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Letters to the Editor

Ambulatory Versus Home Versus Clinic Blood Pressure

Kazuo Eguchi, Kazuomi Kario
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https://doi.org/10.1161/HYPERTENSIONAHA.111.189712
Hypertension. 2012;59:e25
Originally published February 15, 2012
Kazuo Eguchi
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Kazuomi Kario
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To the Editor:

There is growing evidence that blood pressure (BP) monitoring and home BP monitoring are useful for predicting hypertensive target organ damage and the risk of cardio- and cerebrovascular events. Ambulatory BP monitoring and home BP monitoring have been reported to be better predictors than clinic BP in many population studies. In a recent issue of Hypertension, Hara et al showed that ambulatory BP, especially nighttime BP, was better correlated with silent cerebrovascular disease than home BP and that home BP was better associated with carotid atherosclerosis than ambulatory BP.1 However, they also found that clinic BP was not a good predictor of these measures of target organ damage.

In their report, Hara et al compared clinic, home, and ambulatory BP in association with brain infarcts and carotid atherosclerosis. However, Hara et al did not show the intervals between measurements. The assessment of target organ damage is not affected by the time of day when measurement was taken, but BP readings vary according to conditions such as seasonal differences. The timing of home BP and ambulatory BP measurements should be almost the same when they are compared. In our recent article, home BP values in the second and third of 3 consecutive home BP readings were 133±16/77±9 mm Hg, and the average of awake ambulatory BP was 131±14/79±10 mm Hg.2 Home BP was measured for 8 weeks, and ambulatory BP monitoring was performed in the middle of the study period (fourth week). However, the data of Hara et al (Table 1 of their report) show that daytime systolic BP were 7 and 6 mm Hg higher in the silent cerebrovascular lesion (−) and silent cerebrovascular lesion (+) groups, respectively, than in the home systolic BP group. Those authors did not discuss why the BP levels were so different between the ambulatory BP monitoring and home BP monitoring in their study. In clinical practice, when a patient-obtained ambulatory BP and home BP differ from each other, we might consider which of these 2 measures to use. If the timing of these 2 measurements differs, it is very hard to consider the data clinically useful. In addition, it is not clear how to interpret the different BP readings. Another issue we have with that study is, what were the results when the subjects were limited to hypertensive patients under treatment?

Kazuo Eguchi
Division of Cardiovascular Medicine
Department of Medicine
Jichi Medical University
Shimotsuke, Japan

Kazuomi Kario
Division of Cardiovascular Medicine
Department of Medicine
Jichi Medical University
Shimotsuke, Japan

Disclosures

None.

Footnotes

  • Letters to the Editor will be published, if suitable, as space permits. They should not exceed 1000 words (typed double-spaced) in length and may be subject to editing or abridgment.

  • © 2012 American Heart Association, Inc.

References

  1. 1.↵
    1. Hara A,
    2. Tanaka K,
    3. Ohkubo T,
    4. Kondo T,
    5. Kikuya M,
    6. Metoki H,
    7. Hashimoto T,
    8. Satoh M,
    9. Inoue R,
    10. Asayama K,
    11. Obara T,
    12. Hirose T,
    13. Izumi S-I,
    14. Satoh H,
    15. Imai Y
    . Ambulatory versus home versus clinic blood pressure: the association with subclinical cerebrovascular diseases: the Ohasama study. Hypertension. 2012;59:22–28.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. Eguchi K,
    2. Kuruvilla S,
    3. Ogedegbe G,
    4. Gerin W,
    5. Schwartz JE,
    6. Pickering TG
    . What is the optimal interval between successive home blood pressure readings using an automated oscillometric device? J Hypertens. 2009;27:1172–1177.
    OpenUrlCrossRefPubMed
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March 2012, Volume 59, Issue 3
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    Ambulatory Versus Home Versus Clinic Blood Pressure
    Kazuo Eguchi and Kazuomi Kario
    Hypertension. 2012;59:e25, originally published February 15, 2012
    https://doi.org/10.1161/HYPERTENSIONAHA.111.189712

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    Ambulatory Versus Home Versus Clinic Blood Pressure
    Kazuo Eguchi and Kazuomi Kario
    Hypertension. 2012;59:e25, originally published February 15, 2012
    https://doi.org/10.1161/HYPERTENSIONAHA.111.189712
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