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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
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Camafort M, Kreutz R, Cho MC. Diagnosis and management of resistant hypertension. Heart 2023:heartjnl-2022-321730. [PMID: 38135468 DOI: 10.1136/heartjnl-2022-321730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Abstract
Resistant hypertension is a condition where blood pressure levels remain elevated above target despite changes in lifestyle and concurrent use of at least three antihypertensive agents, including a long-acting calcium channel blocker (CCB), a blocker of the renin-angiotensin system (ACE inhibitor or angiotensin receptor blocker) and a diuretic. To be diagnosed as resistant hypertension, maintaining adherence to therapy is required along with confirmation of blood pressure levels above target by out-of-office blood pressure measurements and exclusion of secondary causes of hypertension. The key management points of this condition include lifestyle changes such as reduced sodium and alcohol intake, regular physical activity, weight loss and discontinuation of substances that can interfere with blood pressure control. It is also recommended that current treatment be rationalised, including single pill combination treatment where antihypertensive drugs should be provided at the maximum tolerated dose. It is further recommended that current drugs be replaced with a more appropriate and less difficult treatment regimen based on the patient's age, ethnicity, comorbidities and risk of drug-drug interactions. The fourth line of treatment for patients with resistant hypertension should include mineralocorticoid receptor antagonists such as spironolactone, as demonstrated in the PATHWAY-2 trial and meta-analyses. Alternatives to spironolactone include amiloride, doxazosin, eplerenone, clonidine and beta-blockers, as well as any other antihypertensive drugs not already in use. New approaches under research are selective non-steroidal mineralocorticoid receptor antagonists such as finerenone, esaxerenone and ocedurenone, selective aldosterone synthase inhibitors such as baxdrostat, and dual endothelin antagonist aprocitentan.
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Affiliation(s)
- Miguel Camafort
- Hypertensión Unit. Internal Medicine Department, Hospital Clinic de Barcelona, Barcelona, Spain
- CIBEROBN, Instituto de Salud Carlos III, Madrid, Spain
| | - Reinhold Kreutz
- Charite Medical Faculty Berlin, Berlin, Germany
- Institut für Klinische Pharmakologie und Toxikologie, Berlin Institute of Health at Charite, Berlin, Germany
| | - Myeong-Chan Cho
- Cardiology, Chungbuk National University Hospital, Cheongju, Korea
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Kim HM, Shin J. Role of home blood pressure monitoring in resistant hypertension. Clin Hypertens 2023; 29:2. [PMID: 36641498 PMCID: PMC9840827 DOI: 10.1186/s40885-022-00226-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/18/2022] [Indexed: 01/16/2023] Open
Abstract
The definition of resistant hypertension (RHT) has been updated to include failure to achieve target blood pressure (BP) despite treatment with ≥3 antihypertensive drugs, including diuretics, renin-angiotensin system blockers, and calcium channel blockers, prescribed at the maximum or maximally tolerated doses, or as success in achieving the target blood pressure but requiring ≥4 drugs. RHT is a major clinical problem, as it is associated with higher mortality and morbidity than non-RHT. Therefore, it is crucial to accurately identify RHT patients to effectively manage their disease. Out-of-clinic BP measurement, including home BP monitoring and ambulatory BP monitoring is gaining prominence for the diagnosis and management of RHT. Home BP monitoring is advantageous as it is feasibly repetitive, inexpensive, widely available, and because of its reproducibility over long periods. In addition, home BP monitoring has crucial advantage of allowing safe titration for the maximum or maximally tolerable dose, and for self-monitoring, thereby improving clinical inertia and nonadherence, and allowing true RHT to be more accurately identified.
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Affiliation(s)
- Hyue Mee Kim
- grid.411651.60000 0004 0647 4960Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jinho Shin
- grid.49606.3d0000 0001 1364 9317Division of Cardiology, Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, 04763 Seoul, Republic of Korea
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Groenland EH, Vendeville JPAC, Bemelmans RHH, Monajemi H, Bots ML, Visseren FLJ, Spiering W. Smartphone Application-Assisted Home Blood Pressure Monitoring Compared With Office and Ambulatory Blood Pressure Monitoring in Patients With Hypertension: the AMUSE-BP Study. Hypertension 2022; 79:2373-2382. [PMID: 35959685 PMCID: PMC9444260 DOI: 10.1161/hypertensionaha.122.19685] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The development of automated, smartphone application (app)-assisted home blood pressure monitoring (HBPM) allows for standardized measurement of blood pressure (BP) at home. The aim of this study was to evaluate the (diagnostic) agreement between app-assisted HBPM, automated office BP (OBP), and the reference standard 24-hour ambulatory BP monitoring (ABPM).
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Affiliation(s)
- Eline H Groenland
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, the Netherlands (E.H.G., J.-P.A.C.V., F.L.J.V., W.S.)
| | - Jean-Paul A C Vendeville
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, the Netherlands (E.H.G., J.-P.A.C.V., F.L.J.V., W.S.)
| | - Remy H H Bemelmans
- Department of Internal Medicine, Ziekenhuis Gelderse Vallei, Ede, the Netherlands (R.H.H.B.)
| | - Houshang Monajemi
- Department of Internal Medicine, Rijnstate, Arnhem, the Netherlands (H.M.)
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (M.L.B.)
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, the Netherlands (E.H.G., J.-P.A.C.V., F.L.J.V., W.S.)
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, the Netherlands (E.H.G., J.-P.A.C.V., F.L.J.V., W.S.)
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Barochiner J, Aparicio LS, Martínez R, Alfie J, Marín MJ. Prognostic value of masked uncontrolled apparent resistant hypertension detected through home blood pressure monitoring. J Hypertens 2021; 39:2141-2146. [PMID: 34128493 DOI: 10.1097/hjh.0000000000002913] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Resistant hypertension carries a poor prognosis and current guidelines recommend the exclusion of the white-coat phenomenon for proper diagnosis. However, guidelines do not focus on patients treated with at least three drugs whose blood pressure (BP) is controlled at the office but elevated out of it. We aimed at determining whether this masked uncontrolled apparent resistant hypertension (MUCRH) detected through home blood pressure monitoring (HBPM) has prognostic value for fatal and nonfatal events in these hypertensive patients. METHODS Hypertensive patients treated with at least three drugs who performed a baseline HBPM between 2008 and 2015 were followed to register the occurrence of total mortality, cardiovascular mortality, and fatal and nonfatal cardiac and cerebrovascular events. MUCRH was defined as office blood pressure less than 140/90 mmHg and home BP at least 135 and/or 85 mmHg. Multivariable Cox proportional hazard models were adjusted to determine the independent prognostic value of MUCRH for the events of interest. RESULTS We included 470 patients, 35.5% male, mean age 71.9 years, and treated with 3.3 antihypertensive drugs on average. Among study population, 15.5% had MUCRH (33.3% when considering only patients with adequate BP control at the office). Median follow-up was 6.7 years. In multivariable models, MUCRH was an independent predictor for cardiovascular mortality and cerebrovascular events: hazard ratio 4.9 (95% CI 1.2-19.9, P = 0.03) and 5.1 (95% CI 1.5-16.9, P = 0.01), respectively. CONCLUSION MUCRH is not rare and is independently associated with cardiovascular morbidity and mortality. The systematic monitoring of intensively treated individuals through HBPM would be useful for the detection of patients at increased risk of events.
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Affiliation(s)
- Jessica Barochiner
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires
- Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB), UE de triple dependencia CONICET- Instituto Universitario del Hospital Italiano (IUHI)- Hospital Italiano (HIBA), Buenos Aires, Argentina
| | - Lucas S Aparicio
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires
| | - Rocío Martínez
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires
- Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB), UE de triple dependencia CONICET- Instituto Universitario del Hospital Italiano (IUHI)- Hospital Italiano (HIBA), Buenos Aires, Argentina
| | - José Alfie
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires
| | - Marcos J Marín
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires
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Cardoso CRL, Salles GF. Prognostic Impact of Home Blood Pressures for Adverse Cardiovascular Outcomes and Mortality in Patients With Resistant Hypertension: A Prospective Cohort Study. Hypertension 2021; 78:1617-1627. [PMID: 34565185 DOI: 10.1161/hypertensionaha.121.18064] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Claudia R L Cardoso
- Department of Internal Medicine, University Hospital Clementino Fraga Filho, School of Medicine, Universidade Federal do Rio de Janeiro
| | - Gil F Salles
- Department of Internal Medicine, University Hospital Clementino Fraga Filho, School of Medicine, Universidade Federal do Rio de Janeiro
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Moura AF, Moura-Neto JA, Rodrigues CIS, Miranda MO, Carvalho TC, Paschoalin Carvalho NP, Souza E, Moura-Jr JA, Cruz CMS. Resistant hypertension: Prevalence and profile of patients followed in a university ambulatory. SAGE Open Med 2021; 9:20503121211020892. [PMID: 34178337 PMCID: PMC8202308 DOI: 10.1177/20503121211020892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/09/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Hypertension affects about 36 million Brazilians. It is estimated that 10%-20% of these have resistant hypertension. These patients are at an increased risk of early target organ damage, as well as cardiovascular and renal events. OBJECTIVE To estimate the prevalence of resistant hypertension in a specialized outpatient clinic, to describe the sociodemographic and clinical characteristics of these patients, and to identify possible factors associated with resistant hypertension. METHODS Data collection from medical records of hypertensive patients treated using oral antihypertensive drugs in optimized doses at a specialized university clinic from March 2014 to December 2014, after ethical approval statement. All patients were using appropriate antihypertensive drugs in optimized doses and assisted at a teaching-assistance clinic of internal medicine of the Bahiana School of Medicine and Public Health in Brazil. RESULTS A total of 104 patients were enrolled and 31.7% (n = 33) had criteria for resistant hypertension. Of the total participants, 75.7% were female and 54.8% were black or brown. The average age was 61.7 years (SD ± 10.1). In the resistant hypertension group, 63.6% had diabetes, compared to 32.4% in the hypertension group. Among resistant hypertensive patients, 51.5% had dyslipidemia. Regarding drug treatment, 75.8% of the resistant hypertension group and 51.4% of the hypertension group used statins. Among patients with resistant hypertension, 90.9% used angiotensin II receptor blockers and 66.7%, dihydropyridine calcium channel blockers. In the resistant hypertension group, 75.8% used beta-blockers, against 25.4% in the hypertension group. CONCLUSION The prevalence of hypertension was higher than that described in the global literature, which may be associated with the high percentage of black and brown ("pardos") patients in the population studied, and also because the study was performed in a specialized outpatient clinic.
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Affiliation(s)
- Ana Flávia Moura
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
| | - José A Moura-Neto
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
- Clínica de Nefrologia de Serrinha, Serrinha, Bahia, Brazil
- Clínica de Nefrologia de Juazeiro, Juazeiro, Bahia, Brazil
| | - Cibele Isaac Saad Rodrigues
- Faculdade de Ciências Médicas e da Saúde. Departamento de Clínica. Pontifícia Universidade Católica de São Paulo, São Paulo, Brazil
| | - Mariana O Miranda
- Hospital Universitário Professor Edgard Santos, UFBA, Salvador, Bahia, Brazil
| | | | - Nathalia Pereira Paschoalin Carvalho
- Clínica de Nefrologia de Serrinha, Serrinha, Bahia, Brazil
- Clínica de Nefrologia de Juazeiro, Juazeiro, Bahia, Brazil
- Clínica Senhor do Bonfim, Feira de Santana, Bahia, Brazil
| | - Edison Souza
- Hospital Universitário Pedro Ernesto, UERJ, Rio de Janeiro, Brazil, Brazil
| | - José A Moura-Jr
- Clínica de Nefrologia de Serrinha, Serrinha, Bahia, Brazil
- Clínica de Nefrologia de Juazeiro, Juazeiro, Bahia, Brazil
| | - Constança Margarida S Cruz
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
- Hospital Santo Antônio, Obras Sociais Irmã Dulce, Salvador, Bahia, Brazil
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Muxfeldt ES, Chedier B. Refractory hypertension: what do we know so far? J Hum Hypertens 2020; 35:181-183. [PMID: 32873873 DOI: 10.1038/s41371-020-00409-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/10/2020] [Accepted: 08/18/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Elizabeth Silaid Muxfeldt
- Department of Internal Medicine, Hospital Universitário Clementino Fraga Filho, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Bernardo Chedier
- Department of Internal Medicine, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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9
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Masked Hypertension: A Systematic Review. Heart Lung Circ 2020; 29:102-111. [DOI: 10.1016/j.hlc.2019.08.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 06/15/2019] [Accepted: 08/04/2019] [Indexed: 12/22/2022]
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Denolle T. [Expert consensus statement on blood pressure measurement from the French Society of Hypertension, an affiliate of the French Society of Cardiology]. Presse Med 2019; 48:1319-1328. [PMID: 31732365 DOI: 10.1016/j.lpm.2019.09.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 09/26/2019] [Indexed: 01/03/2023] Open
Abstract
Since 2016, the French Society of Hypertension has warned about the decline in the management of high blood pressure in France: stagnation, or even decreased number of people who know their blood pressure level, take a treatment and are controlled. These results are lower than those observed in many other countries. Blood pressure is measured with an old method in the doctor's office. Accepted, simple and cost-effective, this method is currently unavoidable for reasons of feasibility and social habit. It has been used in observational and intervention studies that are the basis of the medical reasoning for screening, treatment and drug control of hypertension. In practice, it is too often poorly applied and unpredictable. It is now necessary to measure blood pressure in mmHg using a validated oscillometric automatic device coupled to a specific upper arm cuff adapted to the arm circumferences for the diagnosis and monitoring of high blood pressure in the doctor's office and at home. The auscultatoric measurement is only recommended if any doubt about the reliability of the electronic measurement. Blood pressure measurement is basically performed on both arms to detect asymmetry and then on the arm with the highest blood pressure. It is performed in sitting or lying position after a few minutes of rest without speaking and without having smoked and then in standing position to diagnose orthostatic hypotension, especially in elderly, diabetic and multi-medicated subjects. The blood pressure measurement during the consultation must be repeated and include at least 3 consecutive measurements at one minute intervals. The average of the last 2 measurements determines the blood pressure level. It is recommended to perform BP measurements outside the medical environment for the diagnosis and monitoring of hypertension; Home BP measurement is preferred to ambulatory blood pressure measurement for practical reasons unless otherwise specified. The home blood pressure measurement should include three measurements in the morning at breakfast and three measurements in the evening before bedtime at one minute intervals for at least three days. Prior training must be provided. In treated hypertensive patients, a masked hypertension should be considered as an uncontrolled hypertension and antihypertensive therapy adapted accordingly. The measurement of central BP pressure (aorta) should be limited to clinical research.
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Affiliation(s)
- Thierry Denolle
- Société française d'hypertension artérielle, 5, rue des Colonnes-du-Trône, 75012 Paris, France.
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Chudek A, Owczarek AJ, Ficek J, Almgren-Rachtan A, Chudek J. Lower utilization of home blood pressure monitoring in younger, poorly educated hypertensive males – real-life data. Blood Press 2019; 29:95-102. [PMID: 31691573 DOI: 10.1080/08037051.2019.1684818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Anna Chudek
- Department of Pharmacovigilance, Europharma Rachtan Co. Ltd, Katowice, Poland
| | - Aleksander Jerzy Owczarek
- Department of Statistics (Department of Instrumental Analysis), Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Joanna Ficek
- Pathophysiology Unit, Department of Pathophysiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | | | - Jerzy Chudek
- Department of Internal Medicine and Oncological Chemotherapy, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
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Abstract
PURPOSE OF REVIEW To discuss the current definition as well as recommendations for diagnosis and treatment of resistant hypertension (RH) based on the 2018 American Heart Association (AHA) guidelines and recent literature. RECENT FINDINGS RH is defined as uncontrolled blood pressure (BP) on ≥ 3 anti-hypertensives, one of which should be a diuretic, prescribed at maximally tolerated doses and appropriate dosing frequency. The diagnosis of RH requires exclusion of white coat effect and medication non-adherence, underscoring the importance of out-of-office BP measurements. Secondary causes of hypertension must be excluded in all patients with RH. A step-wise approach to treatment focusing on lifestyle modifications and medication optimization can be effective in > 50% of the patients with RH. Device-based interventional therapies for RH are currently investigational. Out-of-office BP measurements are central to the diagnosis of RH. Medication optimization is successful in most patients. Further studies are needed to define the role of device-based interventions.
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Affiliation(s)
- Irene Chernova
- Yale School of Medicine/Section of Nephrology, New Haven, CT, USA
| | - Namrata Krishnan
- Yale School of Medicine/Section of Nephrology, New Haven, CT, USA. .,Veterans Affairs Medical Center, 950 Campbell Ave., West Haven, CT, 06516, USA.
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De León-Robert A, Gascón-Cánovas JJ, Antón-Botella JJ, Hidalgo-García IM, López-Alegría C, Pérez-Cabrera YD, Campusano-Castellanos HM. Validity of self blood pressure measurement in the control of the hypertensive patient: factors involved. BMC Cardiovasc Disord 2019; 19:171. [PMID: 31315567 PMCID: PMC6637525 DOI: 10.1186/s12872-019-1145-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 06/30/2019] [Indexed: 11/23/2022] Open
Abstract
Background Improving clinical practice aimed at controlling hypertension is a pending issue in health systems. One of the methods currently used for this purpose is self blood pressure measurement (SBPM) whose use increases every day. The aims of this study are to establish the optimal cut-off point for the 3-day SMBP protocol and to identify factors that could affect the precision of the 3-day SMBP protocol using 24-h ambulatory blood pressure monitoring (ABPM) as a reference. Method This is a cross-sectional descriptive study to validate a diagnostic test performed by a primary care team in Murcia, Spain. A total of 153 hypertensive patients under 80 years of age who met the inclusion criteria were evaluated. ABPM was performed for 24 h. The SBPM protocol consisted of recording 2 measurements in the morning and 2 at night for 3 days. Results The cut-off point for SBP was set at 135 mmHg (sensitivity: 80.39%, specificity: 74.19%), and for DBP, it was set at 83 mmHg (sensitivity: 76.48%, specificity: 84.89%), which yielded the highest combined sensitivity and specificity. After carrying out the validation study with the new figures, we proceeded to establish which socio-demographic factors prevented a correct classification of patients. These errors were more common in male patients for the assessments of both DBP (OR = 2.4) and SBP (OR = 2.5); hypertensive patients with age < 67,5 years (OR = 1,5); having no work activity (OR = 3,6) and with concomitant chronic kidney disease (CKD) (OR = 5.0). Conclusion Being male, older than 67.5 years, with CKD or with no work activity increases the probability of being misclassified for hypertension during follow-up as assessed by SBPM over 3 days. Trial registration This study was approved by the research ethics committee of the University of Murcia under registration number 1018/2015.
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Affiliation(s)
| | - Juan José Gascón-Cánovas
- Faculty of Medicine (University of Murcia) - Instituto Murciano de Biosanitaria - Arrixaca (IMIB-Arrixaca), Murcia, Spain
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Morning hypertension is more common in elderly hypertensive patients with controlled documented office blood pressure in primary care clinics. J Hypertens 2017. [DOI: 10.1097/hjh.0000000000001449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Liu L, Xu B, Ju Y. Addition of spironolactone in patients with resistant hypertension: A meta-analysis of randomized controlled trials. Clin Exp Hypertens 2017; 39:257-263. [DOI: 10.1080/10641963.2016.1246564] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Prognostic Importance of Ambulatory Blood Pressure Monitoring in Resistant Hypertension: Is It All that Matters? Curr Hypertens Rep 2016; 18:85. [DOI: 10.1007/s11906-016-0693-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Malachias MVB, Rodrigues CIS, Muxfeldt E, Salles GF, Moreno H, Gus M. 7th Brazilian Guideline of Arterial Hypertension: Chapter 13 - Resistant Arterial Hypertension. Arq Bras Cardiol 2016; 107:75-78. [PMID: 27819392 PMCID: PMC5319459 DOI: 10.5935/abc.20160163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Shimbo D, Abdalla M, Falzon L, Townsend RR, Muntner P. Role of Ambulatory and Home Blood Pressure Monitoring in Clinical Practice: A Narrative Review. Ann Intern Med 2015; 163:691-700. [PMID: 26457954 PMCID: PMC4638406 DOI: 10.7326/m15-1270] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Hypertension, a common risk factor for cardiovascular disease, is usually diagnosed and treated based on blood pressure readings obtained in the clinic setting. Blood pressure may differ considerably when measured inside versus outside of the clinic setting. Over the past several decades, evidence has accumulated on the following 2 approaches for measuring blood pressure outside of the clinic: ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM). Both of these methods have a stronger association with cardiovascular disease outcomes than clinic blood pressure measurement. Controversy exists about whether ABPM or HBPM is superior for estimating risk for cardiovascular disease and under what circumstances these methods should be used in clinical practice for assessing blood pressure outside of the clinic. This review describes ABPM and HBPM procedures, the blood pressure phenotypic measurements that can be ascertained, and the evidence that supports the use of each approach to measuring blood pressure outside of the clinic. It also describes barriers to the successful implementation of ABPM and HBPM in clinical practice, proposes core competencies for the conduct of these procedures, and highlights important areas for future research.
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Affiliation(s)
- Daichi Shimbo
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Marwah Abdalla
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Louise Falzon
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Raymond R. Townsend
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
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