With hypertension being so common, you’d think we’d be pretty definite about it. Taking a blood pressure is one of the first clinical skills we learn, and it something we look at on the charts every day – but as you’ve seen, who reads it (machine or person), where it’s read (home or office), and what time it’s read can make a big difference.
The BMJ have an article from Hodgkinson and colleagues, looking at the accuracy of clinic measurements and home blood pressure monitors, compared with ambulatory blood pressure monitors. The Australian hypertension guidelines note that 15% of patients can have high readings in the office but not on ambulatory monitor, and another 15% vice versa.
Looking at the 10 studies (surprising that there aren’t more! – varying standards make it difficult) with comparisons, the article found that neither the clinic or the home measurement techniques had reasonable sensitivity or specificity to be used as a diagnostic test on it’s own – which is a concern. The guidelines do say however that the diagnosis needs to be made on several measurements, not just one. Considering that once you start an anti-hypertensive you’re rarely taken off it, it’s important to get this one right.
The BMJ article is . While you’re thinking about it, why not read the latest Australian hypertension guidelines, just updated at the end of last year, via the direct link here.