Assessing the Validity of the Omron HEM-907XL Oscillometric Blood Pressure Measurement Device in a National Survey Environment

J Clin Hypertens (Greenwich). 2010;12:22–28. ^© 2009 Wiley Periodicals, Inc.
Blood pressure (BP) readings taken by Omron HEM-907XL were compared with the results obtained using sphygmomanometer (HgS) in 509 individuals using 2002 Association for the Advancement of Medical Instrumentation (AAMI) criteria. With the exception of diastolic BP in youth ages 13 to 19 years (mean difference, −1.77 mm Hg; standard deviation, 8.65), the Omron device met the criteria. Agreement for hypertension (BP ≥140/90 mm Hg) was above chance (κ=0.68) and, compared with HgS, Omron underestimated the prevalence of hypertension by 2.65%. The Omron and HgS measurements were highly correlated ( r =0.94 for systolic BP and r =0.83 for diastolic BP). Both increased systolic and diastolic BP decreased device agreement (β-coefficient=−0.10872, P <.0001; β-coefficient=−0.25981, P <.0001, respectively). The Omron device meets AAMI criteria with the exception of diastolic BP in youth ages 13 to 19 years. However, Omron underestimated the prevalence of hypertension and device agreement decreases with increased systolic and diastolic BP.     

Blood pressure response to metoprolol and chlorthalidone in European and African Americans with hypertension

Despite the availability of many antihypertensive drug classes, half of patients with hypertension have uncontrolled blood pressure (BP). The authors sought to assess the effect of age on BP response in European American and African American patients with hypertension. Clinic BP from the PEAR2 (Pharmacogenomics Evaluation of Antihypertensive Responses 2) study was used to estimate BP responses from baseline following sequential treatment with metoprolol 100 mg twice daily and chlorthalidone 25 mg daily for 8 to 9 weeks each, with a minimum 4‐week washout between treatments. BP responses to both drugs were compared in 159 European Americans and 119 African Americans by age with adjustment for baseline BP and sex. European Americans younger than 50 years responded better to metoprolol than chlorthalidone (diastolic BP: ?9.6 ± 8.0 vs ?5.9 ± 6.8 mm Hg, adjusted P = .003), whereas patients 50 years and older responded better to chlorthalidone than metoprolol (systolic BP: ?18.7 ± 13.8 vs ?13.6 ± 14.8 mm Hg, adjusted P = .008). African Americans younger than 50 years responded similarly to both drugs, whereas those 50 years and older responded better to chlorthalidone than metoprolol (?17.0 ± 13.2/?9.6 ± 7.5 vs ?7.0 ± 18.6/?6.7 ± 9.3 mm Hg, adjusted P<.0001/.008). Therefore, age should be considered when selecting antihypertensive therapy in European and African American populations with hypertension.     

Validation of a wrist‐type home nocturnal blood pressure monitor in the sitting and supine position according to the ANSI/AAMI/ISO81060‐2:2013 guidelines: Omron HEM‐9601T

This study aimed to validate the accuracy of the Omron HEM‐9601T, an automatic wrist‐type device for self‐blood pressure (BP) measurement with a timer function for automatic measurement of nocturnal BP, in the sitting position according to the American National Standards Institute/Association for the Advancement of Medical Instrumentation/International Organization for Standardization (ANSI/AAMI/ISO) 81060‐2:2013 guidelines, and to assess its performance in the supine position by applying the same protocol as conducted in the sitting position. The mean differences between the reference BPs and HEM‐9601T readings were 1.2 ± 6.9/1.1 ± 5.5 mmHg, 2.2 ± 6.5/1.8 ± 5.7 mmHg, 0.1 ± 6.6/1.5 ± 6.2 mmHg, and ?0.8 ± 7.2/0.5 ± 6.4 mmHg for systolic BP/diastolic BP for criterion 1 in the sitting position, supine with sideways palm position, supine with upward palm position, and supine with downward palm position, respectively. In addition, the mean differences and their standard deviations for systolic BP and diastolic BP calculated according to criterion 2 in the ANSI/AAMI/ISO 81060‐2:2013 guidelines were acceptable in all four positions. In conclusion, the Omron HEM‐9601T fulfilled the validation criteria of the ANSI/AAMI/ISO81060‐2:2013 guidelines when used in the sitting position with the wrist at heart level, and its accuracy in the supine position was acceptable and roughly equivalent to that in the sitting position. The wrist‐type home BP monitor could be a more suitable tool for repeated nocturnal BP measurements at home than upper‐arm devices, and could improve the reliability of diagnosis and management of nocturnal hypertension.     

Antecedent rest may not be necessary for automated office blood pressure at lower treatment targets

In SPRINT (Systolic Blood Pressure Intervention Trial), use of the Omron 907XL blood pressure (BP) monitor set at 5 minutes of antecedent rest to record BP produced an automated office BP value 7/6 mm Hg lower than awake ambulatory BP at 27 months. The authors studied the impact on automated office BP of setting the Omron 907XL to 0 minutes instead of 5 minutes of rest in patients with readings in the lower normal BP range, similar to on‐treatment BP in the SPRINT intensive therapy group. Patients (n = 100) in cardiac rehabilitation were randomized to three BP readings at 1‐minute intervals using an Omron 907XL BP device set for 5 or 0 minutes of antecedent rest. Mean (±standard deviation) automated office BP (mm Hg) after 5 minutes of rest (120.2 ± 14.6/66.9 ± 8.6 mm Hg) was lower (P < .001/P < .01) than without rest (124.2 ± 16.4/67.9 ± 9.1 mm Hg). When target BP is in the lower normal range, automated office BP recorded without antecedent rest using an Omron 907XL device should be higher and closer to the awake ambulatory BP, compared with readings taken after 5 minutes of rest.     

Measure Accurately,Act Rapidly,and Partner With Patients (MAP) improves hypertension control in medically underserved patients: Care Coordination Institute and American Medical Association Hypertension Control Project Pilot Study results

Measure Accurately, Act Rapidly, and Partner With Patients (MAP) is an evidence‐based protocol implemented to improve hypertension control in a clinic for underserved patients (49.9% Medicaid and 50.2% black). Patients with hypertension seen during the year before intervention and with at least one visit during the 6‐month intervention (N = 714) were included. If initial attended blood pressure (BP; standard aneroid manometer) was ≥140/≥90 mm Hg, unattended automated office BP was measured in triplicate and averaged (Measure Accurately) using an Omron HEM‐907XL. When automated office BP was ≥140/≥90 mm Hg, Act Rapidly included intensification of antihypertensive medications, assessed by therapeutic inertia. Partner With Patients included BP self‐monitoring, reducing pill burden, and minimizing medication costs, which was assessed by systolic BP change per therapeutic intensification. Between baseline and the last study visit, BP control to <140/<90 mm Hg increased from 61.2% to 89.9% (P < .0001). MAP rapidly and significantly improved hypertension control in medically underserved patients, largely as a result of measuring BP accurately and partnering with patients.     

Validation of the RisingSun RS‐651 Blood Pressure Monitor Based on Auscultation in Adults According to the ANSI/AAMI/ISO 81060‐2:2013 Standard

This study validated the RisingSun RS‐651 blood pressure (BP) monitor based on auscultation in adults according to the American National Standards Institute/Association for the Advancement of Medical Instrumentation/International Organization for Standardization (ANSI/AAMI/ISO) 81060‐2:2013 standard. The RS‐651 device was evaluated in a study of 97 participants. The same arm simultaneous method, as defined in the ANSI/AAMI/ISO standard, was used. The mean differences±standard deviation for criterion 1 were 0.8±2.3 mm Hg for systolic BP (SBP) and ?0.1±2.9 mm Hg for diastolic BP (DBP). Analysis for criterion 2 resulted in values of 0.8±1.5 mm Hg for SBP and ?0.1±2.1 mm Hg for DBP. All of the data fulfilled the ANSI/AAMI/ISO 81060‐2:2013 standard requirements to pass the validation. The RisingSun RS‐651 device can be recommended for both clinical and self/home use in adults according to the ANSI/AAMI/ISO 81060‐2:2013 standard.     

Association of ambulatory blood pressure variability with coronary artery calcium

Blood pressure (BP) variability is associated with progression to clinical atherosclerosis. The evidence is inconclusive if BP variability predicts cardiovascular outcomes in low‐risk populations. The aim of this study was to analyze the association of 24‐hour BP variability with coronary artery calcium (CAC) among a group of individuals without coronary artery disease. The Masked Hypertension Study targeted patients with borderline high BP (120?149 mm Hg systolic and/or 80‐95 mm Hg diastolic). Ambulatory blood pressure monitoring (ABPM) was performed at two time‐points, 8 days apart. CAC was measured at exit visit via cardiac CT and reported as Agatston Score. Weighted standard deviations and average real variability were calculated from ABPM. Of the 322 participants who underwent cardiac CT, 26% (84) had CAC present, 52% (168) were female, and 21% (64) were black. BP variability did not differ by CAC group. In this low cardiovascular risk group, CAC was not associated with 24‐hour ambulatory BP variability.     

Validation of the OMRON M3500 Blood Pressure Measuring Device Using Normal‐ and High‐Speed Modes in Adult and Specific Populations (Obese and Children) According to AAMI Protocol

The present study aimed to validate the accuracy of blood pressure (BP) measurements of the OMRON M3500 automatic oscillometric BP device by using normal‐ and high‐speed modes in adult and specific populations (obese and children) according to American National Standards Institute/Association for the Advancement of Medical Instrumentation (AAMI)/International Organization for Standardization/81060‐2:2009 protocol. The validation was performed in 135 patients: 100 adults and 35 children (aged 3–12 years). The results showed a mean error of the individual paired determinations of the OMRON device and mercury sphygmomanometers within values of criterion 1 (5±8 mm Hg). Analysis of the averaged paired determinations per subject of the OMRON device and standard mercury sphygmomanometer fit within the acceptable ranges of criterion 2 (<6.71 systolic BP and <5.77 diastolic BP). Readings of the OMRON M3500 BP device fulfill criteria 1 and 2 of the AAMI protocol in both speed modes.     

Comparison of Aneroid and Oscillometric Blood Pressure Measurements in Children

Limited data exist on the comparison of blood pressure (BP) measurements using aneroid and oscillometric devices. The purpose of the study was to investigate the difference in BP obtained using oscillometric and aneroid BP monitors in 9‐ to 10‐year‐old children. A total of 979 children were divided into group O, which underwent two oscillometric BP readings followed by two aneroid readings, and group A, which had BP measured in the reverse order. No significant difference was found between the mean (±standard deviation) of the two systolic BP readings obtained using the oscillometric and aneroid devices (111.5±8.6 vs 111.3±8.1 mm Hg; P=.39), whereas the mean diastolic BP was lower with the oscillometric monitor (61.5±8.0 vs 64.5±6.8 mm Hg; P<.001). A significant downward trend in BP was observed with each consecutive measurement, and agreement between the two monitors was limited. Multiple BP measurements are, therefore, recommended before the diagnosis of elevated BP or hypertension is made with either method.     

Ambulatory blood pressure in the dash diet trial: Effects of race and albuminuria

We evaluated whether low‐grade albuminuria or black race modulates ambulatory blood pressure (BP) or nocturnal BP response to the DASH diet. Among 202 adults enrolled in the DASH multicenter trial who were fed the DASH or control diet for 8 weeks, reductions in 24‐hour daytime and nighttime SBP and DBP were significantly larger for DASH compared to control. Median changes in nocturnal BP dipping were not significant. Compared to urine albumin excretion of <7 mg/d, ≥7 mg/d was associated with larger significant median reductions in 24‐hour SBP (?7.3 vs ?3.1 mm Hg), all measures of DBP (24‐hour: ?5.9 vs ?1.8 mm Hg; daytime: ?9.9 vs ?4.0 mm Hg; nighttime ?9.0 vs ?2.0 mm Hg), and with increased nocturnal SBP dipping (2.3% vs ?0.5%). Black race was associated with larger median reduction in 24‐hour SBP only (?5.5 vs ?2.4 mm Hg). This analysis suggests greater effect of DASH on ambulatory BP in the presence of low‐grade albuminuria.     

Validation of a wrist‐type home nocturnal blood pressure monitor in the sitting and supine position according to the ANSI/AAMI/ISO81060‐2:2013 guidelines: Omron HEM‐9600T

The purpose of the present study was to evaluate the performance of the Omron HEM‐9600T, an automatic wrist‐type device for self BP measurement, in the sitting position with the wrist at heart level and supine position according to the ANSI/AAMI/ISO81060‐2:2013 guidelines. In the supine position, we evaluated the device under 3 different conditions: using the supine with sideways palm position, the supine with upwards palm position, and the supine with downwards palm position. After 106 subjects were screened and 21 subjects were excluded, the same 85 subjects (38 men [44.7%] and 47 women [55.3%]) were included in the analyses for each position. The average age of the subjects was 54.5 ± 12.2 years (mean ± SD). The mean wrist circumference was 17.0 ± 2.4 cm. The wrist size distribution fulfilled the requirements of the guidelines. The mean differences between reference BPs and HEM‐9600T readings were 1.0 ± 6.7/1.4 ± 5.7 mm Hg, 6.6 ± 7.2/5.5 ± 6.0 mm Hg, 4.8 ± 7.2/4.9 ± 5.8 mm Hg, and 2.1 ± 7.2/2.8 ± 6.8 mm Hg for SBP/DBP in the sitting position, supine with sideways palm position, supine with upwards palm position, and supine with downwards palm position, respectively. In conclusion, the Omron HEM‐9600T in the sitting position fulfilled the validation criteria of the ANSI/AAMI/ISO81060‐2:2013 guidelines. On the other hand, the accuracies of HEM‐9600T in the supine position differed depending on the positioning of the palm, with only the downwards palm‐position measurement fulfilling both validation criteria of the ANSI/AAMI/ISO81060‐2:2013 guidelines.     

Comparison between oscillometric and intra-arterial blood pressure measurements in ill preterm and full-term neonates

Conflicting data exist regarding the accuracy of the oscillometric method of blood pressure (BP) measurement in neonates. There is limited data regarding intra-arterial BP trends in neonates. We aimed to determine the accuracy of oscillometric BP measurements and to evaluate the BP distributions in ill neonates. A total of 1492 simultaneously obtained oscillometric and intra-arterial (umbilical arterial [UAC] or radial arterial) BP measurements were used for comparisons and 125,580 intra-arterial BP readings were used to the evaluate BP distribution. There was a statistically significant difference (P < .0001) between the oscillometric and radial mean arterial BP (MAP) 4.8 ± 9.8 mm Hg, systolic BP 8.3 ± 11.6 mm Hg, diastolic BP 4.3 ± 9.3 mm Hg and between the oscillometric and UAC systolic BP 5.2 ± 11.9 mm Hg and diastolic BP −0.8 ± 10.4 mm Hg. The MAP increased with increases in weight (35.3 ± 4.92 mm Hg/kg), post-menstrual age (−0.29 ± 1.41 mm Hg/week) and advanced gestational age at birth (13.12 ± 0.90 mm Hg/week). Oscillometric BP measurements are not equivalent to the intra-arterial (UAC or radial arterial) BP in ill neonates. The BP increases with increase in weight, gestational age at birth, and post-menstrual age in ill neonates.     

Blood pressure measurement: Should technique define targets?

Accurate assessment of blood pressure (BP) is the cornerstone of hypertension management. The objectives of this study were to quantify the effect of medical personnel presence during BP measurement by automated oscillometric BP (AOBP) and to compare resting office BP by AOBP to daytime average BP by 24‐h ambulatory BP monitoring (ABPM). This study is a prospective randomized cross‐over trial, conducted in a referral population. Patients underwent measurements of casual and resting office BP by AOBP. Resting BP was measured as either unattended (patient alone in the room during resting and measurements) or as partially attended (nurse present in the room during measurements) immediately prior to and after 24‐h ABPM. The primary outcome was the effect of unattended 5‐min rest preceding AOBP assessment as the difference between casual and resting BP measured by the Omron HEM 907XL. Ninety patients consented and 78 completed the study. The mean difference between the casual and Omron unattended systolic BP was 7.0 mm Hg (95% confidence interval [CI] 4.5, 9.5). There was no significant difference between partially attended and unattended resting office systolic BP. Resting office BP (attended and partially attended) underestimated daytime systolic BP load from 24‐h ABPM. The presence or absence of medical personnel does not impact casual office BP which is higher than resting office AOBP. The requirement for unattended rest may be dropped if logistically challenging. Casual and resting office BP readings by AOBP do not capture the complexity of information provided by the 24‐h ABPM.     

A comparative study of an ambulatory blood pressure measuring device and a wrist blood pressure monitor with a position sensor versus a mercury sphygmomanometer

BackgroundSelf-measurements of blood pressure (BP) and 24-hour BP measurements are better predictors of cardiovascular mortality and morbidity than office BP measurements. The objective of this study was to compare the accuracy and precision of a wrist BP monitor with a position sensor (Omron 637IT) and of an ambulatory BP measuring monitor (ABPM; Nissei DS-250) with a mercury sphygmomanometer.MethodsA total of 139 patients (69 women and 70 men) were included in the study. The BP of each subject was first measured with a mercury device using the same (left) arm. After this, the wrist monitor was used for BP measurement. Upon completion of the BP readings, 24-hour BP monitoring was performed using Nissei DS-250 monitors. Mean and standard deviations were calculated for all devices. In order to assess the agreement between the measurement methods, the Bland–Altman method and graphics were utilized.ResultsThe mean systolic BP measured by the mercury device was 133.2 ± 18.4 mmHg and the diastolic BP was 85.4 ± 12.5 mmHg, whereas the digital device measured systolic BP as 135.7 ± 17.2 mmHg and diastolic BP as 87.0 ± 12.5 mmHg. The 24-hour BP measurement was 134.6 ± 16.6 mmHg for systolic BP and 85.6 ± 11.1 mmHg for diastolic BP. The difference with regard to systolic BP between the mercury and the Omron devices was − 2.5 ± 5.3 mmHg, which is within the AAMI standard. However, while the mean values of the differences between the mercury and ABPM devices remained under 5 mmHg, their standard deviation was above ±  8 mmHg. For diastolic BP, the difference between all of the devices was below 5 ± 8 mmHg.ConclusionsThe wrist BP monitor produced results consistent with those of the mercury sphygmomanometer when both were compared with the results of the ABPM. As BP measurement with these devices is a practical and repeatable method, they can be used instead of ABPM in the diagnosis and monitoring of hypertension. However, there is a need for further comparative studies.     

Early Morning Surge and Dipping Status of Blood Pressure: Are These of Predictive Value for Silent Myocardial Ischemia?

To investigate the predictive value of morning surge (MS) and dipping status of blood pressure (BP) for ST-segment depression (ST depression) in hypertensive persons, the combined 24-hour ambulatory BP measurement and Holter electrocardiographic recordings of 344 patients (132 women and 212 men, 60±12 years) were analyzed. The morning BP surge was calculated as mean systolic BP during the 2 hours after awaking minus the mean systolic BP during the 1 hour that included the lowest sleep BP. Depending on the percentage decrease in systolic BP at night, patients were subdivided into extreme dippers, dippers, nondippers, and risers. ST depression was defined as horizontal or descending ST depression of 1 mm of 1 minute duration and a 1-minute interval after the previous episode or 24-hour mean ST-segment value <−0.1 mV. ST depression was observed in 76 (22.1%) of 344 patients. The mean MS in patients with ST depression was with 25±15 mm Hg and not significantly different when compared with patients without ST depression (26±15 mm Hg). The prevalence of ST depression was not significantly different in dippers, extreme dippers, nondippers, and risers (20%, 23.5%, 23%, and 25.5%, respectively). Systolic and diastolic BP values during ST depression were significantly higher in the morning as compared with ST depression in the evening (149/84 mm Hg vs 138/78 mm Hg, P <.05). In the present study, MS and dipping status of BP were not associated with ST depression. ST depression was, however, characterized by significantly higher BP peaks in the early morning hours.     

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.     

Effects of different statin types and dosages on systolic/diastolic blood pressure: Retrospective analysis of 24‐hour ambulatory blood pressure database

We previously demonstrated lower diastolic blood pressure (BP) levels under statin therapy in adult individuals who consecutively underwent 24‐hour ambulatory BP monitoring and compared their levels to untreated outpatients. Here we evaluated systolic/diastolic BP levels according to different statin types and dosages. 987 patients (47.5% female, age 66.0 ± 10.1 years, BMI 27.7 ± 4.6 kg/m², clinic BP 146.9 ± 19.4/86.1 ± 12.1 mm Hg, 24‐hour BP 129.2 ± 14.4/74.9 ± 9.2 mm Hg) were stratified into 4 groups: 291 (29.5%) on simvastatin 10‐80 mg/d, 341 (34.5%) on atorvastatin 10‐80 mg/d, 187 (18.9%) on rosuvastatin 5‐40 mg/d, and 168 (17.0%) on other statins. There were no significant BP differences among patients treated by various statin types and dosages, except in lower clinic (P = .007) and daytime (P = .013) diastolic BP in patients treated with simvastatin and atorvastatin compared to other statins. Favorable effects of statins on systolic/diastolic BP levels seem to be independent of types or dosages, thus suggesting a potential class effect of these drugs.     

White‐Coat Effect Among Older Adults: Data From the Jackson Heart Study

Many adults with elevated clinic blood pressure (BP) have lower BP when measured outside the clinic. This phenomenon, the “white‐coat effect,” may be larger among older adults, a population more susceptible to the adverse effects of low BP. The authors analyzed data from 257 participants in the Jackson Heart Study with elevated clinic BP (systolic/diastolic BP [SBP/DBP] ≥140/90 mm Hg) who underwent ambulatory BP monitoring (ABPM). The white‐coat effect for SBP was larger for participants 60 years and older vs those younger than 60 years in the overall population (12.2 mm Hg, 95% confidence interval [CI], 9.2–15.1 mm Hg and 8.4 mm Hg, 95% CI, 5.7–11.1, respectively; P=.06) and among those without diabetes or chronic kidney disease (15.2 mm Hg, 95% CI, 10.1–20.2 and 8.6 mm Hg, 95% CI, 5.0–12.3, respectively; P=.04). After multivariable adjustment, clinic SBP ≥150 mm Hg vs <150 mm Hg was associated with a larger white‐coat effect. Studies are needed to investigate the role of ABPM in guiding the initiation and titration of antihypertensive treatment, especially among older adults.     

Measurement variation among 12 electronic home blood pressure monitors

Although there are AAMI and BHS standards for accuracy of electronic home electronic blood pressure monitors (HBPM), patient composition differences and differences in manufacturer's algorithm for calculation of the systolic and diastolic measurement may result in measurement differences between monitors. The aim of this study was the measurement of differences among HBPM. Paired comparisons were performed between the Omron 712c electronic home monitor and each of 12 other HBPM (Sunbeam 7654, Sunbeam 7623, Omron 711, Omron 432c, A&D-UA767, Lumiscope 1085M, Omron 725CIC, Assure A30, Lumiscope 1083N, Omron 815, Omron 605, and Assure BD-W20), in addition to comparison to the auscultatory method by trained observers. Measurements were made in normotensive subjects in an ambulatory setting. The main outcome measures were systolic and diastolic blood pressure measurements. All of the HBPM, except for the Sunbeam 7654 and the Assure A30/ BD-W20 (wrist) models, demonstrated small differences of <4/4 mm Hg for systolic/diastolic measurements with pulse measurement differences of <3 beats/min. These differences were less than the differences previously reported for office BP auscultation of 6/5-10 mm Hg for systolic/diastolic measurements. The Omron 712c, passing previous AAMI and BHS standards, measured the systolic reading within 2 mm Hg of auscultatory mercury or aneroid measurement and under-measured the diastolic by 6-9 mm Hg. Differences in the patient composition studied could account for the difference. The wrist and finger manometers performed clinically similar to the Omron 712c, except for the Assure BD-W20, which overmeasured the diastolic by 7 mm Hg. It is concluded that the small differences among the various HBPM, which are less than those in clinical office auscultation, should encourage greater use of electronic manometers in the office and at home.     

Effectiveness of using long-acting angiotensin II type 1 receptor blocker in Japanese obese patients with metabolic syndrome on morning hypertension monitoring by using telemedicine system (FUJIYAMA Study)

Aim: Recently, obesity patients have been diagnosed as metabolic syndrome. The aim of this study was to evaluate which angiotensin type 1 receptor blockers (ARBs), telmisartan or candesartan, is superior for the control of home blood pressure (BP) in the morning when the outpatient clinic BP was well controlled in the patients with metabolic syndrome.

Methods: The patients with metabolic syndrome were enrolled. Home BP was monitored by using a telemedicine system. After a 2- to 4-week control period to establish baseline home BP values, these patients were randomly divided into telmisartan (20–80?mg) and candesartan (4–12?mg) groups. These end points were evaluated by using the telemedicine system during steady-state active therapy. A total of 356 patients attending 60 outpatient Japanese centers were recruited.

Results: On a day of active therapy, telmisartan significantly lowered both systolic and diastolic home BP in the morning to a greater extent compared to candesartan. At the end of the study, reductions in systolic and diastolic home BP in the morning, in telmisartan group were significantly larger compared to the changes in the candesartan group (systolic; Tel: 12.0?±?8.9 versus Can: 8.1?±?17.1?mmHg, p?=?0.0292, diastolic; Tel: 7.4?±?6.1 versus Can: 3.7?±?6.8?mmHg, p?=?0.0053). Additionally in the telmisartan treated group, LDL-cholesterol showed significant reduction (p?=?0.037), but candesartan did not.

Conclusion: The present study by using the telemedicine system clearly demonstrated that telmisartan has a strong effect on reducing morning home BP, and a good effect on lipid metabolism in patients with metabolic syndrome.