A Home Blood Pressure Monitor Equipped With a Graphic Function Facilitates Faster Blood Pressure Control than the Conventional Home Blood Pressure Monitor

In this study, we evaluated whether antihypertensive therapy using a home blood pressure monitor (HBPM) equipped with a graphic display of weekly and monthly averaged blood pressure (BP) can obtain better BP control than the conventional HBPM. Sixty-five hypertensive outpatients who had HBP >135/85 mm Hg were enrolled by 8 doctors in 2 different hospitals. The patients were randomly assigned either a graph-equipped HBPM (graph-equipped HBPM group; n=33) or an HBPM without the graph function (conventional HBPM group; n=32). The patients were treated with antihypertensive medications targeting HBP <135/85 mm Hg. After 2 months, the home systolic BP level was lower in the graph-equipped HBPM group than in the conventional HBPM group (141.3±15.4 vs 147.7±10.8 mm Hg; P<.05); its reduction was significantly larger in the former group (11.9 vs 5.6 mm Hg; P<.05). Using an HBP device with a graphic display could accelerate the achievement of BP control.     

Home blood pressure normalcy: The Didima study

To evaluate reference values of home blood pressure (HBP) a cross-sectional community study was conducted on 694 adult subjects (aged ≥ 18 years) of the village Didima in southern Greece (participation rate 76.4%). Clinic blood pressure (CBP) was measured on two visits (triplicate measurements, mercury sphygmomanometer) and HBP on 3 workdays (duplicate morning and evening measurements, oscillometric devices; Omron HEM 705CP). After exclusion of 132 subjects (103 treated hypertensives and 29 with incomplete data), 562 subjects were analyzed (mean ± SD aged 51.2 ± 17.2 years, 42.7% men). Average HBP (120.0 ± 17.8/72.6 ± 8.8 mm Hg, systolic/diastolic) was strongly correlated (P < .0001) with CBP (118.7 ± 17.7/73.8 ± 10.5 mm Hg). Systolic CBP was 1.3 mm Hg lower than HBP (P < .01, 95% confidence interval 0.4, 2.2), whereas diastolic CBP was 1.2 mm Hg higher than HBP (P < .0001, 95% confidence interval 0.6, 1.7). The threshold of HBP normality determined using three different approaches was 1) 139.7/83.0 mm Hg (systolic/diastolic) using the distribution criterion (95th percentile of the HBP distribution among 476 normotensive subjects); 2) 139.7/85.8 mm Hg using the correspondence criterion (the percentiles of the CBP distribution that correspond to CBP ≥ 140/90 mm Hg were estimated, and the levels of BP that correspond to these same percentiles on the HBP distribution were calculated); and 3) 137.4/82.7 mm Hg using the regression criterion (calculation of the levels of HBP that correspond to CBP of 140/90 mm Hg using the regression equation between HBP and CBP). Overall, the findings of the three criteria suggest that average HBP < 137/82 mm Hg might be considered as probably normal, > 140/86 mm Hg as probably abnormal, and within these limits as borderline. Until mortality-based prospective data are available, this approach might be useful in the interpretation of HBP in clinical practice.     

Masked Hypertension Defined by Ambulatory Blood Pressure Monitoring Is Associated With an Increased Serum Glucose Level and Urinary Albumin‐Creatinine Ratio

J Clin Hypertens(Greenwich). 2010;12:578–587. © 2010 Wiley Periodicals, Inc. The authors evaluated the relationship of hypertensive target organ damage to masked hypertension assessed by ambulatory blood pressure (BP) and home blood pressure (HBP) monitoring in 129 participants without taking antihypertensive medication. Masked hypertension was defined as office BP ≤140/90 mm Hg and 24-hour ambulatory BP ≥130/80 mm Hg. The masked hypertensive participants defined by 24-hour ambulatory BP (n=13) had a higher serum glucose level (126 vs 96 mg/dL, P=.001) and urinary albumin-creatinine ratio (38.0 vs 7.5 mg/gCr, P<.001) than the normotensive participants (n=74); however, these relationships were not observed when the authors defined groups using HBP (≥135/85 mm Hg). Masked hypertension by both 24-hour ambulatory BP and HBP had a higher urinary albumin-creatinine ratio than normotension by both 24-hour ambulatory BP and HBP (62.1 vs 7.4 mg/gCr, P=.001), and than masked hypertension by HBP alone (9.3 mg/gCr, P=.009). Masked hypertension defined by 24-hour ambulatory BP is associated with an increased serum glucose level and urinary albumin-creatinine ratio, but these relationships are not observed in masked hypertension defined by HBP.     

Nebivolol in High‐Risk,Obese African Americans With Stage 1 Hypertension: Effects on Blood Pressure,Vascular Compliance,and Endothelial Function

The authors sought to determine whether nebivolol treatment results in changes in blood pressure (BP), nitric oxide bioavailability, and vascular function in obese African Americans with recently diagnosed stage 1 hypertension. Forty‐three obese, hypertensive African Americans (mean BP: systolic, 148.8±14.3 mm Hg; diastolic, 90.4±8.2 mm Hg) were treated with nebivolol (5–10 mg/d) for 8 weeks. Primary outcomes were change in systolic and diastolic BP and efficacy in reaching normotensive BP. Mean systolic BP decreased by 9.2±14 mm Hg (P<.005) and diastolic BP decreased 6.8±9 mm Hg (P<.005) with 8 weeks of therapy. Significant improvements were seen in arterial compliance with nebivolol treatment as measured by aortic augmentation index (P<.005) and time to wave reflection (P=.013). Nebivolol treatment improved endothelial function as measured by flow‐mediated dilation (P<.005). Levels of erythrocyte cellular superoxide dismutase increased with nebivolol, indirectly suggesting increased bioavailability of nitric oxide (P<.005). Monotherapy with nebivolol in obese, hypertensive African Americans results in significant systolic and diastolic BP reduction by mechanisms that include improved vascular function and compliance.     

Trend of Blood Pressure Control Status in Hypertensive Outpatients: With Special Reference to Elderly Hypertensives

Blood pressure (BP) control in hypertensives has improved; however, it still remains to be insufficient. We have investigated the trend in BP control status of the hypertensive patients followed for 10 years in hypertension clinic. Subjects included 133 patients who have been followed from the first visit during 1998–2000 to the last visit during 2008–2010. During the mean follow-up period of 10.5 years, average BP and body weight significantly (P < .01) decreased from 143 ± 12/85 ± 8 mm Hg to 129 ± 14/68 ± 11 mm Hg, and from 59.8 ± 9.9 kg to 58.7 ± 10.6 kg, respectively. The achievement rate of good BP control defined as <140/90 mm Hg and the number of antihypertensive drugs also increased significantly during this period (39.1%–77.5% and 1.3 ± 1.0–2.2 ± 1.1, respectively, P < .01). Blood pressure control improved and the number of antihypertensive drugs also increased in 45 patients who were older than 65 years at the last visit. The use of Ca channel blockers (CCBs), angiotensin II receptor antagonists, and diuretics increased significantly during this period. Results suggest that lifestyle modification including body weight reduction as well as intensive antihypertensive treatment contributed to the improved BP control in hypertensive patients including the elderly.     

Long-term Antihypertensive Efficacy of Losartan/Hydrochlorothiazide Combination Therapy on Home Blood Pressure Control

Angiotensin receptor blocker (ARB)/hydrochlorothiazide (HCTZ) combination therapy has been shown to produce a prompt reduction in clinic blood pressure (BP) without serious adverse effects; however, long-term antihypertensive efficacy on home BP has not been fully investigated. In this open-label multicenter observational study, a total of 151 hypertensive patients uncontrolled with antihypertensive regimens including standard dose of ARBs were switched to the fixed-dose combination of losartan (50 mg)/HCTZ (12.5 mg) (mean age 66.9 ± 9.5 years, 51% male, 19% with diabetes mellitus, and 57% with dyslipidemia). After 3 months, losartan/HCTZ treatment significantly reduced mean home systolic BP/diastolic BP from a baseline level of 153 ± 11/85 ± 9 mm Hg to 136 ± 12/77 ± 10 mm Hg (P < .001) and mean clinic BP from 158 ± 9/87 ± 9 to 136 ± 12/77 ± 10 (P < .001), which were maintained through the study period of 12 months (132 ± 11/75 ± 9 and 136 ± 12/77 ± 10; home and clinic BP at 12 months, respectively, P < .001). Furthermore, younger patients (<65 years) receiving ARB monotherapy at the start of the study showed a significantly greater reduction in home BP, but not in clinic BP, compared with elderly patients (≥65 years). In conclusion, losartan/HCTZ combination therapy exerted a 1-year long-term efficacy on home BP as well as clinic BP. In patients uncontrolled with ARB monotherapy, the antihypertensive efficacy on home BP is more pronounced in younger patients compared with that in elderly patients.     

Associations of Peritoneal Glucose Load With Male Sexual Dysfunction and Depression in Peritoneal Dialysis Patients

This cross‐sectional study examined possible associations of peritoneal glucose load with male sexual dysfunction and depression in peritoneal dialysis patients. Compared to patients with peritoneal glucose load ≤3 g/kg per day, those with load >3 g/kg per day had higher Beck Depression Inventory scores, (18.9 ± 5.4 vs. 11.4 ± 5.8, P = 0.002) and lower International Index of Erectile Function scores, serum total testosterone and DHEA [(15.4 ± 6.4 vs. 45.1 ± 20.7, P < 0.001), (8.5 ± 3.0 vs. 13.9 ± 3.2, P < 0.001), (113.9 ± 58.8 vs. 280.2 ± 128.3, P < 0.001); respectively)]. Of participants with peritoneal glucose load >3 g/kg per day, 84.6% had mild to moderate erectile dysfunction and 92.3% had abnormal Beck Depression Inventory scores. Peritoneal glucose load inversely correlated with International Index of Erectile Function scores (P < 0.001), total serum testosterone (P = 0.002) and serum DHEA (P = 0.001); and directly with Beck Depression Inventory scores (P < 0.001) and serum estradiol (P < 0.001). This study demonstrated higher prevalence of sexual dysfunction, depression and sex hormone disturbances in male peritoneal dialysis patients receiving higher peritoneal glucose load.     

Add‐On Use of Eplerenone Is Effective for Lowering Home and Ambulatory Blood Pressure in Drug‐Resistant Hypertension

The authors aimed to investigate the blood pressure (BP)–lowering ability of eplerenone in drug‐resistant hypertensive patients. A total of 57 drug‐resistant hypertensive patients whose home BP was ≥135/85 mm Hg were investigated. The patients were randomized to either an eplerenone group or a control group and followed for 12 weeks. The efficacy was evaluated by clinic, home, and ambulatory BP monitoring. Urinary albumin, pulse wave velocity, and flow‐mediated vasodilation (FMD) were also evaluated. Home morning systolic BP (148±15 vs 140±15 mm Hg) and evening systolic BP (137±16 vs 130±16 mm Hg) were significantly lowered in the eplerenone group (n=35) compared with baseline (both P<.05), while unchanged in the control group (n=22). BP reductions in the eplerenone group were most pronounced for ambulatory awake systolic BP (P=.04), awake diastolic BP (P=.004), and 24‐hour diastolic BP (P=.02). FMD was significantly improved in the eplerenone group. In patients with drug‐resistant hypertension, add‐on use of eplerenone was effective in lowering BP, especially home and ambulatory awake BP.     

Masked Hypertension and Atherogenesis: The Impact on Adiponectin and Resistin Plasma Levels

Recent evidence suggests that masked hypertension (MH) is a predictor of cardiovascular disease and that hypoadiponectinemia and hyperesistinemia may contribute to chronic inflammatory process, insulin resistance, endothelial dysfunction, and accelerated atherogenesis. The aim of this study was to examine the adiponectin and resistin plasma levels in patients with MH and compare the findings with those of healthy normotensive persons matched for age, sex, body mass index, and other risk factors. Overall, 130 (60 men and 70 women) healthy persons (mean age, 45±12 years) who had clinic blood pressure values <140/90 mm Hg were studied. The study population underwent 24‐hour ambulatory blood pressure monitoring (ABPM). According to the ABPM recordings, 24 individuals (8 men and 16 women) had MH (daytime systolic blood pressure ≥135 mm Hg or daytime diastolic blood pressure ≥85 mm Hg; group A) and the remaining 106 participants (52 men and 54 women) had normal ABPM findings (group B). Adiponectin and resistin plasma levels were determined in both groups by enzyme‐linked immunosorbent assay. Significantly higher (P<.01) resistin levels (12±4 vs 6.8±3.6 ng/mL) were found in group A compared with group B, while the adiponectin plasma levels were significantly lower (P<.01) in group A compared with group B (6±2.3 vs 11±2.7 μg/mL). Findings suggest that patients with MH have lower adiponectin levels and higher resistin levels compared with normotensive individuals. This observation may have prognostic significance for future cardiovascular events in patients with MH.     

Elevated preoperative blood pressures in adult surgical patients are highly predictive of elevated home blood pressures

Blood pressure (BP) measurement during the presurgical assessment has been suggested as a way to improve longitudinal detection and treatment of hypertension. The relationship between BP measured during this assessment and home blood pressure (HBP), a better indicator of hypertension, is unknown. The purpose of the present study was to determine the positive predictive value of presurgical BP for predicting elevated HBP. We prospectively enrolled 200 patients at a presurgical evaluation clinic with clinic blood pressures (CBPs) ≥130/85 mm Hg, as measured using a previously validated automated upper-arm device (Welch Allyn Vital Sign Monitor 6000 Series), to undergo daily HBP monitoring (Omron Model BP742N) between the index clinic visit and their day of surgery. Elevated HBP was defined, per American Heart Association guidelines, as mean systolic HBP ≥135 mm Hg or mean diastolic HBP ≥85 mm Hg. Of the 200 participants, 188 (94%) returned their home blood pressure monitors with valid data. The median number of HBP recordings was 10 (interquartile range, 7–14). Presurgical CBP thresholds of 140/90, 150/95, and 160/100 mm Hg yielded positive predictive values (95% confidence interval) for elevated HBP of 84.1% (0.78–0.89), 87.5% (0.81–0.92), and 94.6% (0.87–0.99), respectively. In contrast, self-reported BP control, antihypertensive treatment, availability of primary care, and preoperative pain scores demonstrated poor agreement with elevated HBP. Elevated preoperative CBP is highly predictive of longitudinally elevated HBP. BP measurement during presurgical assessment may provide a way to improve longitudinal detection and treatment of hypertension.     

Sleep Blood Pressure Self‐Measured at Home as a Novel Determinant of Organ Damage: Japan Morning Surge Home Blood Pressure (J‐HOP) Study

To study whether sleep blood pressure (BP) self‐measured at home is associated with organ damage, the authors analyzed the data of 2562 participants in the J‐HOP study who self‐measured sleep BP using a home BP monitoring (HBPM) device, three times during sleep (2 am , 3 am , 4 am ), as well as the home morning and evening BPs. The mean sleep home systolic BPs (SBPs) were all correlated with urinary albumin/creatinine ratio (UACR), left ventricular mass index (LVMI), brachial‐ankle pulse wave velocity (baPWV), maximum carotid intima‐media thickness, and plasma N‐terminal pro‐hormone pro–brain‐type natriuretic peptide (NTproBNP) (all P<.001). After controlling for clinic SBP and home morning and evening SBPs, associations of home sleep SBP with UACR, LVMI, and baPWV remained significant (all P<.008). Even in patients with home morning BP <135/85 mm Hg, 27% exhibited masked nocturnal hypertension with home sleep SBP ≥120 mm Hg and had higher UACR and NTproBNP. Masked nocturnal hypertension, which is associated with advanced organ damage, remains unrecognized by conventional HBPM.     

Management of Hypertensive Patients With Multiple Drug Intolerances: A Single‐Center Experience of a Novel Treatment Algorithm

Multiple drug intolerance to antihypertensive medications (MDI‐HTN) is an overlooked cause of nonadherence. In this study, 55 patients with MDI‐HTN were managed with a novel treatment algorithm utilizing sequentially initiated monotherapies or combinations of maximally tolerated doses of fractional tablet doses, liquid formulations, transdermal preparations, and off‐label tablet medications. A total of 10% of referred patients had MDI‐HTN, resulting in insufficient pharmacotherapy and baseline office blood pressure (OBP) of 178±24/94±15 mm Hg. At baseline, patients were intolerant to 7.6±3.6 antihypertensives; they were receiving 1.4±1.1 medications. After 6 months on the novel MDI‐HTN treatment algorithm, both OBP and home blood pressure (HBP) were significantly reduced, with patients receiving 2.0±1.2 medications. At 12 months, OBP was reduced from baseline by 17±5/9±3 mm Hg (P<.01, P<.05) and HBP was reduced by 11±5/12±3 mm Hg (P<.01 for both) while patients were receiving 1.9±1.1 medications. Application of a stratified medicine approach allowed patients to tolerate increased numbers of medications and achieved significant long‐term lowering of blood pressure.     

Vasopressor and Vasodepressor Hormone-Systems in Adolescent Hypertension

We investigated the activity of the renin-angiotensin-aldosterone-system, the secretion of catecholamines and the kallikrein-kinin-system in 126 adolescents randomly selected from a large study of 1342 young people examined in an epidemiological survey conducted in Cologne in 1975, 1976 and 1980. 73 of them with arterial blood pressures below 145/90 mm Hg were called “normotensives” (systolic blood pressure 127.2 ± 1.0 mm Hg, diastolic bp 79.7 ± 0.8 mm Hg). They were compared with 53 “hypertensives” (systolic blood pressure 147.2 ± 1.6 mm Hg, diastolic bp 93.7 ± 1.1 mm Hg).

Urinary catecholamines were significantly higher in the hypertensives (155.0 ± 13.3 μg/d) compared to the normotensives (100.7 ± 5.3 μg/d) (p < 0.001) whereas plasma levels of adrenaline and noradrenaline were similar. Serum aldosterone levels and plasmarenin-concentrations were not different between the two groups. Angiotensin-converting-enzyme-activity was slightly higher in the hypertensive group (107.1 ± 3.5 U/1 versus 98.0 ± 2.6 U/1, p < 0.001). Urinary kallikrein excretion was found to be modestly lower in hypertensives compared to normotensives (0.40 ± 0.05 versus 0.55 ± 0.06 mU/mg creatinine). Urinary excretion of sodium and potassium, blood levels of glucose, uric acid, cholesterol and triglycerides were similar in both groups. The results of the present study suggest an increased sympathetic activity in the early stage of hypertension in adolescents.     

Aliskiren Reduces Morning Blood Pressure in Hypertensive Patients with Diabetic Nephropathy on Hemodialysis

Our previous study indicated that the exchange from an angiotensin receptor blocker (ARB) to aliskiren reduced morning blood pressure and albuminuria in hypertensive patients with diabetic nephropathy. We extended the above study and assessed the effects of exchanging from an ARB to aliskiren on home blood pressure in hypertensive patients with diabetic nephropathy on chronic hemodialysis. The patients who were persistently hypertensive despite antihypertensive therapy, including ARB, were considered as candidates for the exchange from the ARB to aliskiren. Patients’ age and durations of diabetes and hemodialysis were averaged as 62 ± 9 years old, 15 ± 8 and 7 ± 3 years, respectively. Aliskiren decreased morning systolic blood pressure (149 ± 14 to 144 ± 13 mm Hg, n = 30, P < .01) and plasma renin activity (3.5 ± 1.1 to 1.2 ± 0.6 ng/mL/h, P < .01) without changes in serum potassium. Aliskiren also reduced interdialytic weight gain (2.7 ± 0.6 to 2.5 ± 0.5 kg/interval, P < .05) and attenuated the magnitude of intradialytic declines in systolic (?20 ± 11 to ?17 ± 10 mm Hg, P < .05) and diastolic blood pressure (?9 ± 6 to ?5 ± 5 mm Hg, P < .01). The exchange from an ARB to aliskiren is safe and useful to control home blood pressure in hypertensive hemodialysis patients with diabetic nephropathy. Aliskiren reduced both intradialytic blood pressure drops and interdialytic weight gain in patients with DN.     

Strict Blood Pressure Control Achieved Using an ICT‐Based Home Blood Pressure Monitoring System in a Catastrophically Damaged Area After a Disaster

At the time of the Great East Japan earthquake and tsunami (March 2011), the authors developed a web‐based information and communications technology (ICT)–based blood pressure (BP) monitoring system (the Disaster CArdiovascular Prevention [DCAP] Network) and introduced it in an area that was catastrophically damaged (Minamisanriku town) to help control the survivors' BP. Using this system, home BP (HBP) was monitored and the data were automatically transmitted to a central computer database and to the survivors' attending physicians. The study participants, 341 hypertensive patients, continued to use this system for 4 years after the disaster and all of the obtained HBP readings were analyzed. This DCAP HBP‐guided approach helped achieve a decrease in the participants' HBPs (initial average: 151.3±20.0/86.9±10.2 mm Hg to 120.2±12.1/70.8±10.2 mm Hg) over the 4 years. In addition, the amplitude of seasonal BP variation was suppressed and the duration from the summer lowest HBP values to the winter peak HBP values was gradually prolonged. This ICT‐based approach was useful to achieve strict HBP control and minimize the seasonal BP variation even in a catastrophically damaged area during a 4‐year period after the disaster, suggesting that this approach could be a routine way to monitor BP in the community.     

Changes in home versus clinic blood pressure with antihypertensive treatments: a meta-analysis

Home blood pressure (HBP) monitoring is recommended for assessing the effects of antihypertensive treatment, but it is not clear how the treatment-induced changes in HBP compare with the changes in clinic blood pressure (CBP). We searched PubMed using the terms "home or self-measured blood pressure," and selected articles in which the changes in CBP and HBP (using the upper arm oscillometric method) induced by antihypertensive drugs were presented. We performed a systematic review of 30 articles published before March 2008 that included a total of 6794 subjects. As there was significant heterogeneity in most of the outcomes, a random effects model was used for the meta-analyses. The mean changes (+/-SE) in CBP and HBP (systolic/diastolic) were -15.2+/-0.03/-10.3+/-0.03 mm Hg and -12.2+/-0.04/-8.0+/-0.04 mm Hg respectively, although there were wide varieties of differences in the reduction between HBP and CBP. The reductions in CBP were correlated with those of HBP (systolic BP; r=0.66, B=0.48, diastolic BP; r=0.71, B=0.52, P<0.001). In 7 studies that also included 24-hour BP monitoring, the reduction of HBP was greater than that of 24-hour BP in systolic (HBP; -12.6+/-0.06 mm Hg, 24-hour BP; -11.9+/-0.04 mm Hg, P<0.001). In 5 studies that included daytime and nighttime systolic BP separately, HBP decreased 15% more than daytime ambulatory BP and 30% more than nighttime ambulatory BP. In conclusion, HBP falls approximately 20% less than CBP with antihypertensive treatments. Daytime systolic BP falls 15% less and nighttime systolic BP falls 30% less than home systolic BP.     

Trend of office and home blood pressure control in treated hypertensive patients: changes in antihypertensive medication and salt intake

Blood pressure (BP) control in hypertensives has improved in recent years; however, it remains insufficient. We investigated the trend of BP control status in hypertensive patients with antihypertensive medication and salt intake. Two hundred and eight treated hypertensive patients were prospectively followed between 2007 and 2012. During this period, average clinic BP significantly decreased from 137?±?12/80?±?9 to 133?±?11/76?±?8?mmHg, and the achievement rate of BP control defined as <140/90?mmHg increased from 58% to 71% (p?p?p?相似文献   

Home and clinic blood pressure responses in elderly individuals with systolic hypertension

Home blood pressure (BP) monitoring may enhance assessment of BP control. In this 16-week study, men and women 70 years or older with systolic BP between 150 and 200 mm Hg were randomized to receive valsartan/hydrochlorothiazide (V/HCTZ) 160/12.5 mg (n = 128), HCTZ 12.5 mg (n = 128), or V 160 mg (n = 128) for 4 weeks. Participants whose BP was 140/90 mm Hg or higher at weeks 4, 8, or 12 were uptitrated to a maximum of V/HCTZ 320/25 mg. Participants were evaluated by home BP monitoring using an automated device weekly before taking daily study medication (n = 301). Baseline BP ± SD for clinic (165.5 ± 11.8/85.1 ± 9.5 mm Hg) was approximately 3/1 mm Hg greater than home readings (162.5 ± 15.8/84.3 ± 10.2 mm Hg). Reductions in BP ± SEM at week 4 were similar for clinic (12.6 ± 1.0/4.7 ± 0.5 mm Hg) and home (10.9 ± 1.1/3.8 ± 0.5 mm Hg) readings (P = .25/P = .23; clinic versus home); differences between V/HCTZ and HCTZ or V were also similar for both home and clinic readings and results by either technique correlated significantly (P < .0001). Home BP measurements confirm that treatment initiated with V/HCTZ versus monotherapy resulted in greater antihypertensive efficacy. Home BP monitoring, if done with proper technique, provides a reliable indicator of BP control in elderly patients and may help guide drug dosing and titration.     

Automated office blood pressure measurements in primary care are misleading in more than one third of treated hypertensives: The VALENTINE-Greece Home Blood Pressure Monitoring study

BackgroundThis study assessed the diagnostic reliability of automated office blood pressure (OBP) measurements in treated hypertensive patients in primary care by evaluating the prevalence of white coat hypertension (WCH) and masked uncontrolled hypertension (MUCH) phenomena.MethodsPrimary care physicians, nationwide in Greece, assessed consecutive hypertensive patients on stable treatment using OBP (1 visit, triplicate measurements) and home blood pressure (HBP) measurements (7 days, duplicate morning and evening measurements). All measurements were performed using validated automated devices with bluetooth capacity (Omron M7 Intelli-IT). Uncontrolled OBP was defined as ≥140/90 mmHg, and uncontrolled HBP was defined as ≥135/85 mmHg.ResultsA total of 790 patients recruited by 135 doctors were analyzed (age: 64.5 ± 14.4 years, diabetics: 21.4%, smokers: 20.6%, and average number of antihypertensive drugs: 1.6 ± 0.8). OBP (137.5 ± 9.4/84.3 ± 7.7 mmHg, systolic/diastolic) was higher than HBP (130.6 ± 11.2/79.9 ± 8 mmHg; difference 6.9 ± 11.6/4.4 ± 7.6 mmHg, p < 0.001). WCH phenomenon (high OBP with low HBP) was observed in 22.7% of the patients, MUCH (low OBP with high HBP) in 15.8%, uncontrolled hypertension (high OBP with high HBP) in 29.9%, and controlled hypertension (low OBP with low HBP) in 31.6%. In multivariate logistic regression analysis, WCH was determined by stage-1 systolic hypertension (odds ratio [OR] 8.6, 95% confidence intervals [CI] 5.7, 13.1) and female gender (OR 1.6, 95% CI 1.1, 2.4), whereas MUCH was determined by high-normal systolic OBP (OR 6.2, 95% CI 3.8, 10.1) and male gender (OR 2.0, 95% CI 1.2, 3.1).ConclusionsIn primary care, automated OBP measurements are misleading in approximately 40% of treated hypertensive patients. HBP monitoring is mandatory to avoid overtreatment of subjects with WCH phenomenon and prevent undertreatment and subsequent excess cardiovascular disease in MUCH.