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Home versus ambulatory and office blood pressure in predicting target organ damage in hypertension: a systematic review and meta-analysis
Journal of Hypertension, 06/26/2012
Evidence Based Medicine
Clinical Article
Bliziotis IA et al. – The data suggest that home BP is as good as ambulatory monitoring and superior to office measurements in regard to their association with preclinical organ damage assessed by echocardiographic left ventricular mass index (LVMI).
Methods- A PubMed and Cochrane Library search (1950–2011) revealed 23 studies reporting comparative data of home BP versus ambulatory and/or office measurements in terms of their association with several indices of target organ damage.
- Correlation coefficients were pooled by random–effects model meta–analysis.
- Fourteen studies (n=2485) assessing echocardiographic left ventricular mass index (LVMI) showed similar correlations with home (coefficients r=0.46/0.28, systolic/diastolic) as with ambulatory BP (0.37/0.26, P=NS for difference versus home BP), and superior to office measurements (r=0.23/0.19, P<0.001/0.009 for difference versus home BP).
- Four methodologically heterogeneous studies assessing the glomerular filtration rate (n=609) could not be pooled or lead to a concrete result.
- Four studies assessing carotid intima–media thickness (n=1222), three assessing pulse wave velocity (n=720) and two assessing urinary protein excretion (n=156) showed no difference in pooled correlation coefficients with home versus office BP measurements.
- With all the measurement methods SBP was more closely associated with target organ damage than DBP.