Evidence map›Paper›PMID 21705406›Full record

SynthesisBMJ (Clinical research ed.)2011

Relative effectiveness of clinic and home blood pressure monitoring compared with ambulatory blood pressure monitoring in diagnosis of hypertension: systematic review.

J Hodgkinson, J Mant, U Martin, B Guo, F D R Hobbs, J J Deeks, C Heneghan, N Roberts, R J McManus

5 registry-linked trialsOpen access · hybridAbstract readComparative StudySystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ (Clinical research ed.), 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 5 registered trials, which are not on this map. Cited by 152 papers, 13 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
152citing papers in PubMed, 13 pooled it
24.2field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03594825 phase4unknown statusnot on this mapstarted 2018, after this paper: background citation

Effect of Nighttime Valsartan on Prognosis of Nocturnal Hypertension Patients Undergoing Maintenance Hemodialysis

TypeinterventionalSponsorFifth Affiliated Hospital, Sun Yat-Sen UniversityRan2018 to 2023Enrolled68ConditionsHypertension, NephropathyArmsValsartan
NCT03603938 naunknown statusnot on this mapstarted 2018, after this paper: background citation

Effect of Potassium Losartan With Bedtime Dosing on Chronic Kidney Disease Patients With Nondipping Blood Pressure Pattern

TypeinterventionalSponsorFifth Affiliated Hospital, Sun Yat-Sen UniversityRan2018 to 2023Enrolled189ConditionsChronic Kidney Disease PatientsArmspotassium losartan
NCT03604003 naunknown statusnot on this mapstarted 2018, after this paper: background citation

Prognostic Effect of Isolated Nocturnal Hypertension Pattern With Nondialysis CKD

TypeinterventionalSponsorFifth Affiliated Hospital, Sun Yat-Sen UniversityRan2018 to 2023Enrolled252ConditionsChronic Kidney DiseaseArmspotassium losartan
NCT03692013 phase4unknown statusnot on this mapstarted 2018, after this paper: background citation

Effect of Nighttime Losartan on Prognosis of Nocturnal Hypertension Patients Undergoing Continous Ambulatory Peritoneal Dialysis

TypeinterventionalSponsorFifth Affiliated Hospital, Sun Yat-Sen UniversityRan2018 to 2023Enrolled68ConditionsHypertension,NephropathyArmsLosartan
NCT03718585 unknown statusnot on this mapstarted 2018, after this paper: background citation

Whole Exome Sequencing Analysis Project in Chronic Kidney Disease Patients With Nocturnal Hypertension

Typeobservational_patient_registrySponsorFifth Affiliated Hospital, Sun Yat-Sen UniversityRan2018 to 2022Enrolled4,000ConditionsHypertension, NephropathyArmswhole exome sequencing analysis
3 · Its place in the literature

Who cites it

152 citing papers in PubMed, 13 syntheses or guidelines pooled it, 372 citations in OpenAlex.

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  6. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019).Hypertension research : official journal of the Japanese Society of Hypertension · 2019
    Guideline
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92 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors at 3 institutions in 2 countries.

J HodgkinsonPrimary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham B15 2PP.
J Mant
U Martin
B Guo
F D R Hobbs
J J Deeks
C Heneghan
N Roberts
R J McManus
University of Birmingham · GBUniversity of Oxford · GBUniversity of Cambridge · GB

Funding

Department of Health CDF/01/017Medical Research Council G0800808
6 · The paper itself

Abstract

objectiveTo determine the relative accuracy of clinic measurements and home blood pressure monitoring compared with ambulatory blood pressure monitoring as a reference standard for the diagnosis of hypertension.

designSystematic review with meta-analysis with hierarchical summary receiver operating characteristic models. Methodological quality was appraised, including evidence of validation of blood pressure measurement equipment. DATA SOURCES: Medline (from 1966), Embase (from 1980), Cochrane Database of Systematic Reviews, DARE, Medion, ARIF, and TRIP up to May 2010. Eligibility criteria for selecting studies Eligible studies examined diagnosis of hypertension in adults of all ages using home and/or clinic blood pressure measurement compared with those made using ambulatory monitoring that clearly defined thresholds to diagnose hypertension.

resultsThe 20 eligible studies used various thresholds for the diagnosis of hypertension, and only seven studies (clinic) and three studies (home) could be directly compared with ambulatory monitoring. Compared with ambulatory monitoring thresholds of 135/85 mm Hg, clinic measurements over 140/90 mm Hg had mean sensitivity and specificity of 74.6% (95% confidence interval 60.7% to 84.8%) and 74.6% (47.9% to 90.4%), respectively, whereas home measurements over 135/85 mm Hg had mean sensitivity and specificity of 85.7% (78.0% to 91.0%) and 62.4% (48.0% to 75.0%).

conclusionsNeither clinic nor home measurement had sufficient sensitivity or specificity to be recommended as a single diagnostic test. If ambulatory monitoring is taken as the reference standard, then treatment decisions based on clinic or home blood pressure alone might result in substantial overdiagnosis. Ambulatory monitoring before the start of lifelong drug treatment might lead to more appropriate targeting of treatment, particularly around the diagnostic threshold.

Indexed as

Blood Pressure Monitoring, AmbulatoryHealth FacilitiesHome Care ServicesHumansHypertension

Identifiers

PMID21705406
PMCPMC3122300
OpenAlexW2014462481

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.