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. 2020 Nov 30;12(11):e11784.
doi: 10.7759/cureus.11784.

Diagnostic Comparability and Interchangeability Between Daytime Ambulatory Blood Pressure Monitoring and 24-Hour Ambulatory Blood Pressure Monitoring in Detecting Masked Hypertension

Abdulhalim J Kinsara  1 , Ahmed Abuosa  2 , Alaa Meer  1 , Aymen H Elsheikh  1 , Mohammed Abrar  3 , Olga Vriz  4
Affiliations

Diagnostic Comparability and Interchangeability Between Daytime Ambulatory Blood Pressure Monitoring and 24-Hour Ambulatory Blood Pressure Monitoring in Detecting Masked Hypertension

Abdulhalim J Kinsara et al. Cureus. .

Abstract

Background The primary aim of this study was to evaluate the level of diagnostic overlap between daytime ambulatory blood pressure (BP) monitoring (DT-ABPM) and 24-hour ambulatory BP monitoring (24-h ABPM) in detecting masked hypertension (MH). Methods This is a prospective study that was performed in a sample of 196 soldiers aged between 21 and 50 years (without a history of hypertension) undergoing ABPM testing. The diagnosis of MH based on DT-ABPM defined as (office blood pressure (OBP) <140/90 and DT-ABPM ≥135/85) was compared with the 24-h ABPM defined as (OBP <140/90 mm Hg and 24-h ABPM ≥130/80 mm Hg). We critically analyzed the results to see the agreement between the two methods. Results The number of subjects classified as having MH based on both DT-ABPM and 24-h ABPM, only on 24-h ABPM, and only on DT-ABPM were 11 (5.6%), 29 (14.8%), and 18 (9.2%), respectively. The sensitivity, specificity, and positive and negative predictive values for DT-ABPM in detecting MH were: sensitivity = 100% (95% CI: 97.82% - 100%), specificity = 62.07% (95% CI: 42.26% - 79.31%), PPV = 93.82% (95% CI: 90.50% - 96.03%), and NPV = 100%, respectively. The level of agreement between DT-ABPM and 24-h ABPM in diagnosing MH was 94.4% and discordance in 5.6% (11/196); (kappa=0.736, p < 0.001). Conclusion The sensitivity, specificity, positive and negative predictive values all showed agreement between the two BP methods to confirm the diagnoses of MH. DT-ABPM can be used as an alternative to the 24-h ABPM. DT-ABPM eliminates sleep disturbance attributable to ABPM and maximizes patient compliance with the ABPM test. A further larger trial is needed for more confirmation and to affect the guidelines for using daytime ABPM.

Keywords: 24 h measurement; agreement; ambulatory; blood pressure; classification; daytime; diagnosis; hypertension; masked.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Systolic DT-ABPM and 24-h
Correlation between systolic daytime-ambulatory blood pressure monitoring (DT-ABPM) and 24-hour ABPM r is the correlation coefficient.
Figure 2
Figure 2. Diastolic DT-ABPM and 24-h ABPM
Correlation between diastolic daytime-ambulatory blood pressure monitoring (DT-ABPM) and 24-hour ABPM
Figure 3
Figure 3. Agreement of systolic blood pressure between DT-ABPM and 24-h ABPM
Bland-Altman plot showing agreement of systolic blood pressure between daytime-ambulatory blood pressure monitoring (DT-ABPM) and 24-h ABPM. Mean differences are shown in red dash-dot lines with ±2 SD in blue solid (dashed) lines.
Figure 4
Figure 4. Agreement of Diastolic blood pressure between DT-ABPM and 24-h ABPM
The Bland-Altman plot showing agreement of Diastolic blood pressure between daytime-ambulatory blood pressure monitoring (DT-ABPM) and 24-h ABPM. Mean differences are shown in red dash-dot lines with ±2 SD in blue solid (dashed) lines.
See this image and copyright information in PMC

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