Clinical significance of home blood pressure and its possible practical application

Circadian blood pressure abnormalities in patients with primary nephrotic syndrome

BACKGROUND

Only a few studies have evaluated the abnormalities of ambulatory blood pressure (ABP) in patients with nephrotic syndrome (NS).

METHODS

The 24-h ABPs were measured in primary NS patients with acute onset of disease and analyzed in relation to the clinical variables.

RESULTS

Our subjects comprised 21 patients: 17 with minimal change disease and 4 with focal segmental glomerulosclerosis. Of these patients, 8 (38%) had daytime hypertension, 13 (62%) had nighttime hypertension, and 13 (62%) were non-dippers (nighttime-to-daytime ratio of ABP: NDR > 0.9). The serum sodium level was correlated with the average 24-h ABP and NDR, after adjustment for other clinical variables, such as the increase in body weight, serum albumin level, and urinary protein excretion. The data from repeated ABP measurements, before and after the achievement of remission, showed a marked decrease in the average 24-h ABP after remission. Furthermore, change in the serum sodium level was significantly correlated with the change in NDR.

CONCLUSION

These results suggest that alteration in renal handling of sodium and water, which might be reflected in serum sodium level, is involved in the abnormality of circadian blood pressure in primary NS patients.

Effectiveness of Self-Monitoring Blood Pressure in Primary Care: A Randomized Controlled Trial

OBJECTIVE

To examine the effectiveness of self-monitoring blood pressure (SMBP) in a randomized controlled trial with 12 months of follow-up in a community hospital.

METHODS

A total of 224 eligible patients with hypertension were randomly allocated to the SMBP (n = 111) and usual care groups (n = 113). Each patient in the SMBP group was provided with a blood pressure (BP) monitor for home BP measurement. Mixed model regression was used to compare changes in BP at months 6 and 12 and compare between groups.

RESULTS

At month 12, compared with usual care, the SMBP group had average systolic BP decreased by 2.5 mm Hg. The benefit of the SMBP was found in those aged ≥60 years, which significantly decreased by -8.9 mm Hg (95% CI = -15.1 to -2.7) compared with those in the usual care. For individuals aged 60 years and older in the SMBP group, the proportion of those with uncontrolled BP decreased from 90.9% at baseline to 38.2% at month 12 (P < .05). However, among those aged <60 years, SMBP did not perform better than the usual care group.

CONCLUSION

For primary care setting in urban area, the SMBP resulted in lower BP in the older persons with hypertension at 12 months. Further study on effectiveness of SMBP in other settings may be warranted.