura (mañana-noche) eran mayores que los restantes días y lecturas (tendencia lineal p < 0,001). Al emplear todas las lecturas para calcular la media los parámetros de rendimiento diagnóstico obtenidos fueron: sensibilidad (S) 47,6%, especificidad (E) 77,4%, valores predictivos positivo y negativo 58,8 y 68,6%, coeficientes de probabilidad positivo y negativo (CPP y CPN) 2,10 y 0,67, respectivamente. Al eliminar las lecturas con mayor reacción de alerta (primer día y primera lectura mañana-noche) se incrementaba la S (61,9%) a expensas de un descenso excesivo de la E (64,5%), sin que mejorara el CPP (1,74). Conclusiones. La AMPAd en el diagnóstico de la HBB obtiene un bajo rendimiento que no mejora con el empleo de diferentes sistemas para calcular la media de presión arterial

Objective. To describe the variations in the diagnosis performance of home blood pressure self-monitoring (hBPSM) with different methods for mean calculation, in order to diagnose white-coat hypertension (WCH). Design. Multi-centre, descriptive, and comparative study to assess the diagnosis performance of a test method. Setting. Four primary health care centres. Participants. A total of 157 recently-diagnosed, untreated patients with mild-moderate hypertension took part in the study. Methods. The results obtained with hBPSM (3 consecutive days with readings in triplicate, morning-night) were compared with a "gold standard" out-patient blood pressure reading (OutBP). Results. Systolic and diastolic BP values of the first day and first reading (morning-night) were higher than the remaining days and readings (linear trend P<.001). Results in hBPSM diagnostic performance using all readings to calculate the mean were: sensitivity (S), 47.6%; specificity (Sp), 77.4%; positive and negative predictive values (PPV and NPV), 58.8% and 68.6%, with positive and negative probability coefficients (PPC and NPC), 2.10 and 0.67. When readings with greater patient alarm reaction (first day and first reading, morning-night) were removed, greater values of S (61.9%) were obtained, albeit at expense of an excessive loss in Sp (64.5%) and without improvement in PPC (1.74). Conclusions. The diagnostic performance of hBPSM in WCH was low and failed to improve with the use of different systems to calculate mean BP