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Previous cross-sectional studies have demonstrated that blood pressure measurements at home (HBP) in the morning display stronger predictive power for micro- and macrovascular complications in type 1 and 2 diabetic patients than casual/clinic blood pressure (CBP) measurements. This longitudinal study investigated which of these measurements offers stronger predictive power for outcomes over 6 years. At baseline, 400 Japanese patients with type 2 diabetes were classified as hypertensive or normotensive based on HBP and CBP measurements. Mean (±SD) survey duration of all patients was 42.1 ± 20.0 months (range, 3–72 months). Primary and secondary endpoints were death and new, worsened, or improved micro- and macrovascular events, respectively. Differences in outcomes for each endpoint between hypertensive and normotensive patients in each group were analyzed using survival curves from Kaplan-Meier analysis and log-rank testing. Associated risk factors related to outcomes were assessed using Cox proportional hazards modeling. On the basis of HBP, cumulative events of death and new or worsened microvascular diseases were significantly higher in hypertensive patients than in normotensive patients. On the basis of CBP, no significant differences were identified. New or worsened macrovascular events were significantly higher in hypertensive patients than in normotensive patients on the basis of both HBP and CBP. One associated risk factor was morning hypertension. A longitudinal study of type 2 diabetic patients demonstrated that elevated HBP in the morning is predictive of micro- and macrovascular complications. [ABSTRACT FROM AUTHOR]

Background: Clinic blood pressure measurement (CBPM) is currently the most commonly used form of screening for hypertension, however it might have a problem detecting white coat hypertension (WCHT) and masked hypertension (MHT). Home blood pressure measurement (HBPM) may be an alternative, but its diagnostic performance is inconclusive relative to CBPM. Therefore, this systematic review aimed to estimate the performance of CBPM and HBPM compared with ambulatory blood pressure measurement(ABPM) and to pool prevalence of WCHT and MHT.Methods: Medline, Scopus, Cochrane Central Register of Controlled Trials and WHO's International Clinical Trials Registry Platform databases were searched up to 23rd January 2020. Studies having diagnostic tests as CBPM or HBPM with reference standard as ABPM, reporting sensitivity and specificity of both tests and/or proportion of WCHT or MHT were eligible. Diagnostic performance of CBPM and HBPM were pooled using bivariate mixed-effect regression model. Random effect model was applied to pool prevalence of WCHT and MHT.Results: Fifty-eight studies were eligible. Pooled sensitivity, specificity, and diagnostic odds ratio (DOR) of CBPM, when using 24-h ABPM as the reference standard, were 74% (95% CI: 65-82%), 79% (95% CI: 69%, 87%), and 11.11 (95% CI: 6.82, 14.20), respectively. Pooled prevalence of WCHT and MHT were 0.24 (95% CI 0.19, 0.29) and 0.29 (95% CI 0.20, 0.38). Pooled sensitivity, specificity, and DOR of HBPM were 71% (95% CI 61%, 80%), 82% (95% CI 77%, 87%), and 11.60 (95% CI 8.98, 15.13), respectively.Conclusions: Diagnostic performances of HBPM were slightly higher than CBPM. However, the prevalence of MHT was high in negative CBPM and some persons with normal HBPM had elevated BP from 24-h ABPM. Therefore, ABPM is still necessary for confirming the diagnosis of HT. [ABSTRACT FROM AUTHOR]