1
|
Habas E, Errayes A, Habas E, Alfitori G, Habas A, Farfar K, Rayani A, Habas A, Elzouki AN. Masked phenomenon: renal and cardiovascular complications; review and updates. Blood Press 2024; 33:2383234. [PMID: 39056371 DOI: 10.1080/08037051.2024.2383234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/10/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND In the in-clinic blood pressure (BP) recording setting, a sizable number of individuals with normal BP and approximately 30% of patients with chronic renal disease (CKD) exhibit elevated outpatient BP records. These individuals are known as masked hypertension (MHTN), and when they are on antihypertensive medications, but their BP is not controlled, they are called masked uncontrolled hypertension (MUHTN). The masked phenomenon (MP) (MHTN and MUHTN) increases susceptibility to end-organ damage (a two-fold greater risk for cardiovascular events and kidney dysfunction). The potential extension of the observed benefits of MP therapy, including a reduction in end-organ damage, remains questionable. AIM AND METHODS This review aims to study the diagnostic methodology, epidemiology, pathophysiology, and significance of MP management in end-organs, especially the kidneys, cardiovascular system, and outcomes. To achieve the purposes of this non-systematic comprehensive review, PubMed, Google, and Google Scholar were searched using keywords, texts, and phrases such as masked phenomenon, CKD and HTN, HTN types, HTN definition, CKD progression, masked HTN, MHTN, masked uncontrolled HTN, CKD onset, and cardiovascular system and MHTN. We restricted the search process to the last ten years to search for the latest updates. CONCLUSION MHTN is a variant of HTN that can be missed if medical professionals are unaware of it. Early detection by ambulatory or home BP recording in susceptible individuals reduces end-organ damage and progresses to sustained HTN. Adherence to the available recommendations when dealing with masked phenomena is justifiable; however, further studies and recommendation updates are required.
Collapse
Affiliation(s)
- Elmukhtar Habas
- Medical Department, Hamad General Hospital, Qatar University, Doha, Qatar
| | - Almehdi Errayes
- Medical Department, Hamad General Hospital, Qatar University, Doha, Qatar
| | - Eshrak Habas
- Internal Medicine, Medical Department, Tripoli Central Hospital, University of Tripoli, Tripoli, Libya
| | - Gamal Alfitori
- Medical Department, Hamad General Hospital, Qatar University, Doha, Qatar
| | - Ala Habas
- Medical Department, Alwakra General Hospital, Qatar University, Alwakra, Qatar
| | - Kalifa Farfar
- Medical Department, Alwakra General Hospital, Qatar University, Alwakra, Qatar
| | - Amnna Rayani
- Tripoli Children Hospital, University of Tripoli, Tripoli, Libya
| | - Aml Habas
- Tripoli Children Hospital, University of Tripoli, Tripoli, Libya
| | | |
Collapse
|
2
|
Lee EM. When and how to use ambulatory blood pressure monitoring and home blood pressure monitoring for managing hypertension. Clin Hypertens 2024; 30:10. [PMID: 38556887 PMCID: PMC10983625 DOI: 10.1186/s40885-024-00265-w] [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: 09/27/2023] [Accepted: 02/10/2024] [Indexed: 04/02/2024] Open
Abstract
Many individuals have different blood pressure (BP) values in the office setting compared to that outside the office setting. Therefore, confirming hypertension based on office BP (OBP) measurement alone can lead to misdiagnosis and mistreatment. The limitations of OBP measurement have led to the complementary use of out-of-office BP measurements, including 24-hour ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM). This review aims to describe when and how ABPM or HBPM can be used to accurately diagnose and treat hypertension. Both methods should be performed using validated automated oscillometric devices. To minimize user errors, ABPM should be performed using standard techniques, whereas HBPM requires patient education regarding proper BP measurements. ABPM provides short-term comprehensive information on BP, including daytime, nighttime, morning, and 24-h BP. Therefore, ABPM is recommended for the initial diagnosis of hypertension, assessment of BP phenotypes and circadian patterns, and detection of nocturnal hypertension, Furthermore, ABPM plays a critical role in confirming true resistant hypertension thereby excluding pseudo-resistant hypertension. However, it is not suitable for long-term follow-up of patients with hypertension. In contrast, HBPM involves multiple BP readings taken at specific times during the day and evening over a long period. Therefore, HBPM is recommended for diagnosing hypertension and assessing BP phenotypes. However, this method has limitations in measuring nocturnal BP and circadian BP patterns. HBPM is preferred over ABPM for the long-term follow-up of patients with hypertension. This approach improves patient adherence to treatment and ultimately enhances the rate of control of hypertension. Additionally, both methods play an important role in diagnosing and treating white coat hypertension during pregnancy. Consequently, out-of-office BP measurement is essential to prevent the misdiagnosis and mistreatment of hypertension. However, these two methods offer different information regarding the BP status of an individual, and they indeed show discrepancies in the diagnosis of hypertensive phenotypes. Therefore, it is crucial to understand the advantages and limitations of both ABPM and HBPM to ensure their appropriate use in clinical practice.
Collapse
Affiliation(s)
- Eun Mi Lee
- Division of Cardiology, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Gunpo, Gyeonggi-do, 15865, Republic of Korea.
| |
Collapse
|
3
|
Sotomayor Julio AD, Montana-Jimenez LP, Bernal Torres W, López Ponce de León JD, Zambrano Franco JA, Coca A, Camafort M, Vesga Reyes C. [Ambulatory blood pressure monitoring, adult and pediatric population. A narrative review]. HIPERTENSION Y RIESGO VASCULAR 2024; 41:104-117. [PMID: 38480108 DOI: 10.1016/j.hipert.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 04/14/2024]
Abstract
Hypertension has become a central risk factor for the development of cardiovascular disease, underscoring the importance of its accurate diagnosis. Numerous studies have established a close relationship between elevated systolic (SBP) and diastolic (DBP) blood pressure and an increased risk of cardiovascular event (CVE). Traditionally, blood pressure (BP) measurements performed in clinical settings have been the main method for diagnosing and assessing hypertension. However, in recent years, it has been recognized that BP measurements obtained outside the clinical setting, using self-monitoring blood pressure (SMBP) and ambulatory blood pressure monitoring (ABPM), offer a more realistic perspective of patients' daily lives and therefore provide more reliable results. Given the evolution of medical devices, diagnostic criteria, and the increasing relevance of certain components of ABPM in the prediction of adverse cardiovascular outcomes, a comprehensive update that is practical for daily clinical practice is required. The main objective of this article is to provide an updated review of ABPM, focusing on its importance in the evaluation of hypertension and its impact on public health in Colombia. In addition, it will discuss the implications of changes in diagnostic thresholds and provide concrete recommendations for the effective implementation of ABPM in clinical practice, allowing health professionals to make informed decisions and improve the care of their patients.
Collapse
Affiliation(s)
- A D Sotomayor Julio
- Departamento de Cardiología, Fundación Valle del Lili, Valle del Cauca, Cali, Colombia; Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia.
| | - L P Montana-Jimenez
- Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - W Bernal Torres
- Centro de Investigaciones Clínicas, Hospital Universitario Fundación Valle del Lili, Cali, Colombia; Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - J D López Ponce de León
- Centro de Investigaciones Clínicas, Hospital Universitario Fundación Valle del Lili, Cali, Colombia; Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - J A Zambrano Franco
- Departamento de Cardiología, Fundación Valle del Lili, Valle del Cauca, Cali, Colombia; Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - A Coca
- Universidad de Barcelona, Barcelona, España
| | - M Camafort
- Universidad de Barcelona, Barcelona, España
| | - C Vesga Reyes
- Departamento de Cardiología, Fundación Valle del Lili, Valle del Cauca, Cali, Colombia; Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| |
Collapse
|
4
|
Feitosa ADDM, Barroso WKS, Mion Junior D, Nobre F, Mota-Gomes MA, Jardim PCBV, Amodeo C, Oliveira AC, Alessi A, Sousa ALL, Brandão AA, Pio-Abreu A, Sposito AC, Pierin AMG, Paiva AMGD, Spinelli ACDS, Machado CA, Poli-de-Figueiredo CE, Rodrigues CIS, Forjaz CLDM, Sampaio DPS, Barbosa ECD, Freitas EVD, Cestario EDES, Muxfeldt ES, Lima Júnior E, Campana EMG, Feitosa FGAM, Consolim-Colombo FM, Almeida FAD, Silva GVD, Moreno Júnior H, Finimundi HC, Guimarães ICB, Gemelli JR, Barreto-Filho JAS, Vilela-Martin JF, Ribeiro JM, Yugar-Toledo JC, Magalhães LBNC, Drager LF, Bortolotto LA, Alves MADM, Malachias MVB, Neves MFT, Santos MC, Dinamarco N, Moreira Filho O, Passarelli Júnior O, Vitorino PVDO, Miranda RD, Bezerra R, Pedrosa RP, Paula RBD, Okawa RTP, Póvoa RMDS, Fuchs SC, Lima SGD, Inuzuka S, Ferreira-Filho SR, Fillho SHDP, Jardim TDSV, Guimarães Neto VDS, Koch VHK, Gusmão WDP, Oigman W, Nadruz Junior W. Brazilian Guidelines for In-office and Out-of-office Blood Pressure Measurement - 2023. Arq Bras Cardiol 2024; 121:e20240113. [PMID: 38695411 DOI: 10.36660/abc.20240113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/19/2024] Open
Affiliation(s)
- Audes Diogenes de Magalhães Feitosa
- Universidade Federal de Pernambuco (UFPE), Recife, PE - Brasil
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE - Brasil
- Instituto de Assistência, Pesquisa e Ensino em Saúde (IAPES), Recife, PE - Brasil
| | | | - Decio Mion Junior
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Fernando Nobre
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP - Brasil
| | - Marco Antonio Mota-Gomes
- Centro Universitário CESMAC, Maceió, AL - Brasil
- Hospital do Coração de Alagoas, Maceió, AL - Brasil
- Centro de Pesquisas Clínicas Dr. Marco Mota, Maceió, AL - Brasil
| | | | - Celso Amodeo
- Hcor, Associação Beneficente Síria, São Paulo, SP - Brasil
| | | | | | - Ana Luiza Lima Sousa
- Faculdade de Enfermagem da Universidade Federal de Goiás (UFG), Goiânia, GO - Brasil
| | | | - Andrea Pio-Abreu
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Andrei C Sposito
- Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo - Brasil
| | | | | | | | | | | | - Cibele Isaac Saad Rodrigues
- Pontifícia Universidade Católica de São Paulo, Faculdade de Ciências Médicas e da Saúde,Sorocaba, SP - Brasil
| | | | | | | | | | | | - Elizabeth Silaid Muxfeldt
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho - Programa de Hipertensão Arterial Resistente (ProHArt), Rio de Janeiro, RJ - Brasil
- Instituto de Educação Médica (IDOMED) - Universidade Estácio de Sá, Rio de Janeiro, RJ - Brasil
| | | | | | - Fabiana Gomes Aragão Magalhães Feitosa
- Universidade Federal de Pernambuco (UFPE), Recife, PE - Brasil
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE - Brasil
- Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, PE - Brasil
| | | | - Fernando Antônio de Almeida
- Pontifícia Universidade Católica de São Paulo, Faculdade de Ciências Médicas e da Saúde,Sorocaba, SP - Brasil
| | - Giovanio Vieira da Silva
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | | | - José Marcio Ribeiro
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil
- Hospital Felício Rocho, Belo Horizonte, MG - Brasil
| | | | | | - Luciano F Drager
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Luiz Aparecido Bortolotto
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
| | | | - Marcus Vinícius Bolívar Malachias
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil
- Fundação Educacional Lucas Machado (FELUMA), Belo Horizonte, MG - Brasil
| | | | - Mayara Cedrim Santos
- Universidade Federal de Pernambuco (UFPE), Recife, PE - Brasil
- Instituto de Assistência, Pesquisa e Ensino em Saúde (IAPES), Recife, PE - Brasil
| | - Nelson Dinamarco
- Colegiado de Medicina - Universidade Estadual de Santa Cruz (UESC), Ilhéus, BA - Brasil
| | | | | | | | | | - Rodrigo Bezerra
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE - Brasil
- Laboratório de Imunopatologia Keizo Asami da Universidade Federal de Pernambuco, Recife, PE - Brasil
| | | | | | | | | | - Sandra C Fuchs
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | - Sayuri Inuzuka
- Unidade de Hipertensão Arterial - NIPEE - LHA/UFG, Goiânia, GO - Brasil
| | | | | | | | | | - Vera Hermina Kalika Koch
- Instituto da Criança e do adolescente do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Waléria Dantas Pereira Gusmão
- Centro Universitário CESMAC, Maceió, AL - Brasil
- Universidade Estadual de Ciências da Saúde de Alagoas (UNCISAL), Maceió, AL - Brasil
| | - Wille Oigman
- Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ - Brasil
| | | |
Collapse
|
5
|
Ohkubo T, Satoh M. Prognostic Significance of Home and Ambulatory Blood Pressure: Summary of Longitudinal Evidence from the Ohasama Study. TOHOKU J EXP MED 2023; 260:273-282. [PMID: 37286522 DOI: 10.1620/tjem.2023.j045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The Ohasama Study is a long-term prospective cohort study of the general population in the town of Ohasama (currently, Hanamaki city) in Iwate Prefecture, Japan, that was started in 1986. Ohasama is a typical farming village in the Tohoku region that consists of part-time farming households that cultivate mainly fruit trees. At the start of the study, the prevention of hypertension, a main cause of strokes, was taken to be an important issue in public health activities because of the many people who died or needed care as a result of strokes in Ohasama. A home blood pressure measurement program was then begun with the aim of preventing hypertension while increasing a sense of solidarity among community residents and the awareness that "one must protect one's own health." As a result, this project became the world's first community-based epidemiological study using home blood pressure, as well as 24-hour ambulatory blood pressure, for which measurements were also initiated. In the 1990s, the Ohasama Study reported a linear "the lower, the better" relationship between out-of-office blood pressure and cardiovascular risk. To date, we have accumulated advanced evidence regarding the clinical significance of out-of-office blood pressure. Those have contributed to hypertension management guidelines around the world. This article summarizes the results of representative long-term follow-up studies of the Ohasama Study.
Collapse
Affiliation(s)
- Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine
- Tohoku Institute for Management of Blood Pressure
| | - Michihiro Satoh
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| |
Collapse
|
6
|
Habas E, Akbar RA, Alfitori G, Farfar KL, Habas E, Errayes N, Habas A, Al Adab A, Rayani A, Geryo N, Elzouki ANY. Effects of Nondipping Blood Pressure Changes: A Nephrologist Prospect. Cureus 2023; 15:e42681. [PMID: 37649932 PMCID: PMC10464654 DOI: 10.7759/cureus.42681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/01/2023] Open
Abstract
Blood pressure (BP) variations depend on various internal, environmental, and behavioral factors. BP fluctuations occur both in normotensive and hypertensive people. Although it fluctuates over the 24-hr day and night, the morning BP increases after waking up and declines throughout sleep. It is typical for BP to decrease by 10% to 20%, while sleeping, known as dipping BP. However, if there is no decrease in nighttime mean systolic BP or a drop of less than 10 mmHg, it is called nondipping BP. Conversely, reverse dipping BP means an increase in mean systolic BP instead of a drop during the night. Reverse dipping is observed in hypertension (HTN), diabetes mellitus (DM), chronic kidney disease (CKD), and obstructive sleep apnea (OSA) syndrome. The introduction of ambulatory BP monitoring (ABPM) led to the emergence of identifying normal and elevated BP patterns. Non-dipping BP increases the risk of cardiovascular system (CVS) complications such as left ventricular hypertrophy, proteinuria, glomerular filtration rate (GFR) reduction, and CKD progression. A loss or blunting of the normal BP profile is recognized as a deleterious variant, and restoring abnormal BP patterns has been reported to significantly impact end-organ damage, morbidity, and mortality. In this non-systematic clinically-oriented, comprehensive review, we aim to update the BP variables and the pathophysiology of nondipping BP and point out the areas which need more investigation from a nephrology perspective because the nondipping BP increases the risk of proteinuria, GFR reduction, and CKD progression. A literature search of PubMed, Google, EMBASE, and Google Scholar was conducted. Checks of selected papers and relevant reviews complemented the electronic search. With improved BP measurement methods, the physiology of BP profile variations is readily detectable during the day and night. A nondipping BP profile is a distinct BP pattern that may have significant end-organ damage effects and therapeutic importance for nephrologists. The pathophysiology of the nondipping BP variant must be clarified to prevent complications, and further investigations are required. Furthermore, there is debate about the best BP index to utilize: systolic BP, diastolic BP, mean arterial pressure, or a mixture of all. All these areas are important and need new research projects.
Collapse
Affiliation(s)
| | - Raza A Akbar
- Internal Medicine, Hamad General Hospital, Doha, QAT
| | | | | | - Eshrak Habas
- Internal Medicine, Tripoli University, Tripoli, LBY
| | - Nada Errayes
- Medical Education, University of Lincoln, Lincoln, GBR
| | - Aml Habas
- Renal and Dialysis, Tripoli Pediatric Hospital, Tripoli, LBY
| | - Aisha Al Adab
- Pulmonary Medicine, Hamad General Hospital, Doha, QAT
| | - Amnna Rayani
- Hemato-Oncology, Tripoli Pediatric Hospital, Tripoli University, Tripoli, LBY
| | - Nagat Geryo
- Internal Medicine, Hamad General Hospital, Doha, QAT
| | - Abdel-Naser Y Elzouki
- Medicine, Hamad General Hospital, Doha, QAT
- Internal Medicine, Hamad Medical Corporation, Doha, QAT
| |
Collapse
|
7
|
Mussarat N, Biggio J, Martin J, Morgan J, Tivis R, Elmayan A, Williams FB. Masked pregnancy-associated hypertension as a predictor of adverse outcomes. Am J Obstet Gynecol MFM 2023; 5:100976. [PMID: 37098390 DOI: 10.1016/j.ajogmf.2023.100976] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/12/2023] [Accepted: 04/18/2023] [Indexed: 04/27/2023]
Abstract
BACKGROUND Masked hypertension has been described in nonpregnant populations as elevated blood pressure in the home setting that is not reproduced on clinical assessment. Patients with masked hypertension have a greater risk of cardiovascular morbidity than patients who have blood pressures within normal range or those with white coat hypertension. OBJECTIVE This study aimed to determine whether masked pregnancy-associated hypertension detected on Connected Maternity Online Monitoring, a remote home blood pressure monitoring system, is associated with higher rates of hypertensive disorders of pregnancy during delivery admission and maternal and neonatal morbidities. STUDY DESIGN This was a retrospective cohort study of all patients on Connected Maternity Online Monitoring who delivered at 6 hospitals in a single healthcare system between October 2016 and December 2020. Patients were classified as having either normal blood pressure or masked pregnancy-associated hypertension. Masked pregnancy-associated hypertension was defined as remotely detected systolic blood pressure of ≥140 mm Hg or diastolic blood pressure of ≥90 mm Hg after 20 weeks of gestation on 2 occasions before diagnosis in a clinical setting. The chi-square test and Student t test were used for demographic and outcomes comparisons. Logistic regression was used to adjust outcomes by race, insurance, and body mass index. RESULTS A total of 2430 deliveries were included in our analysis, including 165 deliveries that met the criteria for masked pregnancy-associated hypertension. Clinically established pregnancy-associated hypertension, defined at the time of delivery, was more common in the masked pregnancy-associated hypertension group than in the normotensive group (66% vs 10%; adjusted odds ratio, 17.2; 95% confidence interval, 11.91-24.81). Patients with masked pregnancy-associated hypertension had higher rates of preeclampsia with severe features on delivery admission than normotensive patients (28% vs 2%; adjusted odds ratio, 23.35; 95% confidence interval, 14.25-38.26). Preterm delivery (16% vs 7%; adjusted odds ratio, 2.47; 95% confidence interval, 1.55-3.94), cesarean delivery(38% vs 26%; adjusted odds ratio, 1.58; 95% confidence interval, 1.13-2.23), small for gestational age (11% vs 5%; adjusted odds ratio, 2.27; 95% confidence interval, 1.31-3.94), and neonatal intensive care unit admission (8% vs 4%; adjusted odds ratio, 2.20; 95% confidence interval, 1.18-4.09) were more common among patients with masked pregnancy-associated hypertension than among normotensive patients. CONCLUSION With more outcomes research, remote blood pressure monitoring may prove to be an important tool in identifying pregnancies at risk of complications related to masked hypertension.
Collapse
Affiliation(s)
- Naiha Mussarat
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ochsner Health Center - New Orleans, New Orleans, LA.
| | - Joseph Biggio
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ochsner Health Center - New Orleans, New Orleans, LA
| | - Jane Martin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ochsner Health Center - New Orleans, New Orleans, LA
| | - John Morgan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ochsner Health Center - New Orleans, New Orleans, LA
| | - Rick Tivis
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ochsner Health Center - New Orleans, New Orleans, LA
| | - Ardem Elmayan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ochsner Health Center - New Orleans, New Orleans, LA
| | - Frank B Williams
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ochsner Health Center - New Orleans, New Orleans, LA
| |
Collapse
|
8
|
Staplin N, de la Sierra A, Ruilope LM, Emberson JR, Vinyoles E, Gorostidi M, Ruiz-Hurtado G, Segura J, Baigent C, Williams B. Relationship between clinic and ambulatory blood pressure and mortality: an observational cohort study in 59 124 patients. Lancet 2023; 401:2041-2050. [PMID: 37156250 DOI: 10.1016/s0140-6736(23)00733-x] [Citation(s) in RCA: 69] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 01/26/2023] [Accepted: 01/29/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Ambulatory blood pressure provides a more comprehensive assessment than clinic blood pressure, and has been reported to better predict health outcomes than clinic or home pressure. We aimed to examine associations of clinic and 24-h ambulatory blood pressure with all-cause and cardiovascular mortality in a large cohort of primary care patients referred for assessment of hypertension. METHODS We did an observational cohort study using clinic and ambulatory blood pressure data obtained from March 1, 2004, to Dec 31, 2014, from the Spanish Ambulatory Blood Pressure Registry. This registry included patients from 223 primary care centres from the Spanish National Health System in all 17 regions of Spain. Mortality data (date and cause) were ascertained by a computerised search of the vital registry of the Spanish National Institute of Statistics. Complete data were available for age, sex, all blood pressure measures, and BMI. For each study participant, follow-up was from the date of their recruitment to the date of death or Dec 31, 2019, whichever occurred first. Cox models were used to estimate associations between usual clinic or ambulatory blood pressure and mortality, adjusted for confounders and additionally for alternative measures of blood pressure. For each measure of blood pressure, we created five groups (ie, fifths) defined by quintiles of that measure among those who subsequently died. FINDINGS During a median follow-up of 9·7 years, 7174 (12·1%) of 59 124 patients died, including 2361 (4·0%) from cardiovascular causes. J-shaped associations were observed for several blood pressure measures. Among the top four baseline-defined fifths, 24-h systolic blood pressure was more strongly associated with all-cause death (hazard ratio [HR] 1·41 per 1 - SD increment [95% CI 1·36-1·47]) than clinic systolic blood pressure (1·18 [1·13-1·23]). After adjustment for clinic blood pressure, 24-h blood pressure remained strongly associated with all-cause deaths (HR 1·43 [95% CI 1·37-1·49]), but the association between clinic blood pressure and all-cause death was attenuated when adjusted for 24-h blood pressure (1·04 [1·00-1·09]). Compared with the informativeness of clinic systolic blood pressure (100%), night-time systolic blood pressure was most informative about risk of all-cause death (591%) and cardiovascular death (604%). Relative to blood pressure within the normal range, elevated all-cause mortality risks were observed for masked hypertension (HR 1·24 [95% CI 1·12-1·37]) and sustained hypertension (1·24 [1·15-1·32]), but not white-coat hypertension, and elevated cardiovascular mortality risks were observed for masked hypertension (1·37 [1·15-1·63]) and sustained hypertension (1·38 [1·22-1·55]), but not white-coat hypertension. INTERPRETATION Ambulatory blood pressure, particularly night-time blood pressure, was more informative about the risk of all-cause death and cardiovascular death than clinic blood pressure. FUNDING Spanish Society of Hypertension, Lacer Laboratories, UK Medical Research Council, Health Data Research UK, National Institute for Health and Care Research Biomedical Research Centres (Oxford and University College London Hospitals), and British Heart Foundation Centre for Research Excellence.
Collapse
Affiliation(s)
- Natalie Staplin
- Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alejandro de la Sierra
- Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Barcelona, Spain
| | - Luis M Ruilope
- Hypertension Unit and Cardiorenal Translational Research Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre and CIBER of Cardiovascular Disease (CIBERCV), Madrid, Spain; School of Doctoral Studies and Research, Universidad Europea de Madrid, Madrid, Spain
| | - Jonathan R Emberson
- Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Manuel Gorostidi
- Department of Nephrology, Hospital Universitario Central de Asturias, RedinRen, Oviedo, Spain
| | - Gema Ruiz-Hurtado
- Hypertension Unit and Cardiorenal Translational Research Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre and CIBER of Cardiovascular Disease (CIBERCV), Madrid, Spain
| | - Julián Segura
- Hypertension Unit and Cardiorenal Translational Research Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre and CIBER of Cardiovascular Disease (CIBERCV), Madrid, Spain
| | - Colin Baigent
- Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Bryan Williams
- University College London (UCL) Institute of Cardiovascular Science and National Institute for Health Research, UCL Hospitals Biomedical Research Centre, London, UK.
| |
Collapse
|
9
|
Abstract
White-coat hypertension (WCH) has been defined as an increased blood pressure (BP) in the doctor's office and a normal BP outside the office by 24 hr ambulatory BP monitoring (ABPM) or home BP measurement. It is generated by fear and anxiety of whether an abnormal value could be found and indicate the existence of hypertension. When first described, it was defined as a neuro-defense reaction related to the presence of the doctor in their office or clinic and associated with an increase in heart rate. Initially it was considered a benign condition, not associated with the hypertension mediated organ damage (HMOD) and not requiring treatment. However, recent studies have shown that WCH is not a benign condition and is associated with HMOD and cardiovascular (CV) events (CVE). According to recent ACC/AHA guidelines, the outside of office normal BP should be < 130/80 mmHg and according to the ESC/ESH guidelines, the outside of office normal BP should be < 135/85 mmHg. The prevalence of WCH varies by different studies from 15% to 40% and up to 50% in older subjects. Currently, the management of WCH if not associated with CV risk factors should be conservative with healthy lifestyle changes and exercise. Drug therapy should be considered if these measures do not work or in the presence of CV risk factors, HMOD, or preexisting cardiovascular disease.
Collapse
Affiliation(s)
- Steven G Chrysant
- Department of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| |
Collapse
|
10
|
Coccina F, Pierdomenico AM, Cuccurullo C, Pizzicannella J, Trubiani O, Pierdomenico SD. Ambulatory Resistant Hypertension and Risk of Heart Failure in the Elderly. Diagnostics (Basel) 2023; 13:1631. [PMID: 37175024 PMCID: PMC10177959 DOI: 10.3390/diagnostics13091631] [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: 03/26/2023] [Revised: 04/16/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
(1) Background: The aim of the study was to assess the risk of heart failure (HF) in elderly treated hypertensive patients with white coat uncontrolled hypertension (WUCH), ambulatory nonresistant hypertension (ANRH) and ambulatory resistant hypertension (ARH), when compared to those with controlled hypertension (CH). (2) We studied 745 treated hypertensive subjects older than 65 years. CH was defined as clinic blood pressure (BP) < 140/90 mmHg and 24-h BP < 130/80 mmHg; WUCH was defined as clinic BP ≥ 140/90 mmHg and 24-h BP < 130/80 mmHg; ANRH was defined as 24-h BP ≥ 130/80 mmHg in patients receiving ≤2 antihypertensive drugs; ARH was defined as 24-h BP ≥ 130/80 mmHg in patients receiving ≥3 antihypertensive drugs. (3) Results: 153 patients had CH, 153 had WUCH, 307 had ANRH and 132 (18%) had ARH. During the follow-up (8.4 ± 4.8 years), 82 HF events occurred. After adjustment for various covariates, when compared to CH, the hazard ratio (95% confidence interval) for HF was 1.30 (0.51-3.32), 2.14 (1.03-4.43) and 3.52 (1.56-7.96) in WUCH, ANRH and ARH, respectively. (4) Conclusions: among elderly treated hypertensive patients, those with ARH are at a considerably higher risk of developing HF when compared to CH.
Collapse
Affiliation(s)
- Francesca Coccina
- Department of Innovative Technologies in Medicine & Dentistry, University “Gabriele d’Annunzio”, Chieti-Pescara, 66100 Chieti, Italy
| | - Anna M. Pierdomenico
- Department of Medicine and Aging Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, 66100 Chieti, Italy
| | - Chiara Cuccurullo
- Department of Medicine and Aging Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, 66100 Chieti, Italy
| | - Jacopo Pizzicannella
- Department of Engineering and Geology, University “Gabriele d’Annunzio”, Chieti-Pescara, 66100 Chieti, Italy
| | - Oriana Trubiani
- Department of Innovative Technologies in Medicine & Dentistry, University “Gabriele d’Annunzio”, Chieti-Pescara, 66100 Chieti, Italy
| | - Sante D. Pierdomenico
- Department of Innovative Technologies in Medicine & Dentistry, University “Gabriele d’Annunzio”, Chieti-Pescara, 66100 Chieti, Italy
| |
Collapse
|
11
|
Vinyoles E, Puig C, Roso-Llorach A, Soldevila N, de la Sierra A, Gorostidi M, Segura J, Divison-Garrote JA, Muñoz MÁ, Ruilope LM. Role of ambulatory blood pressure on prediction of cardiovascular disease. A cohort study. J Hum Hypertens 2023; 37:279-285. [PMID: 35338244 DOI: 10.1038/s41371-022-00679-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 02/19/2022] [Accepted: 03/10/2022] [Indexed: 11/09/2022]
Abstract
Ambulatory blood pressure (BP) is associated with mortality, but it is also interesting to expand its association with cardiovascular morbidity. This study sought to evaluate association with cardiovascular morbidity and cardiovascular mortality. Patients without cardiovascular disease who had a first 24-hour ambulatory BP monitoring were followed-up until the onset of the first event (a combined variable of cardiovascular mortality, coronary heart disease, cerebrovascular disease, peripheral arteriopathy, or hospital admission for heart failure). Changes in antihypertensive treatment couldn't be collected. Cox regression analysis was adjusted for risk factors and office BP. We included 3907 patients (mean age, 58.0, SD 13.8 years), of whom 85.5% were hypertensive. The follow up period was 6.6 (95% CI 5.0-8.5) years. A total of 496 (12.7%) events were recorded. The incidence rate was 19.3 (95% CI 17.7-21.1) cases per 1000 person-years. The patients with an event compared to the rest of patients were mostly men, older, with higher office and ambulatory systolic BP, higher prevalence of diabetes, chronic kidney disease, dyslipidemia, and non-dipper or riser circadian profile. In the fully adjusted model, office BP loses its significant association with the main variable. Ambulatory BP association remained significant with cardiovascular morbidity and mortality, HR 1.494 (1.326-1.685) and 0.767 (0.654-0.899) for 24-hour systolic and diastolic BP, respectively. Nighttime systolic BP also maintained this significant association, 1.270 (1.016-1.587). We conclude that nighttime systolic BP and 24-hour BP are significantly associated with cardiovascular events and cardiovascular mortality in patients without cardiovascular disease attended under conditions of routine clinical practice.
Collapse
Affiliation(s)
- Ernest Vinyoles
- La Mina Primary Care Center, University of Barcelona, Barcelona, Spain.
- Jordi Gol University Institute for Research in Primary Care, Barcelona, Spain.
- Cardiovascular Research Group (GREC). Catalan Health Institute, Barcelona, Spain.
| | - Clara Puig
- Jordi Gol University Institute for Research in Primary Care, Barcelona, Spain
- Cardiovascular Research Group (GREC). Catalan Health Institute, Barcelona, Spain
| | - Albert Roso-Llorach
- Jordi Gol University Institute for Research in Primary Care, Barcelona, Spain
| | - Núria Soldevila
- La Mina Primary Care Center, University of Barcelona, Barcelona, Spain
- Cardiovascular Research Group (GREC). Catalan Health Institute, Barcelona, Spain
| | | | - Manuel Gorostidi
- Nephrology Service, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Julián Segura
- Hypertension Unit, Doce de Octubre Hospital, Madrid, Spain
| | | | - Miguel-Ángel Muñoz
- Cardiovascular Research Group (GREC). Catalan Health Institute, Barcelona, Spain
| | | |
Collapse
|
12
|
Satoh M, Yoshida T, Metoki H, Murakami T, Tatsumi Y, Hirose T, Takabatake K, Tsubota-Utsugi M, Hara A, Nomura K, Asayama K, Kikuya M, Hozawa A, Imai Y, Ohkubo T. The long-term reproducibility of the white-coat effect on blood pressure as a continuous variable from the Ohasama Study. Sci Rep 2023; 13:4985. [PMID: 36973366 PMCID: PMC10043024 DOI: 10.1038/s41598-023-31861-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
There is little information about the reproducibility of the white coat effect, which was treated as a continuous variable. To investigate a long-term interval reproducibility of the white-coat effect as a continuous variable. We selected 153 participants without antihypertensive treatment (men, 22.9%; age, 64.4 years) from the general population of Ohasama, Japan, to assess the repeatedly measured white-coat effect (the difference between blood pressures at the office and home) in a 4-year interval. The reproducibility was assessed by testing the intraclass correlation coefficient (two-way random effect model-single measures). The white-coat effect for systolic/diastolic blood pressure slightly decreased by 0.17/1.56 mmHg at the 4-year visit on average. The Bland-Altman plots showed no significant systemic error for the white-coat effects (P ≥ 0.24). The intraclass correlation coefficient (95% confidence interval) of the white-coat effect for systolic blood pressure, office systolic blood pressure, and home systolic blood pressure were 0.41 (0.27-0.53), 0.64 (0.52-0.74), and 0.74 (0.47-0.86), respectively. Change in the white-coat effect was mainly affected by a change in office blood pressure. Long-term reproducibility of the white-coat effect is limited in the general population without antihypertensive treatment. The change in the white-coat effect is mainly caused by office blood pressure variation.
Collapse
Grants
- 21K10478 Scientific Research, Ministry of Education, Culture, Sports, Science and Technology, Japan
- 21K10452 Scientific Research, Ministry of Education, Culture, Sports, Science and Technology, Japan
- 18K17396 Scientific Research, Ministry of Education, Culture, Sports, Science and Technology, Japan
- 20K08612 Scientific Research, Ministry of Education, Culture, Sports, Science and Technology, Japan
- 19K19466 Scientific Research, Ministry of Education, Culture, Sports, Science and Technology, Japan
- 21K19670 Scientific Research, Ministry of Education, Culture, Sports, Science and Technology, Japan
- 21K19670 Scientific Research, Ministry of Education, Culture, Sports, Science and Technology, Japan
- 19H03908 Scientific Research, Ministry of Education, Culture, Sports, Science and Technology, Japan
- The Academic Contributions Bayer Yakuhin, Ltd
- The Academic Contributions Pfizer Japan Inc.
- Scholarship donations Daiichi Sankyo Co.,Ltd.
- Astellas Pharma Inc. Research Support
- Research Support Takeda Pharmaceutical Co.,Ltd.
- internal research grants Keio University
- ACRO Incubation Grants Teikyo University
- H29-Junkankitou-Ippan-003 Grant-in-aid from the Ministry of Health, Labor, and Welfare, Japan
Collapse
Affiliation(s)
- Michihiro Satoh
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino-Ku, Sendai, Miyagi, 983-8536, Japan.
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
| | - Tomoya Yoshida
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino-Ku, Sendai, Miyagi, 983-8536, Japan
| | - Hirohito Metoki
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino-Ku, Sendai, Miyagi, 983-8536, Japan
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Takahisa Murakami
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino-Ku, Sendai, Miyagi, 983-8536, Japan
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Division of Aging and Geriatric Dentistry, Department of Rehabilitation Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Yukako Tatsumi
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Takuo Hirose
- Department of Endocrinology and Applied Medical Science, Tohoku University Graduate School of Medicine, Sendai, Japan
- Division of Nephrology and Endocrinology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Kyosuke Takabatake
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino-Ku, Sendai, Miyagi, 983-8536, Japan
| | - Megumi Tsubota-Utsugi
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Azusa Hara
- Division of Drug Development and Regulatory Science, Faculty of Pharmacy, Keio University, Tokyo, Japan
| | - Kyoko Nomura
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, Akita, Japan
| | - Kei Asayama
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Masahiro Kikuya
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Atsushi Hozawa
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Yutaka Imai
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Takayoshi Ohkubo
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| |
Collapse
|
13
|
Kim HL, Lee EM, Ahn SY, Kim KI, Kim HC, Kim JH, Lee HY, Lee JH, Park JM, Cho EJ, Park S, Shin J, Kim YK. The 2022 focused update of the 2018 Korean Hypertension Society Guidelines for the management of hypertension. Clin Hypertens 2023; 29:11. [PMID: 36788612 PMCID: PMC9930285 DOI: 10.1186/s40885-023-00234-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/25/2023] [Indexed: 02/16/2023] Open
Abstract
Hypertension is the leading cause of death in human being, which shows high prevalence and associated complications that increase the mortality and morbidity. Controlling blood pressure (BP) is very important because it is well known that lowering high BP effectively improves patients' prognosis. This review aims to provide a focused update of the 2018 Korean Hypertension Society Guidelines for the management of hypertension. The importance of ambulatory BP and home BP monitoring was further emphasized not only for the diagnosis but also for treatment target. By adopting corresponding BPs, the updated guideline recommended out-of-office BP targets for both standard and intensive treatment. Based on the consensus on corresponding BPs and Systolic Blood Pressure Intervention Trial (SPRINT) revisit, the updated guidelines recommended target BP in high-risk patients below 130/80 mmHg and it applies to hypertensive patients with three or more additional cardiovascular risk factors, one or more risk factors with diabetes, or hypertensive patients with subclinical organ damages, coronary or vascular diseases, heart failure, chronic kidney disease with proteinuria, and cerebral lacunar infarction. Cerebral infarction and chronic kidney disease are also high-risk factors for cardiovascular disease. However, due to lack of evidence, the target BP was generally determined at < 140/90 mmHg in patients with those conditions as well as in the elderly. Updated contents regarding the management of hypertension in special situations are also discussed.
Collapse
Affiliation(s)
- Hack-Lyoung Kim
- grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun Mi Lee
- grid.410899.d0000 0004 0533 4755Department of Internal Medicine, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Republic of Korea
| | - Shin Young Ahn
- grid.411134.20000 0004 0474 0479Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kwang-il Kim
- grid.412480.b0000 0004 0647 3378Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Hyeon Chang Kim
- grid.15444.300000 0004 0470 5454Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ju Han Kim
- grid.411597.f0000 0004 0647 2471Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hae-Young Lee
- grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jang Hoon Lee
- grid.258803.40000 0001 0661 1556Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Jong-Moo Park
- grid.255588.70000 0004 1798 4296Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, Republic of Korea
| | - Eun Joo Cho
- grid.488414.50000 0004 0621 6849Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sungha Park
- grid.15444.300000 0004 0470 5454Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinho Shin
- grid.49606.3d0000 0001 1364 9317Department of Internal Medicine, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Young-Kwon Kim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
14
|
Basalely A, Hill-Horowitz T, Sethna CB. Ambulatory Blood Pressure Monitoring in Pediatrics, an Update on Interpretation and Classification of Hypertension Phenotypes. Curr Hypertens Rep 2023; 25:1-11. [PMID: 36434426 DOI: 10.1007/s11906-022-01231-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW This review highlights the major changes reflected in the 2022 American Heart Association (AHA) Scientific Statement on Ambulatory Blood Pressure Monitoring (ABPM) in Children and Adolescents with a specific focus on the newly defined phenotypes of hypertension and their epidemiology and associated outcomes. RECENT FINDINGS The 2022 AHA guidelines' most notable changes include the following: (1) alignment of blood pressure (BP) thresholds with the 2017 American Academy of Pediatrics (AAP) clinical practice guidelines, 2017 American College of Cardiology (ACC)/AHA hypertension guidelines, and 2016 European Society of Hypertension (ESH) pediatric recommendations; (2) expansion of the use of ABPM to diagnose and phenotype pediatric hypertension in all pediatric patients; (3) removal of BP loads from diagnostic criteria; and (4) simplified classification of new hypertension phenotypes to prognosticate risks and guide clinical management. Recent studies suggest that utilizing the 2022 AHA pediatric ABPM guidelines will increase the prevalence of pediatric ambulatory hypertension, especially for wake ambulatory hypertension in older, taller males and for nocturnal hypertension in both males and females ≥ 8 years of age. The new definitions simplify the ambulatory hypertension criteria to include only the elements most predictive of future health outcomes, increase the sensitivity of BP thresholds in alignment with recent data and other guidelines, and thus make hypertension diagnoses more clinically meaningful. This guideline will also aid in the transition of adolescents and young adults to adult medical care. Further studies will be necessary to study ambulatory BP norms in a more diverse pediatric population and evaluate the impact of these guidelines on prevalence and future outcomes.
Collapse
Affiliation(s)
- Abby Basalely
- Division of Pediatric Nephrology, Department of Pediatrics, Cohen Children's Medical Center, 420 Lakeville Road, New Hyde Park, NY, 11042, USA.,Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Taylor Hill-Horowitz
- Division of Pediatric Nephrology, Department of Pediatrics, Cohen Children's Medical Center, 420 Lakeville Road, New Hyde Park, NY, 11042, USA
| | - Christine B Sethna
- Division of Pediatric Nephrology, Department of Pediatrics, Cohen Children's Medical Center, 420 Lakeville Road, New Hyde Park, NY, 11042, USA. .,Feinstein Institutes for Medical Research, Manhasset, NY, USA.
| |
Collapse
|
15
|
Mahmud S, Ibtehaz N, Khandakar A, Sohel Rahman M, JR. Gonzales A, Rahman T, Shafayet Hossain M, Sakib Abrar Hossain M, Ahasan Atick Faisal M, Fuad Abir F, Musharavati F, E. H. Chowdhury M. NABNet: A Nested Attention-guided BiConvLSTM network for a robust prediction of Blood Pressure components from reconstructed Arterial Blood Pressure waveforms using PPG and ECG signals. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
16
|
Prediction of Masked Uncontrolled Hypertension Detected by Ambulatory Blood Pressure Monitoring. Diagnostics (Basel) 2022; 12:diagnostics12123156. [PMID: 36553162 PMCID: PMC9777728 DOI: 10.3390/diagnostics12123156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/28/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
The aim of this study was to provide prediction models for masked uncontrolled hypertension (MUCH) detected by ambulatory blood pressure (BP) monitoring in an Italian population. We studied 738 treated hypertensive patients with normal clinic BPs classified as having controlled hypertension (CH) or MUCH if their daytime BP was < or ≥135/85 mmHg regardless of nighttime BP, respectively, or CH or MUCH if their 24-h BP was < or ≥130/80 mmHg regardless of daytime or nighttime BP, respectively. We detected 215 (29%) and 275 (37%) patients with MUCH using daytime and 24-h BP thresholds, respectively. Multivariate logistic regression analysis showed that males, those with a smoking habit, left ventricular hypertrophy (LVH), and a clinic systolic BP between 130−139 mmHg and/or clinic diastolic BP between 85−89 mmHg were associated with MUCH. The area under the receiver operating characteristic curve showed good accuracy at 0.78 (95% CI 0.75−0.81, p < 0.0001) and 0.77 (95% CI 0.73−0.80, p < 0.0001) for MUCH defined by daytime and 24 h BP, respectively. Internal validation suggested a good predictive performance of the models. Males, those with a smoking habit, LVH, and high-normal clinic BP are indicators of MUCH and models including these factors provide good diagnostic accuracy in identifying this ambulatory BP phenotype.
Collapse
|
17
|
Imai Y. A personal history of research on hypertension From an encounter with hypertension to the development of hypertension practice based on out-of-clinic blood pressure measurements. Hypertens Res 2022; 45:1726-1742. [PMID: 36075990 DOI: 10.1038/s41440-022-01011-1] [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: 05/17/2022] [Revised: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 11/09/2022]
Abstract
In the 1970s, many people had severe hypertension and related cardiovascular and cerebrovascular diseases; however, antihypertensive treatments were not available at the time. The author encountered such conditions during the initial exposure to medicine. The author subsequently entered the field of hypertension medicine to prevent such conditions and engaged in hypertension research for more than 50 years. The author's central interest was the physiological and clinical aspects of blood pressure (BP) variability. Out-of-clinic BP measurements were the focus of clinical research. It was anticipated that self-measurement of BP at home (HBP) would improve medical practice surrounding hypertension. To establish evidence-based hypertension medicine, the Ohasama study (an epidemiology based on HBP) was conducted. The study provided firm evidence of the clinical significance of HBP and diagnostic criteria for hypertension and normotension. To establish target HBP levels for antihypertensive therapy, the Hypertension Objective treatment based on Measurement by Electrical Devices of Blood Pressure (HOMED-BP) study (a prospective intervention study) was also conducted. Application of HBP measurements expanded to obstetric, clinical pharmacology, pathophysiology, and genetic studies. During these studies, crucial information on the clinical significance of BP variability (such as circadian and day-by-day variation of BP, nocturnal BP, white-coat hypertension, and masked hypertension) was established. Finally, the author described the priority of HBP over clinic-measured BP for the diagnosis of hypertension in the 2014 Japanese Society of Hypertension Guidelines. In this article, the author's history of hypertension research, from the first encounter with hypertension to the construction of guidelines on hypertension, is reviewed.
Collapse
Affiliation(s)
- Yutaka Imai
- Tohoku Institute for the Management of Blood Pressure, Sendai, Japan. .,Emeritus Professor Tohoku University, Sendai, Japan.
| |
Collapse
|
18
|
Bellows BK, Xu J, Sheppard JP, Schwartz JE, Shimbo D, Muntner P, McManus RJ, Moran AE, Bryant KB, Cohen LP, Bress AP, King JB, Shikany JM, Green BB, Yano Y, Clark D, Zhang Y. Predicting Out-of-Office Blood Pressure in a Diverse US Population. Am J Hypertens 2022; 35:533-542. [PMID: 35040867 PMCID: PMC9203065 DOI: 10.1093/ajh/hpac005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/04/2022] [Accepted: 01/14/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The PRedicting Out-of-OFfice Blood Pressure (PROOF-BP) algorithm accurately predicted out-of-office blood pressure (BP) among adults with suspected high BP in the United Kingdom and Canada. We tested the accuracy of PROOF-BP in a diverse US population and evaluated a newly developed US-specific algorithm (PROOF-BP-US). METHODS Adults with ≥2 office BP readings and ≥10 awake BP readings on 24-hour ambulatory BP monitoring from 4 pooled US studies were included. We compared mean awake BP with predicted out-of-office BP using PROOF-BP and PROOF-BP-US. Our primary outcomes were hypertensive out-of-office systolic BP (SBP) ≥130 mm Hg and diastolic BP (DBP) ≥80 mm Hg. RESULTS We included 3,058 adults, mean (SD) age was 52.0 (11.9) years, 38% were male, and 54% were Black. The area under the receiver-operator characteristic (AUROC) curve (95% confidence interval) for hypertensive out-of-office SBP was 0.81 (0.79-0.82) and DBP was 0.76 (0.74-0.78) for PROOF-BP. For PROOF-BP-US, the AUROC curve for hypertensive out-of-office SBP was 0.82 (0.81-0.83) and for DBP was 0.81 (0.79-0.83). The optimal predicted out-of-office BP ranges for out-of-office BP measurement referral were 120-134/75-84 mm Hg for PROOF-BP and 125-134/75-84 mm Hg for PROOF-BP-US. The 2017 American College of Cardiology/American Heart Association BP guideline (referral range 130-159/80-99 mm Hg) would refer 93.1% of adults not taking antihypertensive medications with office BP ≥130/80 mm Hg in the National Health and Nutrition Examination Survey for out-of-office BP measurement, compared with 53.1% using PROOF-BP and 46.8% using PROOF-BP-US. CONCLUSIONS PROOF-BP and PROOF-BP-US accurately predicted out-of-office hypertension in a diverse sample of US adults.
Collapse
Affiliation(s)
- Brandon K Bellows
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Jingyu Xu
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - James P Sheppard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Joseph E Schwartz
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, New York, USA
| | - Daichi Shimbo
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Andrew E Moran
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Kelsey B Bryant
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Laura P Cohen
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Adam P Bress
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Jordan B King
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - James M Shikany
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Beverly B Green
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente, Seattle, Washington, USA
| | - Yuichiro Yano
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
| | - Donald Clark
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Yiyi Zhang
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| |
Collapse
|
19
|
Fu X, Ren H, Xie J, Wang W, Li Y, Gao P, Chen N. Association of Nighttime Masked Uncontrolled Hypertension With Left Ventricular Hypertrophy and Kidney Function Among Patients with Chronic Kidney Disease Not Receiving Dialysis. JAMA Netw Open 2022; 5:e2214460. [PMID: 35616936 PMCID: PMC9136624 DOI: 10.1001/jamanetworkopen.2022.14460] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
IMPORTANCE Nighttime hypertension is prevalent and associated with adverse outcomes in patients with chronic kidney disease (CKD), but nighttime hypertension, a subtype of masked uncontrolled hypertension (MUCH), is often undetected among patients with controlled office blood pressure. Little attention has been paid to patients with CKD and nighttime MUCH. OBJECTIVE To investigate the prevalence of nighttime MUCH and its associations with cardiovascular and kidney outcomes in patients with CKD who were not receiving dialysis. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included patients with nondialysis CKD and hypertension, enrolled in Shanghai, China, from July 2012 through November 2020 and followed up for a median of 39 months. EXPOSURES Participants were classified as having controlled hypertension, sustained hypertension, and MUCH, which was further divided into isolated nighttime MUCH and day-night MUCH, assessed by office and ambulatory blood pressure monitoring. MAIN OUTCOMES AND MEASURES Left ventricular hypertrophy (LVH) was determined by echocardiography. The composite kidney outcome consisted of end-stage kidney diseases (ESKD) and a reduction of estimated glomerular filtration rate (eGFR) by 50% or more. Logistic and Cox regression assessed the associations of hypertension subtypes with LVH and kidney outcomes. RESULTS The 675 patients (425 [63.0%] men; mean [SD] age, 50.8 [15.9] years; mean [SD] eGFR, 61.6 [29.4] mL/min/1.73 m2) included 125 (19.3%) with controlled hypertension, 244 (37.6%) with MUCH, and 280 (43.1%) sustained hypertension. Among patients with MUCH, 2 (0.8%) had isolated daytime MUCH, 154 (63.1%) had isolated nighttime MUCH, and 88 (36.1%) had day-night MUCH. During a median (IQR) follow-up of 39 (19-64) months, 130 composite kidney events, including 97 ESKD events, occurred. Compared with controlled hypertension, MUCH and sustained hypertension were associated with LVH (eg, MUCH: odds ratio [OR], 2.94; 95% CI, 1.18-7.34; P = .02) and the composite kidney outcome (eg, MUCH: hazard ratio [HR], 4.12; 95% CI, 1.75-9.73; P = .001) after adjustment for age, sex, proteinuria, eGFR, and other baseline risk factors. Multivariate-adjusted associations were also significant between day-night MUCH and LVH (OR, 3.26; 95% CI, 1.15-9.25) and between isolated nighttime MUCH and the composite kidney outcome (HR, 4.27; 95% CI, 1.69-10.77). CONCLUSIONS AND RELEVANCE In this cohort study, nighttime MUCH was common and associated with LVH and poor kidney outcomes among patients with hypertension and nondialysis CKD. These findings suggest that ambulatory blood pressure monitoring was inadequately used in patients with CKD and hypertension, calling for more widespread use, even in patients with controlled office hypertension.
Collapse
Affiliation(s)
- Xiaocen Fu
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Hong Ren
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Jingyuan Xie
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Weiming Wang
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Yan Li
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, National Key Laboratory of Medical Genomics, The Shanghai Institute of Hypertension, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China
| | - Pingjin Gao
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, National Key Laboratory of Medical Genomics, The Shanghai Institute of Hypertension, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China
| | - Nan Chen
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| |
Collapse
|
20
|
Coccina F, Pierdomenico AM, Cuccurullo C, Pizzicannella J, Guagnano MT, Renda G, Trubiani O, Cipollone F, Pierdomenico SD. Prognostic value of non-resistant and resistant masked uncontrolled hypertension detected by ambulatory blood pressure monitoring. J Clin Hypertens (Greenwich) 2022; 24:591-597. [PMID: 35301793 PMCID: PMC9106087 DOI: 10.1111/jch.14460] [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: 01/23/2022] [Revised: 02/09/2022] [Accepted: 02/24/2022] [Indexed: 11/28/2022]
Abstract
Masked uncontrolled hypertension (MUCH) is at higher cardiovascular risk than controlled hypertension (CH). In previous studies, patients with MUCH were considered as a unique group though those receiving ≤2 drugs could be defined as having nonresistant MUCH (NRMUCH) and those receiving ≥3 drugs as having resistant MUCH (RMUCH). The aim of this study was to assess the prognostic value of NRMUCH and RMUCH detected by ambulatory blood pressure (BP) monitoring. Cardiovascular risk was evaluated in 738 treated hypertensive patients with normal clinic BP. Patients were classified as having CH or MUCH if daytime BP < or ≥ 135/85 mmHg, respectively, regardless of nighttime BP, or CH or MUCH if 24-h BP < or ≥ 130/80 mmHg, respectively, regardless of daytime or nighttime BP. By daytime or 24-h BP, the authors detected 523 (71%), 178 (24%), and 37 (5%) or 463 (63%), 231 (31%), and 44 (6%) patients with CH, NRMUCH, and RMUCH, respectively. During the follow-up (median 10 years), 148 events occurred. After adjustment for covariates, compared to CH, the hazard ratio (HR), 95% confidence interval (CI), for cardiovascular events was 1.81, 1.27-2.57, and 2.99, 1.73-5.16, in NRMUCH and RMUCH defined by daytime BP, respectively, and 1.58, 1.12-2.23, and 2.21, 1.27-3.82, in NRMUCH and RMUCH defined by 24-h BP, respectively. If RMUCH was compared with NRMUCH, the risk tended to be higher in RMUCH but did not attain statistical significance (P = .08 and P = .23 by daytime and 24-h BP thresholds, respectively). In conclusion, both NRMUCH and RMUCH are at increased cardiovascular risk than CH.
Collapse
Affiliation(s)
- Francesca Coccina
- Department of Innovative Technologies in Medicine & DentistryUniversity “Gabriele d'Annunzio”, Chieti‐PescaraChietiItaly
| | - Anna M. Pierdomenico
- Department of Medicine and Aging SciencesUniversity “Gabriele d'Annunzio”, Chieti‐PescaraChietiItaly
| | - Chiara Cuccurullo
- Department of Medicine and Aging SciencesUniversity “Gabriele d'Annunzio”, Chieti‐PescaraChietiItaly
| | - Jacopo Pizzicannella
- Department of Innovative Technologies in Medicine & DentistryUniversity “Gabriele d'Annunzio”, Chieti‐PescaraChietiItaly
| | - Maria T. Guagnano
- Department of Medicine and Aging SciencesUniversity “Gabriele d'Annunzio”, Chieti‐PescaraChietiItaly
| | - Giulia Renda
- Department of Neurosciences, Imaging and Clinical SciencesUniversity “Gabriele d'Annunzio”, Chieti‐PescaraChietiItaly
| | - Oriana Trubiani
- Department of Innovative Technologies in Medicine & DentistryUniversity “Gabriele d'Annunzio”, Chieti‐PescaraChietiItaly
| | - Francesco Cipollone
- Department of Medicine and Aging SciencesUniversity “Gabriele d'Annunzio”, Chieti‐PescaraChietiItaly
| | - Sante D. Pierdomenico
- Department of Innovative Technologies in Medicine & DentistryUniversity “Gabriele d'Annunzio”, Chieti‐PescaraChietiItaly
| |
Collapse
|
21
|
Eyyupkoca F, Kocak A, Yildirim O, Altintas MS, Ercan K, Sabanoglu C, Okutucu S. Is there a relationship between heart rate recovery and blood pressure in white coat hypertension? KARDIOLOGIIA 2022; 62:55-63. [PMID: 35569164 DOI: 10.18087/cardio.2022.4.n1897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/14/2021] [Accepted: 11/26/2021] [Indexed: 06/15/2023]
Abstract
Aim Increasing evidence suggests that autonomic dysfunction may be involved in the etiology of white coat hypertension (WCH). The aim of this study was to evaluate cardiac autonomic function by using heart rate recovery (HRR) indices in patients with WCH classified according to their circadian rhythm type of blood pressure (BP).Material and methods This cross-sectional study included 120 participants over the age of 18 yrs, including 50 patients diagnosed with WCH and 70 healthy controls with normal in- and out-of-office BP and without any known disease. Circadian rhythm types, i.e., dippers and non-dippers, were identified using ambulatory BP monitoring. The HRR indices were calculated by subtracting the 1st-minute (HRR1), 2nd-minute (HRR2), and 3rd-minute (HRR3) heart rates from the maximal heart rate recorded during stress testing.Results The lesser decline in nighttime BP (6.4±2.14 and 13.3±2.2 mmHg, respectively; p<0.001) and the smaller mean HRR1 (25.5±3.0 and 30.3±3.1 beats / min, respectively; p<0.001) were evident in WCH non-dippers compared to WCH dippers. Linear regression analysis showed that HRR1 (β±SE=0.43±0.11; p<0.001) and diastolic BP at maximum exercise (β±SE=0.14±0.07; p=0.040) are independent risk factors for the blunted decline in nighttime BP.Conclusion Delayed recovery of heart rate after an exercise stress test is associated with non-dipper type of circadian rhythm of BP. This was more pronounced in WCH patients, and these patients are at risk of autonomic dysfunction.
Collapse
|
22
|
Abstract
OBJECTIVES Masked hypertension - a blood pressure (BP) phenotype characterized by a clinic BP in the normal range but elevated BP outside the office - is associated with early hypertension-mediated organ damage. This study examined early target organ manifestations of masked hypertension diagnosed by home (HBPM) and ambulatory (ABPM) BP monitoring. METHODS Left ventricular (LV) structure and diastolic function measured by echocardiography, microalbuminuria, and coronary artery calcification were evaluated in 420 patients with high clinic BP (SBP 120-150 mmHg or DBP 80-95 mmHg). Evidence of hypertension-mediated organ damage was compared in patients with sustained normotension, masked hypertension, and sustained hypertension based on measurements by HBPM, daytime ABPM, and 24-h ABPM. RESULTS The 420 participants averaged 48 (12) [mean (SD)] years of age; the average clinic BP was 130 (13)/81 (8) mmHg. In individuals with masked hypertension diagnosed by HBPM, indexed LV mass, relative wall thickness, and e' and E/e' (indices of LV relaxation), were generally intermediate between values observed in normotensives and sustained hypertensive patients, and were significantly greater in masked hypertension than normotensives. Similar trends were observed when masked hypertension was diagnosed by ABPM but a diagnosis of masked hypertension was not as reliably associated with LV remodeling or impaired LV relaxation in comparison to normotensives. There were trends towards greater likelihoods of detectable urinary microalbumin and coronary calcification in masked hypertension than in normotensives. CONCLUSION These results support previous studies demonstrating early hypertension-mediated organ damage in patients with masked hypertension, and suggest that HBPM may be superior to ABPM in identifying patients with masked hypertension who have early LV remodeling and diastolic LV dysfunction.
Collapse
|
23
|
Mancia G, Facchetti R, Vanoli J, Dell'Oro R, Seravalle G, Grassi G. White-Coat Hypertension Without Organ Damage: Impact on Long-Term Mortality, New Hypertension, and New Organ Damage. Hypertension 2022; 79:1057-1066. [PMID: 35191312 DOI: 10.1161/hypertensionaha.121.18792] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND According to some guidelines, white-coat hypertension (WCH) carries little or no increase of cardiovascular risk in the absence of organ damage (OD), but no data are available on this issue. METHODS Using the population data from PAMELA (Pressioni Arteriose Monitorate E Loro Associazioni), we evaluated cardiovascular and total mortality over a median follow-up of 29 years in WCH (elevated office and normal 24-hour or home blood pressure [BP]) and normotensive controls (normal in- and out-of-office blood pressure) with no echocardiographic left ventricular hypertrophy and no reduction of estimated glomerular filtration rate. Patients with sustained hypertension (SH, in- and out-of-office blood pressure elevation) and normotensive, WCH, and SH with cardiac and renal OD served as controls. RESULTS In the 1423 subjects analyzed, there were 165 cardiovascular and 526 all-cause deaths. After adjustment for confounders, no-OD WCH exhibited a risk of fatal cardiovascular events lower than that of no-OD SH but greater than that of no-ODN (hazard ratio, 2.0 [95% CI, 1.1-3.6], P=0.02), this being the case also for all-cause mortality. Compared with no-OD normotensive, no-OD WCH also exhibited a greater 10-year adjusted risk to develop new SH or OD. Similar findings were obtained in normotensive, WCH, and SH with OD. CONCLUSIONS The present study provides the first evidence that WCH with no OD is accompanied by a noticeable increase in long-term risk of mortality, new hypertension, and new OD, thereby differing from normotensive.
Collapse
Affiliation(s)
| | | | - Jennifer Vanoli
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (J.V., R.D., G.S., G.G.)
| | - Raffaella Dell'Oro
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (J.V., R.D., G.S., G.G.)
| | - Gino Seravalle
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (J.V., R.D., G.S., G.G.)
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (J.V., R.D., G.S., G.G.)
| |
Collapse
|
24
|
de Souza MP, Lopes PC, Bazo G, Rocha PRH, Lorencini DA, Bettiol H, Barbieri MA, Coelho EB. Hypertension defined by the 2017 ACC/AHA guideline is more accurate than 2018 ESC/ESH for detecting early vascular aging in young adults. Medicine (Baltimore) 2022; 101:e28841. [PMID: 35147130 PMCID: PMC8830849 DOI: 10.1097/md.0000000000028841] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 01/23/2022] [Indexed: 01/04/2023] Open
Abstract
Determine the most accurate diagnostic criteria of arterial hypertension (AH) for detecting early vascular aging (EVA) defined by pulse wave velocity (PWV) higher than ≥9.2 m/s.Cross-sectional study of a birth cohort started in 1978/79. The following data were collected between April 6, 2016 and August 31, 2017 from 1775 participants: demographic, anthropometric, office blood pressure (BP) measurement, biochemical risk factors, and PWV. A subsample of 454 participants underwent 24-hour ambulatory BP monitoring. The frequencies of AH, and BP phenotypes were calculated according to both guidelines. BP phenotypes (white-coat hypertension, masked hypertension (MHT), sustained hypertension (SH) and normotension) were correlated with risk factors and subclinical target organ damage after adjustment for confounders by multiple linear regression. Receiver operating characteristic curves were constructed to determine the best BP threshold for detecting EVA.A higher frequency of AH (45.1 vs 18.5%), as well as of SH (40.7 vs 14.8%) and MHT (28.9 vs 25.8%) was identified using the 2017 ACC/AHA criteria comparing with 2018 ESC/ESH. EVA was associated with the higher-risk BP phenotypes (SH and MHT, P < .0001) in both criteria. There was a higher accuracy in diagnosing EVA, with the 2017 ACC/AHA criteria. Analysis of the receiver operating characteristic curves showed office BP cutoff value (128/83 mm Hg) for EVA closer to the 2017 ACC/AHA threshold.The 2017 AHA/ACC guideline for the diagnosis of AH, and corresponding ambulatory BP monitoring values, is more accurate for discriminating young adults with EVA. Clinical application of PWV may help identify patients that could benefit from BP levels <130/80 mm Hg.
Collapse
Affiliation(s)
- Mariana P. de Souza
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Brazil
| | - Paulo Cesar Lopes
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Brazil
| | - Gabriel Bazo
- Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Brazil
| | - Paulo Ricardo H. Rocha
- Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Brazil
| | | | - Heloisa Bettiol
- Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Brazil
| | - Marco Antonio Barbieri
- Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Brazil
| | - Eduardo B. Coelho
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Brazil
| |
Collapse
|
25
|
Naik M, Bhat T, Idrees M, Wani M, Wani I, Wani A, Wani M, Bhat M, Hamid A. A study comparing office blood pressure with ambulatory blood pressure in successful adult kidney-transplant recipients at a tertiary care center in North India. INDIAN JOURNAL OF TRANSPLANTATION 2022. [DOI: 10.4103/ijot.ijot_46_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
26
|
Comparison of the mean of the first two blood pressure readings with the overall mean of three readings on a single occasion. J Hypertens 2021; 40:699-703. [PMID: 34939995 DOI: 10.1097/hjh.0000000000003065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Guidelines differed on the required number of blood pressure (BP) readings for accurate BP assessment. We, therefore, compared the mean of the first two BP readings with the overall mean of three readings in the diagnosis of hypertension. METHODS BP was measured three times consecutively with a 1 min interval using a validated automated electronic BP monitor in volunteers aged at least 18 years. The mean of the first and second BP readings was compared with the mean of the three blood pressure readings for the diagnostic accuracy of hypertension. RESULTS Of the 77 520 study participants, 65.2 and 25.2% had a SBP or DBP difference at least 5 mmHg and at least 10 mmHg between the first and second BP readings, respectively. Regardless whether the BP difference between the first two BP readings was at least 5 mmHg or at least 10 mmHg for systolic and diastolic alone or both, significant (P < 0.0001) SBP/DBP differences between the mean of the first two BP readings and the overall mean of three readings were observed with an absolute value up to 1.28/1.11 mmHg. However, the mean of the first two BP readings exhibited good reliability and sufficient agreement in the diagnosis of hypertension with a kappa statistic at least 0.88, except that the difference between the first and second BP readings was at least 10 mmHg for both systolic and diastolic (κ=0.79). The diagnostic accuracy was similar across age quartile, sex, and BP category. CONCLUSION Two BP readings may be sufficient, unless the BP difference between the two readings was at least 10 mmHg for both systolic and diastolic.
Collapse
|
27
|
Imai Y, Mizuno Tanaka S, Satoh M, Hirata T, Murakami Y, Miura K, Waki T, Hirata A, Sairenchi T, Irie F, Sata M, Ninomiya T, Ohkubo T, Ishikawa S, Miyamoto Y, Ohnishi H, Saitoh S, Tamakoshi A, Yamada M, Kiyama M, Iso H, Sakata K, Nakagawa H, Okayama A, Ueshima H, Okamura T. Prediction of Lifetime Risk of Cardiovascular Disease Deaths Stratified by Sex in the Japanese Population. J Am Heart Assoc 2021; 10:e021753. [PMID: 34845914 PMCID: PMC9075349 DOI: 10.1161/jaha.121.021753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Lifetime risk is an informative estimate for driving lifestyle and behavioral changes especially for young adults. The impact of composite risk factors for cardiovascular disease on lifetime risk stratified by sex has not been investigated in the Japanese population, which has a much lower mortality of coronary heart disease compared with the Western population. We aimed to estimate lifetime risk of death from cardiovascular disease attributable to traditional risk factors. Methods and Results We analyzed pooled individual data from the Evidence for Cardiovascular Prevention from Observational Cohorts in a Japanese cohort study. A modified Kaplan–Meier approach was used to estimate the remaining lifetime risk of cardiovascular death. In total, 41 002 Japanese men and women with 537 126 person‐years of follow‐up were included. The lifetime risk at the index‐age of 45 years for those with optimal risk factors (total cholesterol <4.65 mmol/L, systolic blood pressure <120 mm Hg, diastolic blood pressure <80 mm Hg, absence of diabetes, and absence of smoking habit) was lower compared with the highest risk profile of ≥2 risk factors (6.8% [95% CI, 0%–11.9%] versus 19.4% [16.7%–21.4%] for men and 6.9% [1.2%–11.5%] versus 15.4% [12.6%–18.1%] for women). Conclusions The magnitude and the number of risk factors were progressively associated with increased lifetime risk even in individuals in early adulthood who tend to have low short‐term risk. The degree of established cardiovascular risk factors can be converted into lifetime risk. Our findings may be useful for risk communication in the early detection of future cardiovascular disease risk.
Collapse
Affiliation(s)
- Yukiko Imai
- Department of Preventive Medicine and Public Health School of Medicine Keio University Tokyo Japan
| | | | - Michihiro Satoh
- Division of Public Health, Hygiene, and Epidemiology Tohoku Medical and Pharmaceutical University Sendai Japan
| | - Takumi Hirata
- Department of Public Health Hokkaido University Faculty of Medicine Sapporo Japan
| | - Yoshitaka Murakami
- Department of Medical Statistics Toho University School of Medicine Tokyo Japan
| | - Katsuyuki Miura
- Department of Public Health Center for Epidemiologic Research in AsiaShiga University of Medical Science Shiga Japan
| | - Takashi Waki
- Department of Medical Statistics Shiga University of Medical Science Shiga Japan
| | - Aya Hirata
- Department of Preventive Medicine and Public Health School of Medicine Keio University Tokyo Japan
| | - Toshimi Sairenchi
- Department of Public Health Dokkyo Medical University School of Medicine Tochigi Japan
| | - Fujiko Irie
- Department of Health and Welfare Ibaraki Prefectural Office Ibaraki Japan
| | - Mizuki Sata
- Department of Preventive Medicine and Public Health School of Medicine Keio University Tokyo Japan
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health Teikyo University School of Medicine Tokyo Japan
| | | | - Yoshihiro Miyamoto
- Department of Preventive Medicine and Epidemiologic Informatics National Cerebral and Cardiovascular Center Osaka Japan
| | - Hirofumi Ohnishi
- Department of Public Health Sapporo Medical University Sapporo Japan
| | - Shigeyuki Saitoh
- Department of Nursing Sapporo Medical University School of Health Sciences Sapporo Japan
| | - Akiko Tamakoshi
- Department of Public Health Hokkaido University Faculty of Medicine Sapporo Japan
| | - Michiko Yamada
- Department of Clinical Studies Radiation Effects Research Foundation Hiroshima Japan
| | - Masahiko Kiyama
- Osaka Center for Cancer and Cardiovascular Disease Prevention Osaka Japan
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Kiyomi Sakata
- Department of Hygiene and Preventive Medicine Iwate Medical University School of Medicine Iwate Japan
| | - Hideaki Nakagawa
- Department of Social and Environmental Medicine Kanazawa Medical University Kanazawa Japan
| | - Akira Okayama
- Research Institute of Strategy for Prevention Tokyo Japan
| | - Hirotsugu Ueshima
- Department of Public Health Center for Epidemiologic Research in AsiaShiga University of Medical Science Shiga Japan
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health School of Medicine Keio University Tokyo Japan
| | | |
Collapse
|
28
|
Boyd R, Carter E, Moise N, Alcántara C, Valadares T, Anstey DE, Kronish IM. Awareness, Knowledge, and Attitudes Toward Screening and Treatment of Masked Hypertension in Primary Care. Am J Hypertens 2021; 34:1322-1327. [PMID: 34279025 DOI: 10.1093/ajh/hpab115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/16/2021] [Accepted: 07/16/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hypertension guidelines recommend screening and treatment for masked hypertension (MHT). Yet, few primary care providers (PCPs) screen for MHT, and little is known about PCP awareness, knowledge, and attitudes toward MHT. METHODS Three focus groups involving 30 PCPs from 3 medical centers in New York were conducted. Focus group transcripts were analyzed using thematic content analysis. RESULTS Awareness of MHT varied, and only 2 providers had diagnosed MHT. There was also low knowledge about the prevalence and impact of MHT. While some PCPs were receptive to MHT screening after learning about its significance, others viewed the current evidence as insufficient to change practice. Providers were discomforted by labeling patients with nonelevated office blood pressure (BP) as hypertensive and reluctant to add another screening test to their workload without stronger evidence. There was distrust in the accuracy of home BP monitoring to screen for MHT. There was more confidence in ambulatory BP monitoring (ABPM) for MHT screening, but ABPM was viewed as largely inaccessible. There was broad agreement with lifestyle changes for MHT. There were concerns that antihypertensive medication lacked evidence from randomized trials and could induce harmful side effects. CONCLUSIONS Limited PCP knowledge about MHT, concerns about the accuracy and accessibility of screening tests, overloaded PCPs, and insufficient evidence were major barriers to screening and treatment for MHT. Prior to broad uptake by PCPs, randomized trials demonstrating the net benefits of MHT screening and treatment may be needed, along with increased dissemination of knowledge about MHT and improved access to ABPM.
Collapse
Affiliation(s)
- Rebekah Boyd
- Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Eileen Carter
- School of Nursing, University of Connecticut, Storrs, Connecticut, USA
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | | | - Thais Valadares
- Department of Medicine, Staten Island University Hospital, Northwell Health, New York, New York, USA
| | - D Edmund Anstey
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| |
Collapse
|
29
|
Mancia G, Facchetti R, Bombelli M, Cuspidi C, Grassi G. White-Coat Hypertension: Pathophysiological and Clinical Aspects: Excellence Award for Hypertension Research 2020. Hypertension 2021; 78:1677-1688. [PMID: 34757765 DOI: 10.1161/hypertensionaha.121.16489] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Few issues of modern cardiovascular medicine have been as controversial as the relationship between white-coat hypertension (WCH), that is, a common condition in which office blood pressure is elevated while out-of-office blood pressure (ambulatory blood pressure or home blood pressure) is normal. While earlier studies showed no increased risk of cardiovascular events in WCH compared with the normotensive state, more recent studies have changed this conclusion by showing that an increased cardiovascular risk represents a trait of this hypertensive phenotype. The present article will review a number of issues related to WCH, that is, its definition, pathophysiological background, clinical alterations, and prognostic significance. This will be done by considering the available evidence published during the last decades, with special focus on the data collected in PAMELA (Pressioni Arteriose Monitorate e Loro Associazioni)-a research project performed with a cross-sectional and longitudinal design, which has provided a series of novel clinical information on WCH throughout the years. The final part of the article will discuss the therapeutic implications of the abovementioned evidence, as well as some controversial or still undefined issues related to WCH, whose investigation will be an important goal to pursue by future research.
Collapse
Affiliation(s)
- Giuseppe Mancia
- University of Milano-Bicocca (G.M.), University of Milano-Bicocca, Milan, Italy
| | - Rita Facchetti
- Clinica Medica, Department of Medicine and Surgery (R.F., M.B., C.C., G.G.), University of Milano-Bicocca, Milan, Italy
| | - Michele Bombelli
- Clinica Medica, Department of Medicine and Surgery (R.F., M.B., C.C., G.G.), University of Milano-Bicocca, Milan, Italy
| | - Cesare Cuspidi
- Clinica Medica, Department of Medicine and Surgery (R.F., M.B., C.C., G.G.), University of Milano-Bicocca, Milan, Italy
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery (R.F., M.B., C.C., G.G.), University of Milano-Bicocca, Milan, Italy
| |
Collapse
|
30
|
The Key Role of Ambulatory Blood Pressure Monitoring in the Detection of Masked Hypertension and Other Phenomena in Frail Geriatric Patients. Medicina (B Aires) 2021; 57:medicina57111221. [PMID: 34833439 PMCID: PMC8622895 DOI: 10.3390/medicina57111221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/01/2021] [Accepted: 11/05/2021] [Indexed: 11/24/2022] Open
Abstract
Background and Objectives: This study aims to determine prevalence of masked uncontrolled hypertension (MUH) in frail geriatric patients with arterial hypertension and thus show the role of ambulatory blood pressure monitoring (ABPM) since hypertension occurs in more than 80% of people 60+ years and cardiovascular diseases are the main cause of death worldwide. Despite modern pharmacotherapy, use of combination therapy and normal office blood pressure (BP), patients’ prognoses might worsen due to inadequate therapy (never-detected MUH). Materials and Methods: 118 frail geriatric patients (84.2 ± 4.4 years) treated for arterial hypertension with office BP < 140/90 mmHg participated in the study. 24-h ABPM and clinical examination were performed. Results: Although patients were normotensive in the office, 24-h measurements showed that BP values in 72% of hypertensives were not in the target range: MUH was identified in 47 (40%) patients during 24 h, in 48 (41%) patients during daytime and nocturnal hypertension in 60 (51%) patients. Conclusions: ABPM is essential for frail geriatric patients due to high prevalence of MUH, which cannot be detected based on office BP measurements. ABPM also helps to detect exaggerated morning surge, isolated systolic hypertension, dipping/non-dipping, and set and properly manage adequate treatment, which reduces incidence of cardiovascular events and contributes to decreasing the financial burden of society.
Collapse
|
31
|
Camafort M, Jhund P, Formiga F, Castro-Salomó A, Arévalo-Lorido J, Sobrino-Martínez J, Manzano L, Díez-Manglano J, Aramburu Ó, Montero Pérez-Barquero M, Camafort Babkowski M, Arévalo Lorido JC, Sobrino Martínez J, Manzano Espinosa L, Arias Jiménez JL, Gómez Cerezo J, Francisco J, Díez Manglano J, Aramburu Bodas O, Grau Amorós J, Montero Peréz-Barquero M, Torres Cortada G, Trullàs Vila JC, Varela Aguilar JM, Martínez de las Cuevas G, Salgado Ordóñez F, Méndez Bailón M, Ribas Pizá N. Utilidad pronóstica de las cifras ambulatorias de presión arterial en pacientes de edad avanzada con insuficiencia cardíaca. Resultados del estudio DICUMAP. Rev Clin Esp 2021. [DOI: 10.1016/j.rce.2020.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
32
|
Hosohata K. Biomarkers of high salt intake. Adv Clin Chem 2021; 104:71-106. [PMID: 34462058 DOI: 10.1016/bs.acc.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
High salt intake is associated with hypertension, which is a leading modifiable risk factor for cardiovascular disease (CVD) and chronic kidney disease (CKD). International Guidelines recommend a large reduction in the consumption of sodium to reduce blood pressure, organ damage, and mortality. In its early stages, the symptoms of CKD are generally not apparent. CKD proceeds in a "silent" manner, necessitating the need for urinary biomarkers to detect kidney damage at an early stage. Since traditional renal biomarkers, such as serum creatinine, are not sufficiently sensitive, difficulties are associated with detecting kidney damage induced by a high salt intake, particularly in normotensive individuals. Several new biomarkers for renal tubular damage, such as neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), vanin-1, liver-type fatty acid-binding protein (L-FABP), and monocyte chemotactic protein-1 (MCP-1), have recently been identified. However, few studies have investigated early biomarkers for CKD progression associated with a high salt diet. This chapter provides insights into novel biomarkers for CKD in normo- and hypertensive individuals with a high salt intake. Recent studies using spontaneously hypertensive rats (SHR) and normotensive Wistar Kyoto rats (WKY) fed a high salt diet identified urinary vanin-1 and NGAL as early biomarkers for renal tubular damage in SHR and WKY, whereas urinary KIM-1 was a useful biomarker for salt-induced renal injury in SHR only. Clinical studies are needed to confirm these findings.
Collapse
Affiliation(s)
- Keiko Hosohata
- Education and Research Center for Clinical Pharmacy, Osaka University of Pharmaceutical Sciences, Takatsuki, Osaka, Japan.
| |
Collapse
|
33
|
Gómez-Berrocal A, De Los Santos-Gil I, Abad-Pérez D, Gutiérrez-Liarte Á, Ibáñez-Sanz P, Sanz-Sanz J, Suárez C. Ambulatory Blood Pressure Monitoring in HIV-Infected Patients: Usefulness for Cardiovascular Risk Assessment. J Int Assoc Provid AIDS Care 2021; 19:2325958220935693. [PMID: 32812480 PMCID: PMC7444154 DOI: 10.1177/2325958220935693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background: There is a lack of consensus regarding the risk of hypertension in HIV-infected patients compared to the general population. Ambulatory blood pressure monitoring (ABPM) is the most accurate method for the hypertension diagnosis. Nevertheless, it is rarely used in HIV clinical care. Materials and Methods: All HIV-infected patients who underwent 24 hours ABPM were included. The agreement between office blood pressure (BP) readings and ABPM was analyzed. The rate of patients with masked hypertension (MH), isolated clinical hypertension, and nocturnal hypertension was obtained. Furthermore, it was analyzed if the differences between both methods may affect the cardiovascular risk (CVR) assessment. Results: A total of 116 patients were included. The κ coefficient between office BP and ABPM was 0.248. Over a quarter of the cohort was diagnosed with MH—25.8% (CI 95% 17.7%-34.0%), and 12% (CI 95%: 6.1%-16.1%) was diagnosed with ICH. Moreover, 19% of patients had hypertension exclusively during the night. The patients classified as low risk according to the CVR scores had a different diagnosis with ABPM than with office BP (P < .001). Conclusions: The agreement between office BP and ABPM was low in HIV-infected patients. Ambulatory BP monitoring is useful in HIV-infected patients as a hypertension diagnosis method, especially among patients classified as low risk.
Collapse
Affiliation(s)
- Ana Gómez-Berrocal
- 16517Hospital Universitario de La Princesa, Madrid, Spain.,16517Instituto de Investigación Sanitaria Hospital Universitario de La Princesa, Madrid, Spain
| | - Ignacio De Los Santos-Gil
- 16517Hospital Universitario de La Princesa, Madrid, Spain.,16517Instituto de Investigación Sanitaria Hospital Universitario de La Princesa, Madrid, Spain.,Universidad Autónoma de Madrid, Madrid, Spain
| | | | | | - Patricia Ibáñez-Sanz
- 16517Instituto de Investigación Sanitaria Hospital Universitario de La Princesa, Madrid, Spain
| | - Jesús Sanz-Sanz
- 16517Hospital Universitario de La Princesa, Madrid, Spain.,16517Instituto de Investigación Sanitaria Hospital Universitario de La Princesa, Madrid, Spain
| | - Carmen Suárez
- 16517Hospital Universitario de La Princesa, Madrid, Spain.,16517Instituto de Investigación Sanitaria Hospital Universitario de La Princesa, Madrid, Spain.,Universidad Autónoma de Madrid, Madrid, Spain
| |
Collapse
|
34
|
Angeli F, Reboldi G, Verdecchia P. Masked Nocturnal Hypertension: A Complex Phenomenon to Detect in Clinical Practice. Am J Hypertens 2021; 34:578-580. [PMID: 33417669 DOI: 10.1093/ajh/hpab007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/07/2021] [Indexed: 01/28/2023] Open
Affiliation(s)
- Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
- Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, Varese, Italy
| | | | - Paolo Verdecchia
- Fondazione Umbra Cuore e Ipertensione-ONLUS and Division of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
| |
Collapse
|
35
|
Camafort M, Jhund PS, Formiga F, Castro-Salomó A, Arévalo-Lorido JC, Sobrino-Martínez J, Manzano L, Díez-Manglano J, Aramburu Ó, Montero Pérez-Barquero M. Prognostic value of ambulatory blood pressure values in elderly patients with heart failure. Results of the DICUMAP study. Rev Clin Esp 2021; 221:433-440. [PMID: 34130947 DOI: 10.1016/j.rceng.2020.11.010] [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: 06/23/2020] [Accepted: 11/10/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Ambulatory blood pressure monitoring (ABPM) has demonstrated value in the prognostic assessment of hypertensive patients with heart failure (HF) with or without other cardiovascular diseases. The objective of this study was to evaluate whether ABPM can identify subjects with HF with a worse prognosis. METHODS AND RESULTS Prospective multicenter study that included clinically stable outpatients with HF. All patients underwent ABPM. A total of 154 patients from 17 centers were included. Their mean age was 76.8 years (± 8.3) and 55.2% were female. In total, 23.7% had HF with a reduced ejection fraction (HFrEF), 68.2% were in NYHA functional class II, and 19.5% were in NYHA functional class III. At one year of follow up, there were 13 (8.4%) deaths, of which 10 were attributed to HF. Twenty-nine patients required hospitalization, of which 19 were due to HF. The presence of a non-dipper BP pattern was associated with an increased risk for readmission or death at one year of follow-up (25% vs. 5%; p=.024). According to a Cox regression analysis, more advanced NYHA functional class (hazard ratio 3.51; 95% CI 1.70-7.26; p=.001; for NYHA class III vs. II) and a higher proportional nocturnal reduction in diastolic BP (hazard ratio 0.961; 95%CI 0.926-0.997; p=.032 per 1% diastolic BP reduction) were independently associated with death or readmission at one year. CONCLUSION In older patients with chronic HF, a non-dipper BP pattern measured by ABPM was associated with a higher risk of hospitalization and death due to HF.
Collapse
Affiliation(s)
- M Camafort
- Unidad de Insuficiencia Cardíaca, Servicio de Medicina Interna-ICMiD, Hospital Clínic, Universidad de Barcelona, Barcelona, Spain.
| | - P S Jhund
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - F Formiga
- Servicio de Medicina Interna, Hospital Universitario de Bellvitge-IDIBELL, Universidad de Barcelona, Barcelona, Spain
| | - A Castro-Salomó
- Servicio de Medicina Interna, Hospital Sant Joan, Universidad Rovira i Virgili, Reus, Spain
| | - J C Arévalo-Lorido
- Servicio de Medicina Interna, Hospital Regional de Zafra, Badajoz, Spain
| | - J Sobrino-Martínez
- Servicio de Medicina Interna, Hospital l'Esperit Sant, Santa Coloma de Gramanet, Spain
| | - L Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - J Díez-Manglano
- Servicio de Medicina Interna, Hospital Royo Villanova, Zaragoza, Spain
| | - Ó Aramburu
- Servicio de Medicina Interna, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | | | | |
Collapse
|
36
|
Bakogiannis C, Stavropoulos K, Papadopoulos C, Papademetriou V. The Impact of Various Blood Pressure Measurements on Cardiovascular Outcomes. Curr Vasc Pharmacol 2021; 19:313-322. [PMID: 32223734 DOI: 10.2174/1570161118666200330155905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 11/22/2022]
Abstract
Hypertension is a potent risk factor for cardiovascular morbidity and mortality. High blood pressure (BP) correlates closely with all-cause and cardiovascular mortality. Although the gold standard remains office BP (auscultatory or automated), other methods (central or out-of-office) are gaining popularity as better predictors of CV events. In this review, we investigated the prognostic value of each method of BP measurement and explored their advantages and pitfalls. Unattended automated office BP is a novel technique of BP measurement with promising data. Ambulatory BP monitoring, and to a lesser extent, home BP measurements, seem to predict cardiovascular events and mortality outcomes better, while at the same time, they can help distinguish hypertensive phenotypes. Data on the association of central BP levels with cardiovascular and mortality outcomes, are conflicting. Future extensive cross-sectional and longitudinal studies are needed to evaluate head-to-head the corresponding levels and results of each method of BP measurement, as well as to highlight disparities in their prognostic utility.
Collapse
Affiliation(s)
| | | | | | - Vasilios Papademetriou
- Veterans Affairs Medical Center, Georgetown University, Washington, DC 20422, United States
| |
Collapse
|
37
|
Coccina F, Pierdomenico AM, De Rosa M, Lorenzo B, Foglietta M, Petrilli I, Vitulli P, Pizzicannella J, Trubiani O, Cipollone F, Renda G, Pierdomenico SD. Risk of Atrial Fibrillation in Masked and White Coat Uncontrolled Hypertension. Am J Hypertens 2021; 34:504-510. [PMID: 33186441 DOI: 10.1093/ajh/hpaa185] [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: 09/20/2020] [Revised: 10/17/2020] [Accepted: 11/08/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Risk of atrial fibrillation (AF) in masked and white coat uncontrolled hypertension (MUCH and WUCH, respectively) has not yet been investigated. We assessed the risk of new-onset AF in MUCH and WUCH detected by ambulatory blood pressure (BP) monitoring. METHODS The occurrence of AF was evaluated in 2,135 treated hypertensive patients aged >40 years, with baseline sinus rhythm, by electrocardiogram. Controlled hypertension (CH) was defined as clinic BP <140/90 mm Hg and daytime BP, regardless of nighttime BP, <135/85 mm Hg, MUCH as clinic BP <140/90 mm Hg and daytime BP ≥135 and/or ≥85 mm Hg, WUCH as clinic BP ≥140 and/or ≥90 mm Hg and daytime BP <135/85 mm Hg, and sustained uncontrolled hypertension (SUCH) as clinic BP ≥140 and/or ≥90 mm Hg and daytime BP ≥135 and/or ≥85 mm Hg. RESULTS MUCH was identified in 203 patients (9.5% of all the population, 29% of those with normal clinic BP) and WUCH in 503 patients (23.5% of all the population, 35% of those with high clinic BP). During the follow-up (mean 9.7 years), 116 cases of AF occurred. After adjustment for covariates, patients with MUCH (hazard ratio 2.02, 95% confidence interval, 1.06-3.85) and SUCH (hazard ratio 1.83, 95% confidence interval, 1.04-3.21) had higher risk of new-onset AF than those with CH, whereas those with WUCH (hazard ratio 1.12, 95% confidence interval, 0.59-2.13) did not. CONCLUSIONS When compared with patients with CH, those with MUCH and SUCH are at higher risk (approximately doubled) of new-onset AF, whereas those with WUCH are not.
Collapse
Affiliation(s)
- Francesca Coccina
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Anna M Pierdomenico
- Department of Medicine and Aging Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Matteo De Rosa
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Belli Lorenzo
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Melissa Foglietta
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Ivan Petrilli
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Piergiusto Vitulli
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Jacopo Pizzicannella
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Oriana Trubiani
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Francesco Cipollone
- Department of Medicine and Aging Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Giulia Renda
- Department of Neurosciences, Imaging and Clinical Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| | - Sante D Pierdomenico
- Department of Medical, Oral and Biotechnological Sciences, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
| |
Collapse
|
38
|
Odili AN, Danladi B, Chori BS, Oshaju H, Nwakile PC, Okoye IC, Abdullahi U, Nwegbu MM, Zawaya K, Essien I, Sada K, Ogedengbe JO, Aje A, Isiguzo GC. Prevalence and Determinants of Masked Hypertension in Nigeria: The REMAH Study. Am J Hypertens 2021; 34:359-366. [PMID: 33315068 DOI: 10.1093/ajh/hpaa211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/02/2020] [Accepted: 12/10/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Estimating the burden of hypertension in Nigeria hitherto relied on clinic blood pressure (BP) measurement alone. This excludes individuals with masked hypertension (MH), i.e., normotensive clinic but hypertensive out-of-clinic BP. METHODS In a nationally representative sample of adult Nigerians, we obtained clinic BP using auscultatory method and out-of-clinic BP by self-measured home BP with semi-automated oscillometric device. Clinic BP was average of 5 consecutive measurements and home BP was average of 3 days duplicate morning and evening readings. MH was clinic BP <140 mm Hg systolic and 90 mm Hg diastolic and home BP ≥135 mm Hg systolic and/or 85 mm Hg diastolic. RESULTS Among 933 participants, the prevalence of sustained hypertension, MH, and white-coat hypertension was 28.3%, 7.9%, and 11.9%, respectively. Among subjects whose clinic BP were in the normotensive range (n = 558), the prevalence of MH was 13%; 12% among untreated and 27% among treated individuals. The mutually adjusted odds ratios of having MH among all participants with normotensive clinic BP were 1.33 (95% confidence interval, 1.10-1.60) for a 10-year higher age, 1.59 (1.09-2.40) for a 10 mm Hg increment in systolic clinic BP, and 1.16 (1.08-1.28) for a 10 mg/dl higher random blood glucose. The corresponding estimates in the untreated population were 1.24 (1.03-1.51), 1.56 (1.04-2.44), and 1.16 (1.08-1.29), respectively. CONCLUSIONS MH is common in Nigeria and increasing age, clinic systolic BP, and random blood glucose are the risk factors.
Collapse
Affiliation(s)
- Augustine N Odili
- Department of Epidemiology, Circulatory Health Research Laboratory, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Benjamin Danladi
- Department of Epidemiology, Circulatory Health Research Laboratory, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Babangida S Chori
- Department of Epidemiology, Circulatory Health Research Laboratory, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Henry Oshaju
- Department of Epidemiology, Circulatory Health Research Laboratory, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Peter C Nwakile
- Department of Community Health, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Innocent C Okoye
- Department of Medicine, Chukwuemeka Odumegu Ojukwu University Teaching Hospital, Awka, Nigeria
| | - Umar Abdullahi
- Department of Medicine, Federal Medical Centre Gusau, Gusau, Nigeria
| | - Maxwell M Nwegbu
- Department of Chemical Pathology, Faculty of Basic Clinical Sciences, University of Abuja, Abuja, Nigeria
| | - Kefas Zawaya
- Department of Medicine, Federal Teaching Hospital Gombe, Gombe, Nigeria
| | - Ime Essien
- Department of Medicine, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Kabiru Sada
- Department of Medicine, Federal Medical Centre Gusau, Gusau, Nigeria
| | - John O Ogedengbe
- Department of Human Physiology, Faculty of Basic Medical Sciences, University of Abuja, Abuja, Nigeria
| | - Akinyemi Aje
- Department of Medicine, University College Hospital Ibadan, Ibadan, Nigeria
| | - Godsent C Isiguzo
- Department of Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
| |
Collapse
|
39
|
Lin YT, Lampa E, Fall T, Engström G, Sundström J. Blood pressure phenotypes based on ambulatory monitoring in a general middle-aged population. Blood Press 2021; 30:237-249. [PMID: 33797315 DOI: 10.1080/08037051.2021.1903302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Ambulatory blood pressure monitoring (ABPM) is increasingly recommended for clinical use, but more knowledge about the prevalence and variability in ABPM-derived phenotypes in the general population is needed. We describe these parameters in the community-based Swedish CArdioPulmonary bioImage Study (SCAPIS) cohort. METHODS We examined 5881 men and women aged 50-64 with 24-hour ABPM recordings using validated monitors. ABPM phenotypes were defined according to European guidelines. White coat hypertension was defined as elevated office BP (≥140/90 mmHg) with normal mean ambulatory BP (<135/85 mmHg in day-time, <120/70 mmHg in night-time, <130/80 mmHg over 24-h); and masked hypertension as normal office BP (<140/90 mmHg) with elevated mean ambulatory BP (≥135/85 mmHg in day-time, ≥120/70 mmHg in night-time, ≥130/80 mmHg over 24-h). Blood pressure variability was assessed using the coefficient of variation (CV), standard deviation (SD), and average real variability. RESULTS Based on the ABPM recordings, 36.9% of participants had 24-h hypertension, 40.7% had day-time hypertension, and 37.6% nocturnal hypertension. Among participants treated with anti-hypertensive drugs, one in three had elevated office blood pressures, and more than half had elevated 24-h, day-time or nocturnal blood pressures. Among participants without anti-hypertensive drugs, only one in six had elevated office blood pressures, but one in three had elevated 24-h, day-time or nocturnal blood pressures. Men had higher 24-h blood pressures, more masked hypertension, but less white-coat hypertension than women. The prevalence of white-coat hypertension increased with age, but not the prevalence of masked hypertension. A positive association between blood pressure level and variability was observed, and within-person and between-person SD and CV were of similar magnitude. The variance in ABPM on repeated measurements was substantial. CONCLUSIONS In the middle-aged general population, masked hypertension is an underappreciated problem on the population level.
Collapse
Affiliation(s)
- Yi-Ting Lin
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Erik Lampa
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Tove Fall
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences, Cardiovascular Epidemiology, Lund University, Malmö, Sweden
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,The George Institute for Global Health, University of New South Wales, Sydney, Australia
| |
Collapse
|
40
|
Tatsumi Y, Shima A, Kawamura A, Morino A, Kawatsu Y, Ohkubo T. [Current status of home blood pressure measurement and relevant demographics and lifestyle characteristics of individuals with periodic measurement: a cross-sectional study in a worksite population]. SANGYO EISEIGAKU ZASSHI = JOURNAL OF OCCUPATIONAL HEALTH 2021; 63:43-52. [PMID: 32788508 DOI: 10.1539/sangyoeisei.2020-016-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The current status of home blood pressure (HBP) measurement is unknown at a Japanese worksite. We aimed to calculate the proportion of individuals who periodically measured HBP and to explore the demographic and lifestyle characteristics of these workers. METHODS The study included 4,664 employees aged 40-65 years who worked at a retail company and underwent health check-ups in 2018. Multivariable logistic regression models were used to estimate odds ratios (ORs) of participant's demographics and lifestyle characteristics and habits for HBP measurement by sex and medical treatment for hypertension. Periodic HBP measurement was defined as HBP measurements performed two times or more per month (opportunistic HBP measurement) among participants not being treated for hypertension, and daily measurement of HBP (everyday HBP measurement) among participants treated for hypertension. RESULTS The percentages of opportunistic HBP measurement were 8.7% in males and 12.4% in females not being treated for hypertension. In both sexes, age (ORs per 1-year increment: 1.11 in males and 1.06 in females) and blood pressure (ORs of ≥ 140/90 mmHg: 7.42 in males and 4.71 in females compared with < 130/80 mmHg) were positively associated with opportunistic HBP measurement. Females treated for dyslipidemia (OR: 1.77), who had a self-described fast walking speed (OR: 1.49), and who exercised habitually (OR: 1.79) had significantly high ORs for opportunistic HBP measurement. Females who frequently consumed snacks after dinner had significantly lower ORs (0.65) than those who did not. The percentages of workers who did everyday HBP measurement were 21.6% in males and 25.5% in females treated for hypertension. Males treated for diabetes (OR: 0.23) had significantly lower OR than those who did not. Females treated for dyslipidemia (OR was 0.53), who had uncontrolled hypertension (OR: 0.58), consumed alcohol (OR: 0.60), and frequently ate within two hours before bed (OR: 0.54) had significantly lower ORs. Females who lived alone had significantly higher ORs (2.43) than those who did not. CONCLUSION Approximately 10% of individuals not treated for hypertension periodically measured HBP. Age and blood pressure in males and females, and healthy lifestyles in females, were associated with having opportunistic HBP measurement. Approximately 25% of individuals treated for hypertension measured HBP every day. Individuals treated for dyslipidemia or diabetes and females with unhealthy lifestyle and uncontrolled hypertension were less likely to measure HBP every day.
Collapse
Affiliation(s)
- Yukako Tatsumi
- Department of Hygiene and Public Health, Teikyo University School of Medicine
- Department of Clinical Nursing, Shiga University of Medical Science
| | - Azusa Shima
- Department of Clinical Nursing, Shiga University of Medical Science
- Occupational Health Care Office, Heiwado Co., Ltd
| | | | - Ayumi Morino
- Department of Clinical Nursing, Shiga University of Medical Science
- Occupational Health Care Office, Heiwado Co., Ltd
| | | | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine
| |
Collapse
|
41
|
Cai A, Liu L, Siddiqui M, Zhou D, Chen J, Calhoun DA, Tang S, Zhou Y, Feng Y. Uric Acid Is Not Associated With Blood Pressure Phenotypes and Target Organ Damage According to Blood Pressure Phenotypes. Am J Hypertens 2021; 34:64-72. [PMID: 32812633 DOI: 10.1093/ajh/hpaa130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/20/2020] [Accepted: 08/11/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hypertensive patients with increased serum uric acid (SUA) are at increased cardiovascular (CV) risks. Both the European and American hypertension guidelines endorse the utilization of 24 h-ambulatory blood pressure monitoring (24 h-ABPM) for hypertensive patients with increased CV risk. While there is difference in identifying uric acid as a CV risk factor between the European and American guidelines. Therefore, it is unknown whether 24 h-ABPM should be used routinely in hypertensive patients with increased SUA. METHODS To address this knowledge gap, we investigated (i) the correlation between SUA and 24 h-ABP; (ii) the association between SUA and blood pressure (BP) phenotypes (controlled hypertension [CH], white-coat uncontrolled hypertension [WCUH], masked uncontrolled hypertension [MUCH], and sustained uncontrolled hypertension [SUCH]); (iii) the association between SUA and target organ damage (TOD: microalbuminuria, left ventricular hypertrophy [LVH], and arterial stiffness) according to BP phenotypes. RESULTS In 1,336 treated hypertensive patients (mean age 61.2 and female 55.4%), we found (i) there was no correlation between SUA and 24 h, daytime, and nighttime systolic blood pressure/diastolic blood pressure, respectively; (ii) in reference to CH, SUA increase was not associated WCUH (odds ratio [OR] 0.968, P = 0.609), MUCH (OR 1.026, P = 0.545), and SUCH (OR 1.003, P = 0.943); (iii) the overall prevalence of microalbuminuria, LVH, and arterial stiffness was 2.3%, 16.7%, and 23.2%, respectively. After adjustment for covariates, including age, sex, smoking, body mass index, diabetes mellitus, and estimated glomerular filtration rate, there was no association between SUA and TOD in all BP phenotypes. CONCLUSIONS These preliminary findings did not support routine use of 24 h-ABPM in treated hypertensive patients with increased SUA.
Collapse
Affiliation(s)
- Anping Cai
- Department of Cardiology, Guangdong Cardiovascular Institute, Hypertension Research Laboratory, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lin Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Hypertension Research Laboratory, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Mohammed Siddiqui
- Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Dan Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Hypertension Research Laboratory, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Hypertension Research Laboratory, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - David A Calhoun
- Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Songtao Tang
- Department of Public Health, Community Health Center of the Liaobu County, Dongguan, China
| | - Yingling Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Hypertension Research Laboratory, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yingqing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Hypertension Research Laboratory, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| |
Collapse
|
42
|
Parati G, Lombardi C, Pengo M, Bilo G, Ochoa JE. Current challenges for hypertension management: From better hypertension diagnosis to improved patients' adherence and blood pressure control. Int J Cardiol 2021; 331:262-269. [PMID: 33548384 DOI: 10.1016/j.ijcard.2021.01.070] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/09/2021] [Accepted: 01/27/2021] [Indexed: 12/24/2022]
Abstract
Hypertension control still remains a largely unmet challenge for public health systems. Despite the progress in blood pressure (BP) measurement techniques, and the availability of effective and safe antihypertensive drugs, a large number of hypertensive patients are not properly identified, and a significant proportion of those who receive antihypertensive treatment fail to achieve satisfactory control of their BP levels. It is thus not surprising that hypertension is still a major contributor to disease burden and disability worlwide, even in developed countries. This paper will address current challenges in hypertension management and potential strategies for an improvement in this field. In its first part relevant issues related to hypertension diagnosis will be addressed, in particular how to improve identification of sustained BP elevation and specific BP phenotypes such as white coat and masked hypertension trough the combined use of office and out-of-office BP monitoring techniques. In its second part focus will be on how to improve achievement of hypertension control in treated patients by optimization and simplification of medication regimens, including more efficient selection and titration of antihypertensive drugs and their combinations, aimed at achieving a more consistent 24hBP control; and by favoring a more active patients' and physicians' involvement in hypertension management also through BP telemonitoring and mobile health technologies.
Collapse
Affiliation(s)
- Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, S.Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.
| | - Carolina Lombardi
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, S.Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Martino Pengo
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, S.Luca Hospital, Milan, Italy
| | - Grzegorz Bilo
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, S.Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Juan Eugenio Ochoa
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, S.Luca Hospital, Milan, Italy
| |
Collapse
|
43
|
Mancia G, Facchetti R, Seravalle G, Cuspidi C, Corrao G, Grassi G. Adding Home and/or Ambulatory Blood Pressure to Office Blood Pressure for Cardiovascular Risk Prediction. Hypertension 2021; 77:640-649. [PMID: 33390055 DOI: 10.1161/hypertensionaha.120.16303] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Home and 24-hour blood pressure (BPHome and BP24h) are believed to improve the prognostic value of office BP (BPOffice) alone, but the evidence has limitations such as that (1) these 3 BPs are characterized by multicollinearity and (2) the procedures adopted do not allow quantification of the prognostic advantage. One thousand eight hundred thirty-three individuals belonging to the PAMELA (Pressioni Arteriose Monitorate e Loro Associazioni) were followed for 16 years. Prediction of cardiovascular and all-cause mortality was determined via the goodness of fit of individual data (Cox model), the area underlying the receiving operator curves and the net reclassification improvement of cardiovascular and all-cause mortality risk. Calculations were made for BPOffice alone and after addition of BPHome, BP24h, or both, limited to their residual portion which was found to be unexplained by, and thus independent on, BPOffice. With all methods addition of residual out-of-office systolic or diastolic BP to BPOffice significantly improved cardiovascular and all-cause mortality prediction. The improvement was more consistent when BPHome rather than BP24h was added to BPOffice and, compared with BPOffice plus BPHome, no better prediction was found when addition was extended to BP24h. With all additions, however, the improvement was quantitatively modest, which was the case also when data were separately analyzed in younger and older individuals or in dippers and nondippers. Thus, addition of out-of-office to BPOffice improves prediction of cardiovascular risk, even when data analysis avoids previous limitations. The improvement appears to be limited, however, which raises the question of the advantage to recommend their extended use in clinical practice.
Collapse
Affiliation(s)
- Giuseppe Mancia
- From the Policlinico di Monza (G.M.), University Milano-Bicocca, Milan, Italy
| | - Rita Facchetti
- Clinica Medica, Department of Medicine and Surgery (R.F., G.S., C.C., G.G.), University Milano-Bicocca, Milan, Italy
| | - Gino Seravalle
- Clinica Medica, Department of Medicine and Surgery (R.F., G.S., C.C., G.G.), University Milano-Bicocca, Milan, Italy
| | - Cesare Cuspidi
- Clinica Medica, Department of Medicine and Surgery (R.F., G.S., C.C., G.G.), University Milano-Bicocca, Milan, Italy
| | - Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods (G.C.), University Milano-Bicocca, Milan, Italy
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery (R.F., G.S., C.C., G.G.), University Milano-Bicocca, Milan, Italy
| |
Collapse
|
44
|
Satoh M, Ohkubo T, Asayama K, Murakami Y, Sugiyama D, Waki T, Tanaka-Mizuno S, Yamada M, Saitoh S, Sakata K, Irie F, Sairenchi T, Ishikawa S, Kiyama M, Okayama A, Miura K, Imai Y, Ueshima H, Okamura T. A Combination of Blood Pressure and Total Cholesterol Increases the Lifetime Risk of Coronary Heart Disease Mortality: EPOCH-JAPAN. J Atheroscler Thromb 2021; 28:6-24. [PMID: 32269207 PMCID: PMC7875142 DOI: 10.5551/jat.52613] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 01/08/2020] [Indexed: 12/19/2022] Open
Abstract
AIM Lifetime risk (LTR) indicates the absolute risk of disease during the remainder of an individual's lifetime. We aimed to assess the LTRs for coronary heart disease (CHD) mortality associated with blood pressure (BP) and total cholesterol levels in an Asian population using a meta-analysis of individual participant data because no previous studies have assessed this risk. METHODS We analyzed data from 105,432 Japanese participants in 13 cohorts. Apart from grade 1 and 2-3 hypertension groups, we defined "normal BP" as systolic/diastolic BP <130/<80 mmHg and "high BP" as 130-139/80-89 mmHg. The sex-specific LTR was estimated while considering the competing risk of death. RESULTS During the mean follow-up period of 15 years (1,553,735 person-years), 889 CHD deaths were recorded. The 10-year risk of CHD mortality at index age 35 years was ≤ 0.11%, but the corresponding LTR was ≥ 1.84%. The LTR of CHD at index age 35 years steeply increased with an increase in BP of participants with high total cholesterol levels [≥ 5.7 mmol/L (220 mg/dL)]. This risk was 7.73%/5.77% (95% confidence interval: 3.53%-10.28%/3.83%-7.25%) in men/women with grade 2-3 hypertension and high total cholesterol levels. In normal and high BP groups, the absolute differences in LTRs between the low and high total cholesterol groups were ≤ 0.25% in men and ≤ 0.40% in women. CONCLUSIONS High total cholesterol levels contributed to an elevated LTR of CHD mortality in hypertensive individuals. These findings could help guide high-risk young individuals toward initiating lifestyle changes or treatments.
Collapse
Affiliation(s)
- Michihiro Satoh
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Yoshitaka Murakami
- Department of Medical Statistics, Toho University School of Medicine, Tokyo, Japan
| | - Daisuke Sugiyama
- Faculty of Nursing and Medical Care, School of Medicine, Keio University, Tokyo, Japan
| | - Takashi Waki
- Department of Medical Statistics, Shiga University of Medical Science, Otsu, Japan
| | | | - Michiko Yamada
- Department of Clinical Studies, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Shigeyuki Saitoh
- Division of Medical and Behavioral Subjects, Sapporo Medical University School of Health Sciences, Sapporo, Japan
| | - Kiyomi Sakata
- Department of Hygiene and Preventive Medicine, Iwate Medical University School of Medicine, Iwate, Japan
| | - Fujiko Irie
- Department of Health and Welfare, Ibaraki Prefectural Office, Mito, Japan
| | - Toshimi Sairenchi
- Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsugagun-Mibu, Japan
| | - Shizukiyo Ishikawa
- Medical education center, Jichi medical university, Shimotsuke, Tochigi, Japan
| | - Masahiko Kiyama
- Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka, Japan
| | - Akira Okayama
- Research Institute of Strategy for Prevention, Tokyo, Japan
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan
| | - Yutaka Imai
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan
| |
Collapse
|
45
|
Siddiqui M, Judd EK, Zhang B, Dudenbostel T, Carey RM, Oparil S, Calhoun DA. Masked Uncontrolled Hypertension Is Accompanied by Increased Out-of-Clinic Aldosterone Secretion. Hypertension 2020; 77:435-444. [PMID: 33280407 DOI: 10.1161/hypertensionaha.120.15950] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Masked uncontrolled hypertension (MUCH) in treated patients is defined as controlled office blood pressure (BP) but uncontrolled out-of-clinic ambulatory BP. Previously, we have shown that patients with MUCH have evidence of heightened out-of-clinic sympathetic nervous system activity. The aim is to test the hypothesis that MUCH patients have higher aldosterone secretion compared with patients with true controlled hypertension. Two hundred twenty-two patients were recruited after having controlled office BP readings at ≥3 clinic visits. Patients taking MR (mineralocorticoid receptor) antagonists and epithelial sodium channel blockers were excluded. All patients were evaluated by clinic automated office BP and morning serum aldosterone and plasma renin activity. Out-of-clinic ambulatory BP monitoring and 24-hour urinary aldosterone, catecholamines, and metanephrines were also measured. Sixty-four patients had MUCH, and the remaining 48 patients had true controlled hypertension. MUCH patients had significantly higher out-of-clinic levels of 24-hour urinary aldosterone, catecholamines, and metanephrines compared with true controlled hypertension. The 2 groups did not differ in serum aldosterone, plasma renin activity, or aldosterone-renin ratio collected in clinic. In addition, 32.8% of MUCH patients had high out-of-clinic 24-hour urinary aldosterone (≥12 µg) but normal clinic serum aldosterone (<15 ng/dL) and aldosterone-renin ratio (<20). Further, in correlation matrix analysis, higher 24-hour urinary catecholamines and metanephrines were associated with higher 24-hour urinary aldosterone and plasma renin activity levels in MUCH patients. Patients with MUCH have higher out-of-clinic urinary aldosterone levels compared with patients with true controlled hypertension. This study suggests that patients with MUCH likely have higher out-of-clinic sympathetic nervous system tone increases aldosterone secretion mediated by increased renin release that may contribute to their higher out-of-clinic BP.
Collapse
Affiliation(s)
- Mohammed Siddiqui
- From the Department of Medicine, Vascular Biology and Hypertension Program (M.S., T.D., S.O., D.A.C.), University of Alabama at Birmingham
| | - Eric K Judd
- Division of Nephrology (E.K.J.), University of Alabama at Birmingham
| | - Bin Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (B.Z.).,Department of Pediatrics, University of Cincinnati College of Medicine, University of Cincinnati, OH (B.Z.)
| | - Tanja Dudenbostel
- From the Department of Medicine, Vascular Biology and Hypertension Program (M.S., T.D., S.O., D.A.C.), University of Alabama at Birmingham
| | - Robert M Carey
- Division of Endocrinology and Metabolism, University of Virginia Health System, Charlottesville (R.M.C.)
| | - Suzanne Oparil
- From the Department of Medicine, Vascular Biology and Hypertension Program (M.S., T.D., S.O., D.A.C.), University of Alabama at Birmingham
| | - David A Calhoun
- From the Department of Medicine, Vascular Biology and Hypertension Program (M.S., T.D., S.O., D.A.C.), University of Alabama at Birmingham
| |
Collapse
|
46
|
Filler G, Díaz-González de Ferris ME. Automated Office Blood Pressure Measurement for the Diagnosis of Hypertension. J Pediatr 2020; 227:10-12. [PMID: 32712282 DOI: 10.1016/j.jpeds.2020.07.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Guido Filler
- Departments of Pediatrics, Medicine, and Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada; Lilibeth Caberto Kidney Clinical Research Unit, London, Ontario, Canada.
| | | |
Collapse
|
47
|
Karnjanapiboonwong A, Anothaisintawee T, Chaikledkaew U, Dejthevaporn C, Attia J, Thakkinstian A. Diagnostic performance of clinic and home blood pressure measurements compared with ambulatory blood pressure: a systematic review and meta-analysis. BMC Cardiovasc Disord 2020; 20:491. [PMID: 33225900 PMCID: PMC7681982 DOI: 10.1186/s12872-020-01736-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 10/09/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Clinic blood pressure measurement (CBPM) is currently the most commonly used form of screening for hypertension, however it might have a problem detecting white coat hypertension (WCHT) and masked hypertension (MHT). Home blood pressure measurement (HBPM) may be an alternative, but its diagnostic performance is inconclusive relative to CBPM. Therefore, this systematic review aimed to estimate the performance of CBPM and HBPM compared with ambulatory blood pressure measurement(ABPM) and to pool prevalence of WCHT and MHT. METHODS Medline, Scopus, Cochrane Central Register of Controlled Trials and WHO's International Clinical Trials Registry Platform databases were searched up to 23rd January 2020. Studies having diagnostic tests as CBPM or HBPM with reference standard as ABPM, reporting sensitivity and specificity of both tests and/or proportion of WCHT or MHT were eligible. Diagnostic performance of CBPM and HBPM were pooled using bivariate mixed-effect regression model. Random effect model was applied to pool prevalence of WCHT and MHT. RESULTS Fifty-eight studies were eligible. Pooled sensitivity, specificity, and diagnostic odds ratio (DOR) of CBPM, when using 24-h ABPM as the reference standard, were 74% (95% CI: 65-82%), 79% (95% CI: 69%, 87%), and 11.11 (95% CI: 6.82, 14.20), respectively. Pooled prevalence of WCHT and MHT were 0.24 (95% CI 0.19, 0.29) and 0.29 (95% CI 0.20, 0.38). Pooled sensitivity, specificity, and DOR of HBPM were 71% (95% CI 61%, 80%), 82% (95% CI 77%, 87%), and 11.60 (95% CI 8.98, 15.13), respectively. CONCLUSIONS Diagnostic performances of HBPM were slightly higher than CBPM. However, the prevalence of MHT was high in negative CBPM and some persons with normal HBPM had elevated BP from 24-h ABPM. Therefore, ABPM is still necessary for confirming the diagnosis of HT.
Collapse
Affiliation(s)
| | - Thunyarat Anothaisintawee
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
- Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rachathevi, Bangkok, 10400 Thailand
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Usa Chaikledkaew
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Charungthai Dejthevaporn
- Division of Neurology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - John Attia
- School of Medicine and Public Health, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW Australia
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
48
|
Hypertension in psoriasis patients: based on office and ambulatory blood pressure measurement. Blood Press Monit 2020; 25:351-354. [PMID: 33074930 DOI: 10.1097/mbp.0000000000000489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Psoriasis is a chronic inflammatory disorder, which is associated with high risk of metabolic comorbidities. Hypertension (HTN) is among the most common and serious associations. In this study, we aimed to evaluate HTN in psoriatic patients through office and ambulatory blood pressure monitoring (ABPM). MATERIALS AND METHODS Forty-nine patients with confirmed diagnosis of psoriasis were enrolled in the study. Office measurement of blood pressure was performed and then holter monitoring was used for 24-h ABPM. RESULTS Thirty-six patients (73.4%) had HTN including 13 females (36.1%) and 23 males (63.9%) (P = 0.011). Twelve patients (33.3%) had masked HTN (six females and six males). Office, 24-h, morning, daytime, and nocturnal HTN were present in 49%, 40.8%, 34.7%, 36.7%, and 63.3% of our patients, respectively. The only factor significantly related to morning/daytime/24 h HTN was age, which hypertensive patients had higher age. About 22.4% of patients had metabolic syndrome, which was significantly associated with FBS, weight, waist circumference, and BMI. CONCLUSION Psoriasis is associated with a high rate of HTN. Masked HTN constitutes nearly one-third of hypertensive patients. ABPM increases the accuracy of HTN detection in psoriatic patients.
Collapse
|
49
|
Yılmaz ÖÇ, Özkan S. Is Masked Hypertension an underlying Cause of Unexplained Left Ventricle Hypertrophy? Clin Exp Hypertens 2020; 43:138-141. [PMID: 32985273 DOI: 10.1080/10641963.2020.1825729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Unexplained left ventricular hypertrophy (ULVH) is defined as increased wall thickness in the absence of conditions that predispose to hypertrophy. The aim of this study was to evaluate the rate of masked hypertension in patient with unexplained left ventricle hypertrophy. METHOD A total of 120 consecutive unexplained left ventricle hypertrophy patients without overt hypertension and diabetes and 121 healthy control subjects were included in the study. After a complete medical history and laboratory examination, patients' height, weight, waist circumference heart rate, and office blood pressure were recorded. All subjects underwent ambulatory blood pressure monitoring, and transthoracic echocardiography. RESULTS Mean age were similar between patients with ULVH and controls. There was no significant difference in total cholesterol, HDL, LDL cholesterol and triglyceride levels, left ventricle ejection fraction, between the groups. Prevalence of Masked hypertension was significantly higher in patients with ULVH than controls (28.3% vs 6.6%, p < .001). Left ventricular mass index (141.9 ± 16.8 g/cm2 vs. 67.3 ± 10.3 g/cm2, p < .001) was significantly higher in masked hypertensive patients with ULVH compared to normotensive ULVH and control subjects. CONCLUSION In this study, we found high prevalence of masked hypertension in ULVH patients. Patients with ULVH should be screened by ABPM to detect possible masked hypertension.
Collapse
Affiliation(s)
- Ö Çağlar Yılmaz
- Ankara Private Etimed Hospital Cardiology Department, Private Cardiology Clinic , Ankara, Turkey
| | - Selçuk Özkan
- Department of Cardiology, Medical Park Ankara Hospital, Yuksek Ihtisas University , Ankara, Turkey
| |
Collapse
|
50
|
Nakajima T, Oh A, Saita S, Yoshida T, Ohishi M, Nishigaki N. Comparative Effectiveness of Angiotensin II Receptor Blockers in Patients With Hypertension in Japan - Systematic Review and Network Meta-Analysis. Circ Rep 2020; 2:576-586. [PMID: 33693183 PMCID: PMC7932820 DOI: 10.1253/circrep.cr-20-0076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Angiotensin II receptor blockers (ARBs) are widely used for the management of hypertension in Japan; however, comparative efficacy data within the ARB drug class remain limited. Methods and Results: This systematic literature review identified randomized controlled trials (RCT) indexed in PubMed and Ichushi in Japanese patients with hypertension receiving ARB monotherapy (azilsartan, candesartan cilexetil, irbesartan, losartan potassium, olmesartan medoxomil, telmisartan, valsartan) in at least 1 arm. Of 763 RCTs identified, 77 met the eligibility criteria; of which, 37 reported mean change in systolic blood pressure (SBP) and diastolic blood pressure (DBP) from baseline in the office setting and were used to construct the network. A fixed-effects model (FEM) showed the effect of each drug vs. the reference, azilsartan. Using the FEM, the mean (95% credible interval) change from baseline in SBP/DBP for candesartan cilexetil, irbesartan, losartan potassium, olmesartan medoxomil, telmisartan, and valsartan was 3.8 (2.9-4.8)/2.6 (2.0-3.1), 4.8 (2.0-7.5)/3.7 (1.8-5.6), 3.0 (0.8-5.1)/1.9 (0.5-3.3), 3.2 (1.2-5.1)/2.7 (1.3-4.1), 3.2 (0.8-5.6)/2.0 (0.3-3.6), and 3.1 (1.1-5.1)/2.4 (1.1-3.8) mmHg, respectively. Conclusions: The results of this meta-analysis provide evidence that azilsartan has a more favorable efficacy profile than the other ARBs in reducing SBP and DBP.
Collapse
Affiliation(s)
- Tadashi Nakajima
- Japan Medical Office, Takeda Pharmaceutical Company Limited Tokyo Japan
| | - Akinori Oh
- Japan Medical Office, Takeda Pharmaceutical Company Limited Tokyo Japan
| | - Shun Saita
- Japan Medical Office, Takeda Pharmaceutical Company Limited Tokyo Japan
| | - Takuo Yoshida
- Japan Medical Office, Takeda Pharmaceutical Company Limited Tokyo Japan
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University Kagoshima Japan
| | | |
Collapse
|