Original scientific paper
Deep breath test in the assessment of hypertension in family medicine
Marion Tomičić
; Katedra obiteljske medicine, Medicinski fakultet Split; Dom zdravlja splitsko-dalmatinske županije
Mirjana Rumboldt
; Katedra obiteljske medicine, Medicinski fakultet Split
Vedran Carević
; Klinika za unutrašnje bolesti, KBC Split
Dragomir Petrić
; Katedra obiteljske medicine, Medicinski fakultet Split ; Dom zdravlja splitsko-dalmatinske županije
Zvonko Rumboldt
; Medicinski fakultet Split
Abstract
Unsatisfactory blood pressure (BP) control may be due to white coat effect (WCE). It is unveiled with ABPM. The aim of the study was to assess the validity of deep breath test (DBT) in detection of WCE in relation to ABPM, the „gold standard“. The study included 214 poorly regulated, treated hypertensives, randomized in intervention (N=
106) and control (N= 108) group. Office BP was measured again in all the examinees in the 5th and 15th minute; the intervention group moreover underwent DBT (3-4 cycles over 30 seconds) at that time, and ABPM results were compared. A decrease in systolic BP by ≥15% after DBT (observed in 20% of the subjects) resulted in specificity of 96% (95% CI 79-100%), and in positive predictive value of 94% (95% CI 72- 100%). Minimal systolic BP lowering (<8%) following DBT (sensitivity 0.78%; negative predictive value 78.4%) might confidently exclude vascular hyperreactors. It is concluded that family physician with simple DBT may discern vascular hyperreactors (decrease
in systolic BP ≥15%; about 20% of the poorly controlled patients) from resistant hypertensives (decrease <8%; about 50% of these patients). The remaining 30% of the resistant patients deserved a
careful follow-up, repeated DBT, referral to ABPM or to specialist consultation.
Keywords
white coat hypertension; white coat effect; ABPM; DBT
Hrčak ID:
170440
URI
Publication date:
13.12.2016.
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