ABC | Volume 113, Nº5, November 2019

Original Article Barroso et al. Telemedicine in hypertension diagnosis Arq Bras Cardiol. 2019; 113(5):970-975 Table 1 – HBPM protocols according to the Brazilian guidelines for HBPM (□□□/□□: blood pressure measurement). 7 1 st day Medical office/clinic HBPM 2 nd day Home 3 rd day Home 4 th day Home 5 th day Home Any time □□□/□□ □□□/□□ Morning Before breakfast □□□/□□ □□□/□□ □□□/□□ □□□/□□ □□□/□□ □□□/□□ □□□/□□ □□□/□□ □□□/□□ □□□/□□ □□□/□□ □□□/□□ Night Before dinner or 2 hours later □□□/□□ □□□/□□ □□□/□□ □□□/□□ □□□/□□ □□□/□□ □□□/□□ □□□/□□ □□□/□□ □□□/□□ □□□/□□ □□□/□□ HBPM: home blood pressure monitoring. Table 2 – Comparison of the prevalence of masked hypertension in pre-hypertensive patients with different blood pressure levels Blood pressure behavior 120 ≥ SBP < 130 and 80 ≥ DBP < 85 mmHg (casual measurement) n(%) 130 ≥ SBP < 140 e 85 ≥ DBP < 90 mmHg (casual measurement) n(%) p-value Normotension True hypertension 295 (87.0%) 263 (72.2%) Masked Hypertension 44 (13.0%) 101 (27.8%) * < 0.001 Total 339 (48.2%) 364 (51.8%) * Chi-square. SBP: systolic blood pressure; DBP: diastolic blood pressure. Figure 3 – Participants classified as prehypertensive and stage-1 hypertensive patients considering the casual measurement and reclassified according to the HBPM, n = 1,273. Normotension White-coat hypertension Arterial hypertension Masked hypertension Number of participants Pre-hypertension Stage-1 hypertension 145 (20.6%) 558 (79.4%) 291 (51.1%) 279 (48.9%) 800 700 600 500 400 300 200 100 0 approach and follow-up of these individuals. We emphasize the significant number of individuals included in the study, from nine states of the five Brazilian geographic regions. AH is a highly prevalent disease in the adult population; in a worldwide survey of 1,128,635 individuals, the prevalence was 34.9%, most of them with stage 1 hypertension. It is also known that the prevalence of PH is at the same level, reinforcing the need for a correct diagnosis, so that the most appropriate conduct can be implemented. 10,11 It is also well established that BP monitoring methods outside the office, when compared to the casual measure, have a higher diagnostic accuracy and show a better prediction of cardiovascular risk. 12,13 In the studied sample, when we compared the means of casual BP with HBPM, we found significantly lower means in HBPM, with statistically significant differences (p < 0.001) for both SBP and DBP. Based on this scientific evidence, to avoid diagnostic error, the most recent AH guidelines have strongly recommended the use of ABPM or HBPM for diagnostic evaluation, especially in individuals with initial BP alterations. 1,2,7 When only those individuals with diagnostic criteria for PH or stage 1AHwere assessed, inwhich the chance of casual measures that induce misdiagnosis is higher, we found a prevalence of true normotension and hypertension of only 66.7%, that is, in 33,3% of the cases, the diagnosis would have been wrong, if we considered only the casual measure. These data coincide with other publications that found similar error rates. 14-16 The risk of WCH in stage 1 hypertensive patients is even more important, or MH in prehypertensive patients because, contrary to what was believed, both WCH and MH are associated with higher cardiovascular mortality and, in the specific case of MH, this mortality is even higher than 973