Hundemer Gregory L, Akbari Ayub, Buh Amos, Biyani Nandini, Mahbub Shaafi, Salman Maria, Brown Pierre A, Knoll Greg A, Sood Manish M, Hiremath Swapnil, Ruzicka Marcel
Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
CJC Open. 2025 Jan 11;7(4):508-515. doi: 10.1016/j.cjco.2025.01.007. eCollection 2025 Apr.
Ambulatory blood pressure monitoring (ABPM) is the gold standard for establishing the diagnosis of hypertension yet remains underused in Canada. There remains a scarcity of Canadian data surrounding how commonly misclassification of hypertension phenotypes occurs without regular use of ABPM.
This cross-sectional study included 964 consecutive adult patients referred to the Ottawa Hospital Hypertension Clinic who underwent same-day ABPM and automated office-based blood pressure measurement (AOBPM) between 2019 and 2023. The proportion of hypertension status misclassification was determined by comparing ABPM and AOBPM values. White coat hypertension (if on no antihypertensive medication) or white coat effect (if on antihypertensive medication) was defined as AOBPM ≥140/90 mm Hg but mean 24-hour ABPM <130/80 mm Hg. Masked hypertension (if on no antihypertensive medication) or masked uncontrolled hypertension (if on antihypertensive medication) was defined as AOBPM <140/90 mm Hg but mean 24-hour ABPM ≥130/80 mm Hg.
The mean (SD) age was 60 (16) years, and 46% of the patients were female. Among 296 patients with normotension or controlled hypertension based on ABPM, 146 (49%) met criteria for white coat hypertension (n = 21) or white coat effect (n = 125). Among 668 patients with uncontrolled hypertension based on ABPM, 364 (54%) met criteria for masked hypertension (n = 65) or masked uncontrolled hypertension (n = 299).
The hypertension status of approximately 50% of patients was misclassified by AOBPM vs ABPM. Broader use of ABPM in Canada will improve hypertension awareness, treatment, and control rates.
动态血压监测（ABPM）是确诊高血压的金标准，但在加拿大的应用仍不普遍。关于在不经常使用ABPM的情况下，高血压表型误分类的常见程度，加拿大的数据仍然匮乏。
这项横断面研究纳入了964例连续转诊至渥太华医院高血压诊所的成年患者，这些患者在2019年至2023年间接受了同日ABPM和基于办公室的自动血压测量（AOBPM）。通过比较ABPM和AOBPM值来确定高血压状态误分类的比例。白大衣高血压（未服用抗高血压药物时）或白大衣效应（服用抗高血压药物时）定义为AOBPM≥140/90 mmHg，但24小时平均ABPM<130/80 mmHg。隐匿性高血压（未服用抗高血压药物时）或隐匿性未控制高血压（服用抗高血压药物时）定义为AOBPM<140/90 mmHg，但24小时平均ABPM≥130/80 mmHg。
平均（标准差）年龄为60（16）岁，46%的患者为女性。在基于ABPM诊断为血压正常或高血压得到控制的296例患者中，146例（49%）符合白大衣高血压（n = 21）或白大衣效应（n = 125）的标准。在基于ABPM诊断为高血压未得到控制的668例患者中，364例（54%）符合隐匿性高血压（n = 65）或隐匿性未控制高血压（n = 299）的标准。
与ABPM相比，约50%患者的高血压状态被AOBPM误分类。在加拿大更广泛地使用ABPM将提高高血压的知晓率、治疗率和控制率。
