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Utility of Blood-Pressure Monitoring Outside the Clinic Setting
completed: May 2002

Investigators

Lawrence J. Appel, MD. MPH
Eric B. Bass, MD, MPH
Thomas Erlinger, MD, MPH
Lee Fleisher, MD
Eliseo Guallar, MD, DrPH
Karen A. Robinson, MSc
Neil R. Powe, MD, MPH, MBA

Questions

1. Comparison of clinic, ambulatory and self-measured blood pressure readings, under conditions of typical use: a. What is the distribution of the blood pressure differences between clinic, ambulatory and self-measured blood pressure readings? If there are differences, are these differences reproducible? b. What is the prevalence of white coat hypertension as defined by self-measured blood pressure? Is this pattern reproducible? c. What is the prevalence of white coat hypertension as defined by ambulatory blood pressure measurement? Is this pattern reproducible?
2. The relationship of mean blood pressure levels and white coat hypertension as defined by self-measured blood pressure to clinical events: a. Is self-measured blood pressure more or less strongly associated with blood pressure-related target organ damage than clinic blood pressure measurements? b. Does self-measured blood pressure predict subsequent clinical outcomes? c. What is the incremental gain in prediction of clinical outcomes from use of self-measurement devices beyond prediction from clinic blood pressure alone? d. What is the effect of treatment guided by self-measured blood pressure in comparison to treatment guided by clinic blood pressure, in terms of: i. blood pressure related target organ damage ii. symptoms iii. use of anti-hypertensive drug therapy iv. blood pressure control
3. The relationship of mean levels and white coat hypertension as defined by ambulatory blood pressure measurement to clinical events: a. Is ambulatory blood pressure more or less strongly associated with blood pressure-related target organ damage than clinic blood pressure measurements? b. Does ambulatory blood pressure predict subsequent clinical outcomes? c. What is the incremental gain in prediction of clinical outcomes from use of ambulatory devices beyond prediction from clinic blood pressure alone? d. What is the effect of treatment guided by ambulatory blood pressure in comparison to treatment guided by clinic blood pressure, in terms of: i. blood pressure related target organ damage ii. symptoms iii. use of anti-hypertensive drug therapy iv. blood pressure control
4. Does the evidence for the above questions vary according to a patient's age; gender; income level; race/ethnicity; and clinical subgroups (e.g., hypertensive/normotensive, diabetic, renal transplant status)?

link to summary of report on AHRQ site

link to evidence report on AHRQ site