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Delucchi A, Fernández D, Sorini M, Reisin P, Scarabino M, Rodríguez P. [Inter-arm blood pressure difference: Consecutive versus simultaneous measurements in treated and controlled hypertense patients]. HIPERTENSION Y RIESGO VASCULAR 2024:S1889-1837(24)00084-9. [PMID: 39043554 DOI: 10.1016/j.hipert.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 06/22/2024] [Accepted: 06/25/2024] [Indexed: 07/25/2024]
Abstract
The inter-arm difference (IAD) of systolic blood pressure (SBP) is associated with higher cardiovascular risk. We compared simultaneous and consecutive recordings in measuring IAD of SBP, and evaluated reproducibility between visits. 143 hypertensive patients (63.8±9.5 years, 51.7% women) treated and controlled with stable antihypertensive medication for a period of ≥3 months were included. Blood pressure (BP) in both arms was measured simultaneously and consecutively with an automatic oscillometric device, in two visits. The IAD of the simultaneous SBP was significantly lower compared to the consecutive one, both in the first (3.51±4.1 vs. 4.40±3.7mmHg; P<.01) and in the second visit (3.62±3.5 vs. 5.69±5.1mmHg; P<.001). When the IAD of SBP was categorized as ≥10 or <10mmHg, the reproducibility between visits was insignificant in both simultaneous measurements and consecutive measurements. The frequency of initial dominance was similar between the left and right arm in simultaneous ones (46.2 vs. 43.3%), and greater in the right arm in consecutive ones (55.2 vs. 38.5). The persistence of dominance between both visits was significantly higher when SBP was measured simultaneously (54.4% vs. 45.5%; P<.01). Our study shows that to define the arm with the highest BP, simultaneous measurements are preferable. In treated and controlled hypertensive patients, the poor persistence of initial dominance between visits requires us to review the recommendation of recording, during follow-up, the BP in the arm where it was highest on the first visit.
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Affiliation(s)
- A Delucchi
- Sección Hipertensión Arterial, Sanatorio Municipal «Dr. Julio Méndez», Ciudad Autónoma de Buenos Aires, Argentina.
| | - D Fernández
- Sección Hipertensión Arterial, Sanatorio Municipal «Dr. Julio Méndez», Ciudad Autónoma de Buenos Aires, Argentina
| | - M Sorini
- Sección Hipertensión Arterial, Sanatorio Municipal «Dr. Julio Méndez», Ciudad Autónoma de Buenos Aires, Argentina
| | - P Reisin
- Sección Hipertensión Arterial, Sanatorio Municipal «Dr. Julio Méndez», Ciudad Autónoma de Buenos Aires, Argentina
| | - M Scarabino
- Sección Hipertensión Arterial, Sanatorio Municipal «Dr. Julio Méndez», Ciudad Autónoma de Buenos Aires, Argentina
| | - P Rodríguez
- Sección Hipertensión Arterial, Sanatorio Municipal «Dr. Julio Méndez», Ciudad Autónoma de Buenos Aires, Argentina
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Barochiner J, Aparicio LS, Martínez R, Boggia J. Prognostic value of home blood pressure monitoring in patients under antihypertensive treatment. J Hum Hypertens 2023; 37:775-782. [PMID: 36163509 PMCID: PMC9510727 DOI: 10.1038/s41371-022-00758-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 08/24/2022] [Accepted: 09/12/2022] [Indexed: 11/12/2022]
Abstract
The prognostic value of home blood pressure monitoring (HBPM) has been investigated in several studies in the general population, demonstrating its independent association with cardiovascular events. However, in the case of treated hypertensive subjects, evidence is controversial. Our purpose was to evaluate the prognostic value of HBPM in this population. Medicated hypertensive patients who performed a 4-day HBPM (Omron® HEM-705CP-II) between 2008 and 2015 were followed up for a median of 5.9 years, registering the occurrence of a composite primary outcome of fatal and non-fatal cardiovascular events. Cox regression models were used to analyze the prognostic value of HBPM, considering 4-day measurements, discarding the first day, and analyzing morning, afternoon and evening periods separately. We included 1582 patients in the analysis (33.4% men, median age 70.8 years, on an average of 2.1 antihypertensive drugs). During follow-up, 273 events occurred. HBPM was significantly associated with cardiovascular events in all five scenarios in the unadjusted models. When adjusting for office BP and other cardiovascular risk factors, the association remained marginally significant for the 4-day period, discarding first-day measurements HBPM (HR 1.04 [95% CI 1-1.1] and 1.04 [95% CI 1-1.1], respectively) and statistically significant for all separate periods of measurement: HR 1.32 (95% CI 1.01-1.72); 1.33 (95% CI 1.02-1.72); and 1.30 (95% CI 1.01-1.67), for morning, afternoon and evening, respectively. When analyzing separately fatal and non-fatal events, statistical significance was held for the former only. In conclusion, HBPM is an independent predictor of cardiovascular events in hypertensives under treatment.
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Affiliation(s)
- Jessica Barochiner
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
- Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB), UE de triple dependencia CONICET- Instituto Universitario del Hospital Italiano (IUHI)- Hospital Italiano (HIBA), Buenos Aires, Argentina.
| | - Lucas S Aparicio
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Rocío Martínez
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB), UE de triple dependencia CONICET- Instituto Universitario del Hospital Italiano (IUHI)- Hospital Italiano (HIBA), Buenos Aires, Argentina
| | - José Boggia
- Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
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Márquez DF, Garzón ME, Renna NF, Baroni M, Berger A, Caruso G, Ferretti V, Sabio R, König F, Marín M, Romero CA. [Argentine registry of office blood pressure monitoring. RAMPAC study]. HIPERTENSION Y RIESGO VASCULAR 2022; 39:62-68. [PMID: 35305932 DOI: 10.1016/j.hipert.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Hypertension (HTN) is the leading cause of mortality and disability in the world. In Argentina, almost 44% of hypertensives do not know about their condition and this may be due to the low rate of blood pressure (BP) measurements during the office visit. Our hypothesis is that the measurement and electronic recording of BP (BPMR) is not a routine practice in Argentina. OBJECTIVE To describe the rate of office BP measurement in Argentina. METHODS This is a retrospective, multicentre, point prevalence study. We analysed all office visits on 9/19/2019 at 9 medical institutions in 6 provinces of Argentina. RESULTS Two thousand and eighty-two office visits were analysed. The patients' mean age was 52.1 years (18-103), 1790 (59.7%) were female, and 702 (36.1%) were hypertensives. BP was measured in 420 visits (14.1%; 95% CI 12.8-15.4). In a multivariate logistic regression model, history of HTN (OR 1.91, P<.001) and previous cardiovascular event (OR 1.76, P<.001) were associated with more odds of BPMR. The presence of cancer was associated with fewer odds of BPMR (OR .51, P<.01). Cardiology measured BP up to 49.5% (144/291 visits), followed by internal medicine 30% (152/507 visits). CONCLUSION BPMR during office visits is deficient in Argentina and represents a missed healthcare opportunity. Different strategies are needed to detect hypertensive patients and reduce cardiovascular events.
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Affiliation(s)
- D F Márquez
- Unidad de Hipertensión Arterial, Hospital San Bernardo, Salta, Argentina; Instituto de NefroUrología y Nutrición de Salta, Salta, Argentina
| | - M E Garzón
- Servicio de Clínica Médica, Hospital Ferreyra, Córdoba, Argentina; Servicio de Clínica Médica, Hospital Privado, Córdoba, Argentina
| | - N F Renna
- Departamento de Cardiología, Hospital Español, Mendoza, Argentina
| | - M Baroni
- Facultad de Ciencias Médicas, Universidad Nacional de Cuyo-Mendoza, Servicio de Cardiología, Instituto Modelo de Cardiología, Córdoba, Argentina
| | - A Berger
- Servicio de Clínica Médica, Hospital Ramos Mejía, Ciudad Autónoma de Buenos Aires, Argentina
| | - G Caruso
- Servicio de Clínica Médica, Hospital Ramos Mejía, Ciudad Autónoma de Buenos Aires, Argentina
| | - V Ferretti
- Servicio de Clínica Médica, Sanatorio Norte, Rosario, Argentina
| | - R Sabio
- Hospital de Alta Complejidad, SAMIC-El Calafate, Santa Cruz, Argentina
| | - F König
- Unidad de Hipertensión Arterial, Hospital San Bernardo, Salta, Argentina
| | - M Marín
- Unidad de Hipertensión Arterial, Hospital Italiano de San Justo, Buenos Aires, Argentina
| | - C A Romero
- Servicio de Clínica Médica, Hospital Privado, Córdoba, Argentina; Emory University School of Medicine, Renal Division, Atlanta, EE. UU..
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Barochiner J, Marín MJ, Janson JJ, Conti PR, Martínez R, Micali G, Conte IE, Plazzotta F. White Coat Uncontrolled Hypertension in Teleconsultation: A New and Frequent Entity. High Blood Press Cardiovasc Prev 2021; 29:155-161. [PMID: 34905157 PMCID: PMC8669402 DOI: 10.1007/s40292-021-00498-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/03/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Cardiovascular risk seems not to be greater in patients with white coat uncontrolled hypertension (WUCH) than in patients with sustained blood pressure (BP) control. Therefore, its detection is important to avoid overtreatment. The COVID-19 pandemic determined a massive migration of hypertension consultations from the face-to-face modality to teleconsultations, and it is unknown whether WUCH exists in this context. Aim We aimed to evaluate the prevalence of WUCH through home BP monitoring (HBPM) in treated hypertensive patients evaluated by teleconsultation. Methods We included treated hypertensive patients that owned a digital BP monitor. During teleconsultation, patients were asked to perform two BP measurements and then a 7-day HBPM, using the same device. Patients were classified as having WUCH if BP was ≥ 140 and/or 90 mmHg in teleconsultation and < 135/85 mmHg on HBPM. The prevalence of WUCH and its 95% confidence interval were estimated. One-way ANOVA, the Chi-square test or Fisher’s exact test were used to compare the characteristics of these patients with the other groups. Results We included 341 patients (45.2% male, mean age 62.3 years). The prevalence of WUCH was 33.1% (95% CI 28.3–38.3%). Significant differences were found in terms of age, the number of antihypertensive drugs and the use of calcium channel blockers, all lower in the WUCH group as compared with the groups with elevated BP on HBPM. Conclusion WUCH exists in teleconsultation and is very frequent. It can be easily detected though HBPM, thus avoiding overmedication, and its potential impact on side-effects and health costs.
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Affiliation(s)
- Jessica Barochiner
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB, Buenos Aires, Argentina. .,Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB), UE de triple dependencia CONICET-Instituto Universitario del Hospital Italiano (IUHI)-Hospital Italiano (HIBA), Buenos Aires, Argentina.
| | - Marcos J Marín
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB, Buenos Aires, Argentina
| | - Jorge J Janson
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB, Buenos Aires, Argentina
| | - Patricia R Conti
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB, Buenos Aires, Argentina
| | - Rocío Martínez
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB, Buenos Aires, Argentina.,Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB), UE de triple dependencia CONICET-Instituto Universitario del Hospital Italiano (IUHI)-Hospital Italiano (HIBA), Buenos Aires, Argentina
| | - Gabriel Micali
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB, Buenos Aires, Argentina
| | - Isabel E Conte
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB, Buenos Aires, Argentina
| | - Fernando Plazzotta
- Department of Health Informatics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Barochiner J, Aparicio LS, Martínez R, Alfie J, Marín MJ. Prognostic value of masked uncontrolled apparent resistant hypertension detected through home blood pressure monitoring. J Hypertens 2021; 39:2141-2146. [PMID: 34128493 DOI: 10.1097/hjh.0000000000002913] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Resistant hypertension carries a poor prognosis and current guidelines recommend the exclusion of the white-coat phenomenon for proper diagnosis. However, guidelines do not focus on patients treated with at least three drugs whose blood pressure (BP) is controlled at the office but elevated out of it. We aimed at determining whether this masked uncontrolled apparent resistant hypertension (MUCRH) detected through home blood pressure monitoring (HBPM) has prognostic value for fatal and nonfatal events in these hypertensive patients. METHODS Hypertensive patients treated with at least three drugs who performed a baseline HBPM between 2008 and 2015 were followed to register the occurrence of total mortality, cardiovascular mortality, and fatal and nonfatal cardiac and cerebrovascular events. MUCRH was defined as office blood pressure less than 140/90 mmHg and home BP at least 135 and/or 85 mmHg. Multivariable Cox proportional hazard models were adjusted to determine the independent prognostic value of MUCRH for the events of interest. RESULTS We included 470 patients, 35.5% male, mean age 71.9 years, and treated with 3.3 antihypertensive drugs on average. Among study population, 15.5% had MUCRH (33.3% when considering only patients with adequate BP control at the office). Median follow-up was 6.7 years. In multivariable models, MUCRH was an independent predictor for cardiovascular mortality and cerebrovascular events: hazard ratio 4.9 (95% CI 1.2-19.9, P = 0.03) and 5.1 (95% CI 1.5-16.9, P = 0.01), respectively. CONCLUSION MUCRH is not rare and is independently associated with cardiovascular morbidity and mortality. The systematic monitoring of intensively treated individuals through HBPM would be useful for the detection of patients at increased risk of events.
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Affiliation(s)
- Jessica Barochiner
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires
- Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB), UE de triple dependencia CONICET- Instituto Universitario del Hospital Italiano (IUHI)- Hospital Italiano (HIBA), Buenos Aires, Argentina
| | - Lucas S Aparicio
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires
| | - Rocío Martínez
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires
- Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB), UE de triple dependencia CONICET- Instituto Universitario del Hospital Italiano (IUHI)- Hospital Italiano (HIBA), Buenos Aires, Argentina
| | - José Alfie
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires
| | - Marcos J Marín
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires
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Marín M, Barochiner J, Rodríguez P, Renna N, Castellaro C, Espeche W, De Cerchio A, Del Sueldo M, Vissani S, Zilberman J. Blood pressure control and cardiovascular risk profile in hypertensive patients under specialist care in Argentina: Results from the CHARTER study. J Clin Hypertens (Greenwich) 2019; 21:1456-1462. [PMID: 31479195 DOI: 10.1111/jch.13684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/23/2019] [Accepted: 08/02/2019] [Indexed: 11/29/2022]
Abstract
Worldwide, hypertension control rate is far from ideal. Some studies suggest that patients treated by specialists have a greater chance to achieve control. The authors aimed to determine the BP control rate among treated hypertensive patients under specialist care in Argentina, to characterize patients regarding their cardiovascular risk profile and antihypertensive drug use, and to assess the variables independently associated with adequate BP control. The authors included adult hypertensive patients under stable treatment, managed in 10 specialist centers across Argentina. Office BP was measured thrice with a validated oscillometric device. Adequate BP control was defined as an average of the three readings <140/90 mm Hg (and <150/90 in patients older than 80 years). The authors estimated the proportion of adequate BP control and the variables independently associated with it through a multiple conditional logistic regression model. Among the 1146 included patients, 48.2% were men with a mean age of 63.5 (±13.1) years old. Mean office BP was 135.3 (±14.8)/80.8 (±10) mm Hg, with a 64.8% (95% CI: 62%-67.6%) of adequate control. The mean number of antihypertensive drugs was 2.1 per participant, the commonest being angiotensin receptor blockers and calcium channel blockers. In multivariable analysis, only female sex was a predictor of adequate BP control (OR 1.33 [95% CI 1.02-1.72], P = .04). In conclusion, almost 65% of hypertensive patients treated in specialist centers in Argentina have adequate BP control. The challenge for future research is to define strategies in order to translate this control rate to the primary care level, where most patients are managed.
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Affiliation(s)
- Marcos Marín
- Argentinian Society of Hypertension, Buenos Aires, Argentina.,Hospital Italiano Ctro. Agustín Rocca-San Justo (HICAR), Buenos Aires, Argentina
| | - Jessica Barochiner
- Argentinian Society of Hypertension, Buenos Aires, Argentina.,Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Pablo Rodríguez
- Argentinian Society of Hypertension, Buenos Aires, Argentina.,Sanatorio Municipal Dr. Julio Méndez, Buenos Aires, Argentina
| | - Nicolás Renna
- Argentinian Society of Hypertension, Buenos Aires, Argentina.,Hospital Español de Mendoza, Mendoza, Argentina
| | - Carlos Castellaro
- Argentinian Society of Hypertension, Buenos Aires, Argentina.,Centro de educación médica e investigaciones clínicas "Norberto Quirno" (CEMIC), Buenos Aires, Argentina
| | - Walter Espeche
- Argentinian Society of Hypertension, Buenos Aires, Argentina.,Hospital San Martín, Buenos Aires, Argentina
| | - Alejandro De Cerchio
- Argentinian Society of Hypertension, Buenos Aires, Argentina.,Instituto de Cardiología de Corrientes "Juana Francisca Cabral", Corrientes, Argentina
| | - Mildren Del Sueldo
- Argentinian Society of Hypertension, Buenos Aires, Argentina.,Fundación Certus - Clínica de Especialidades, Córdoba, Argentina
| | - Sergio Vissani
- Argentinian Society of Hypertension, Buenos Aires, Argentina.,Centro de neurología y rehabilitación-CENYR, San Luis, Argentina
| | - Judith Zilberman
- Argentinian Society of Hypertension, Buenos Aires, Argentina.,Hospital General de Agudos "Dr. Cosme Argerich", Buenos Aires, Argentina
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Barochiner J, Posadas Martínez ML, Martínez R, Giunta D. Reproducibility of masked uncontrolled hypertension detected through home blood pressure monitoring. J Clin Hypertens (Greenwich) 2019; 21:877-883. [PMID: 31215143 DOI: 10.1111/jch.13596] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/27/2019] [Accepted: 05/28/2019] [Indexed: 11/28/2022]
Abstract
Masked uncontrolled hypertension (MUCH) is an entity described in treated hypertensive subjects, where office blood pressure (BP) is well controlled and out-of-office BP is elevated. It has been related to a higher cardiovascular risk. However, the reproducibility of MUCH has been scarcely studied. In this study, we aimed to determine the reproducibility of MUCH detected through home blood pressure monitoring (HBPM). Two sets of measurements were performed in hypertensive adults under stable treatment with a 1-week interval. Each set of measurements included three office BP readings and a 4-day HBPM with duplicate readings in the morning, afternoon, and evening (the same validated oscillometric device was employed in both settings). We determined the percentage of agreement regarding the presence of MUCH in the two sets of measurements and quantified such agreement through the Cohen's kappa coefficient (κ), its 95% confidence interval, and P value. We included 105 patients (median age 58.6 [IQR 45.6-67.2] years old, 53.4% men). MUCH prevalence on at least one occasion was 22.3% (95% CI: 15.2-31.5). The reproducibility of MUCH was scant: κ = 0.19 (95% CI: 0.0002-0.38), P = 0.02, due to the poor reproducibility of the office BP component of MUCH in comparison with the home BP component: κ = 0.21 (95% CI: 0.03-0.39), P = 0.01 vs κ = 0.48 (95% CI 0.29-0.67), P < 0.001, respectively. In conclusion, the reproducibility of MUCH detected through HBPM is minimal, mainly due to the poor reproducibility of office BP measurements. An HBPM-based strategy for the management of patients with MUCH may be more adequate in terms of cardiovascular morbidity and mortality.
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Affiliation(s)
- Jessica Barochiner
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - María Lourdes Posadas Martínez
- Internal Medicine Research Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Rocío Martínez
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Diego Giunta
- Internal Medicine Research Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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