Background: Twenty-four-hour mean arterial pressure (MAP) is underutilized for the diagnosis and risk assessment of hypertension in clinical settings. The objective of this study is to assess the relation of MAP with systolic and diastolic blood pressure (BP) in diagnosing hypertension on 24-hour ambulatory blood pressure monitoring (ABPM), while also examining its diagnostic effectiveness.

Methods: This retrospective study analyzed 24-hour ABPM of 532 adults. Hypertension diagnosis was made based on 2 criteria: the standard 24-hour systolic/diastolic BP measurement criteria and the 24-hour MAP measurement criteria. The relation of the 24-hour MAP with systolic and diastolic measurements and the predictors affecting its accuracy were evaluated.

Results: A total of 532 patients were included, and 409 (76.9%) were diagnosed with hypertension based on 24-hour ambulatory systolic/diastolic BP criteria. Among hypertensive patients, 191 (46.7%) were overlooked by 24-hour MAP criteria. Multiple logistic regression analysis identified age ≥52.4 (OR = 3.23, 95% CI:2.02-5.16, P < .001), female gender (OR = 2.54, 95%CI:1.61-4.02, P < .001), and less variation in daytime/nighttime systolic/diastolic BP as significant independent predictors of overlooked hypertension by 24-hour MAP criteria.

Conclusion: Our study highlights a relation between 24-hour MAP and systolic/diastolic BP measurements in diagnosing hypertension via 24-hour ABPM, especially in older adults and women. Systolic/diastolic criteria offer greater sensitivity for hypertension detection compared to MAP alone. This underscores the need for refined diagnostic criteria and suggests that reliance on MAP alone may lead to underdiagnosis in these vulnerable populations, necessitating further investigation.