Limitations and strengths
end-organ damage, hypertension, pain
HYPERTENSION
A possible limitation of all hospital-based hypertension studies is external validity and whether findings can be extrapolated to other settings. Patients referred to a specialized hypertension clinic more frequently have treatment-resistant hypertension or more advanced end-organ damage compared to patients treated in primary care clinics.LF-ABPM is the standard practice in our clinic and several patients from our cohort had undergone one or more ABPMs before inclusion. Patients who previously underwent LF-ABPM, and found it painful or stressful, may decline participation in a study involving several ABPMs. However, when comparing patients who underwent ABPM for the first time with the total study population, we found no difference in 24 h BP or their rating of pain and sleep disturbances. We consider the risk of selection bias to be minimal based on the similarity between first-time ABPM patients and patients with prior ABPM experience. The low number of patients who reported “too uncomfortable/painful” as the reason to decline participation in the study further supports this.