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Miranda RD, Brandão AA, Barroso WKS, Mota-Gomes MA, Barbosa ECD, Ribeiro LP, Aguilar CA, Silveira FS, Gomes CDMR, Epelman A, de Paiva AMG, Feitosa ADM. National Registry of Hypertension Control Evaluated by Office and Home Measurements: The LHAR National Registry. Arq Bras Cardiol 2023; 120:e20220863. [PMID: 37586005 PMCID: PMC10464860 DOI: 10.36660/abc.20220863] [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: 11/27/2022] [Revised: 04/23/2023] [Accepted: 05/17/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND It is known that around 30% of patients have higher blood pressure (BP) values when examined at the office than at home. Worldwide, only 35% of patients with hypertension undergoing treatment have reached their BP targets. OBJECTIVE To provide epidemiological data on BP control in the offices of a sample of Brazilian cardiologists, considering office and home BP measurement. METHODS This is a cross-sectional analysis of patients with a hypertension diagnosis and undergoing antihypertensive treatment, with controlled BP or not. BP was assayed in the office by a medical professional and at home using home BP monitoring (HBPM). The association between categorical variables was verified using the chi-square test (p<0.05). RESULTS The study included 2540 patients, with a mean age of 59.7 ± 15.2 years. Most patients were women (62%; n=1575). Prevalence rates of 15% (n=382) for uncontrolled white coat hypertension and 10% (n=253) for uncontrolled masked hypertension were observed. The rate of BP control in the office was 56.3% and at home, 61%. Meanwhile, 46.4% of the patients had controlled BP in and outside of the office. Greater control was observed in women and in the 49-61 years age group. Considering the new DBHA 2020 threshold for home BP control, the control rate was 42.4%. CONCLUSION BP control in the offices of a sample of Brazilian cardiologists was 56.3%; this rate was 61% when BP was measured at home and 46.4% when considering both the office and home.
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Affiliation(s)
- Roberto Dischinger Miranda
- Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrasilServiço de Cardiologia, Disciplina de Geriatria e Gerontologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP – Brasil
| | - Andréa Araujo Brandão
- Universidade do Estado do Rio de JaneiroRio de JaneiroRJBrasilUniversidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ – Brasil
| | - Weimar Kunz Sebba Barroso
- Liga de Hipertensão ArterialHospital das ClínicasUniversidade Federal de GoiásGoiâniaGOBrasilLiga de Hipertensão Arterial - Hospital das Clínicas - Universidade Federal de Goiás, Goiânia, GO – Brasil
| | - Marco Antonio Mota-Gomes
- Centro Universitário CESMACHospital do CoraçãoMaceióALBrasil Centro Universitário CESMAC, Hospital do Coração, Maceió, AL – Brasil
| | - Eduardo Costa Duarte Barbosa
- Liga de Combate à Hipertensão ArterialPorto AlegreRSBrasil Liga de Combate à Hipertensão Arterial, Porto Alegre, RS – Brasil
| | | | | | - Fabio Serra Silveira
- Centro de PesquisaClínica do CoraçãoAracajuSEBrasilCentro de Pesquisa Clínica do Coração, Aracaju, SE – Brasil
| | | | - Abraham Epelman
- Servier do BrasilRio de JaneiroRJBrasilServier do Brasil, Rio de Janeiro, RJ – Brasil
| | - Annelise Machado Gomes de Paiva
- Centro Universitário CESMACHospital do CoraçãoMaceióALBrasil Centro Universitário CESMAC, Hospital do Coração, Maceió, AL – Brasil
| | - Audes Diógenes Magalhães Feitosa
- Unidade de Hipertensão e Cardiologia PreventivaPROCAPEUniversidade de PernambucoRecifePEBrasilUnidade de Hipertensão e Cardiologia Preventiva do PROCAPE, Universidade de Pernambuco, Recife, PE – Brasil
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Tocci G, Citoni B, Nardoianni G, Figliuzzi I, Volpe M. Current applications and limitations of European guidelines on blood pressure measurement: implications for clinical practice. Intern Emerg Med 2022; 17:645-654. [PMID: 35355208 PMCID: PMC8967564 DOI: 10.1007/s11739-022-02961-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/25/2022] [Indexed: 11/30/2022]
Abstract
Hypertension is the most common cardiovascular (CV) risk factor, strongly and independently associated with an increased risk of major CV outcomes, including myocardial infarction, stroke, congestive heart failure, renal disease and death due to CV causes. Effective control of hypertension is of key importance for reducing the risk of hypertension-related CV complications, as well as for reducing the global burden of CV mortality. However, several studies reported relatively poor rates of control of high blood pressure (BP) in a setting of real-life practice. To improve hypertension management and control, national and international scientific societies proposed several educational and therapeutic interventions, among which the systematic implementation of out-of-office BP measurements represents a key element. Indeed, proper assessment of individual BP profile, including home, clinic and 24-h ambulatory BP levels, may improve awareness of the disease, ensure high level of adherence to prescribed medications in treated hypertensive patients, and thus contribute to ameliorate BP control in treated hypertensive outpatients. In line with these purposes, recent European guidelines have released practical recommendations and clear indications on how, when and how properly measuring BP levels in different clinical settings, with different techniques and different methods. This review aimed at discussing current applications and potential limitations of European guidelines on how to measure BP in office and out-of-office conditions, and their potential implications in the daily clinical management of hypertension.
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Affiliation(s)
- Giuliano Tocci
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome "Sapienza", Via di Grottarossa 1035-9, 00189, Rome, Italy.
| | - Barbara Citoni
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome "Sapienza", Via di Grottarossa 1035-9, 00189, Rome, Italy
| | - Giulia Nardoianni
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome "Sapienza", Via di Grottarossa 1035-9, 00189, Rome, Italy
| | - Ilaria Figliuzzi
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome "Sapienza", Via di Grottarossa 1035-9, 00189, Rome, Italy
| | - Massimo Volpe
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome "Sapienza", Via di Grottarossa 1035-9, 00189, Rome, Italy
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Kagitani H, Hayashi S, Hanamura S, Ozawa K, Kobayashi D, Hiki S, Kario K. A Japan nationwide web-based survey of estimation on patients for renal denervation based on blood pressure level and the number of antihypertensives (J-NEEDs survey). J Clin Hypertens (Greenwich) 2021; 23:1684-1694. [PMID: 34427965 PMCID: PMC8678654 DOI: 10.1111/jch.14339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/06/2021] [Accepted: 07/22/2021] [Indexed: 11/29/2022]
Abstract
Catheter‐based renal denervation (RDN) is currently being developed as a new complementary treatment option for hypertension. RDN has not yet received approval in Japan and so the number of possible candidates for RDN in Japan also remains unknown. A total of 10 756 hypertensive patients who regularly visit medical institutions and reported their latest home blood pressure (BP) values were identified from registrants at an online research company. They filled out a survey regarding their prescribed antihypertensives and latest BP values in March 2020 in Japan. The mean age of the patients was 61.3 years old (83.5% male). According to JSH 2019, the prevalence of resistant hypertension (RHT) was estimated to be 1.4% (0.52% having an office BP of 140/90 mm Hg or more while taking three antihypertensives, including diuretics; 0.84% taking four or more antihypertensives regardless of BP level). Assuming the indication for RDN was RHT with morning home systolic BP (HSBP) ≥ 135 mm Hg and office systolic BP (OSBP) ≥ 140 mm Hg, the number of candidates for RDN was estimated to be approximately 340 000 and 372 000, respectively. When hypertensive patients prescribed three or more, two, one, and no antihypertensives were included, the estimated number based on uncontrolled HSBP and OSBP cumulatively increased 2.6, 14.2, 40.6, and 58.0‐fold; 1.8, 8.6, 25.3, and 36.4‐fold, respectively. These findings revealed that a substantial number of hypertensive patients are unable to adequately control their BP level with existing treatments, and new complemental therapies, such as RDN, would alleviate the burden of hypertension in this population.
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Affiliation(s)
- Hideaki Kagitani
- Clincal Development Department, Terumo Corporation, Tokyo, Japan
| | - Shoko Hayashi
- Clincal Development Department, Terumo Corporation, Tokyo, Japan
| | - Satsuki Hanamura
- Clincal Development Department, Terumo Corporation, Tokyo, Japan
| | - Keisuke Ozawa
- Clincal Development Department, Terumo Corporation, Tokyo, Japan
| | - Daisuke Kobayashi
- Interventional Systems Division, Cardiac and Vascular Company, Terumo Corporation, Tokyo, Japan
| | - Shunsuke Hiki
- Interventional Systems Division, Cardiac and Vascular Company, Terumo Corporation, Tokyo, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
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Self-blood pressure measurement as compared to office blood pressure measurement in a large Indian population; the India Heart Study. J Hypertens 2020; 38:1262-1270. [DOI: 10.1097/hjh.0000000000002410] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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5
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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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Youssef G, Nagy S, El-Gengehe A, Abdel Aal A, Hamid MA. Masked uncontrolled hypertension: Prevalence and predictors. Egypt Heart J 2018; 70:369-373. [PMID: 30591757 PMCID: PMC6303486 DOI: 10.1016/j.ehj.2018.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/03/2018] [Indexed: 11/16/2022] Open
Abstract
Background There are limited data on ‘masked uncontrolled hypertension’ (MUCH) in patients with treated and apparently well-controlled BP is unknown. Objectives To define the prevalence and predictors of MUCH among hypertensive patients with controlled office blood pressure. Methods One hundred ninety-nine hypertensive patients presented to the specialized hypertension clinics at two University Hospitals. All patients had controlled office blood pressure (less than 140/90 mmHg). Patients were assessed regarding history, clinical examination, and laboratory data. All patients underwent ambulatory blood pressure monitoring (ABPM) for 24 h, within a week after the index office visit. MUCH was diagnosed if average 24-h ABPM was elevated (systolic BP ≥ 130 mmHg and/or diastolic BP ≥ 80 mmHg) despite controlled clinic BP. Results Sixty-six patients (33.2%) had MUCH according to 24-h ABPM criteria (mean age 53.5 ± 9.3 years, 60.6% men). MUCH was mostly caused by the poor control of nocturnal BP; with the percentage of patients in whom MUCH was solely attributable to an elevated nocturnal BP almost double that due to daytime BP elevation (57.3% vs. 27.1%, P < 0.001). The most common predictors of MUCH were smoking, DM and positive family history of DM. Conclusion The prevalence of masked suboptimal BP control is high. Office BP monitoring alone is thus inadequate to ascertain optimal BP control because many patients have an elevated nocturnal BP. ABPM is needed to confirm proper BP control, especially in patients with high cardiovascular risk profile. Smoking, DM and positive family history of DM were the most common predictors of MUCH.
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Key Words
- A/C ratio, Albumin/Creatinine ratio
- ABPM, Ambulatory Blood Pressure Monitoring
- ACEI, Angiotensin Converting Enzyme Inhibitor
- ARBs, Angiotensin Receptor Blockers
- Ambulatory BP monitoring
- BB, Beta Blockers
- BMI, Body Mass Index
- BP, Blood Pressure
- CAD, Coronary Artery Disease
- CCB, Calcium Channel Blocker
- CKD, Chronic Kidney Disease
- CV, Cardio-Vascular
- CVD, Cardio-Vascular Diseases
- DBP, Diastolic Blood Pressure
- DM, Diabetes Mellitus
- ECG, ElectroCardioGram
- HBPM, Home Blood Pressure Monitoring
- HDL Cholesterol, High-Density Lipoprotein Cholesterol
- HTN, Hypertension
- LDL Cholesterol, Low-Density Lipoprotein Cholesterol
- LVH, Left Ventricular Hypertrophy
- MH, Masked Hypertension
- MUCH, Masked Uncontrolled Hypertension
- Masked hypertension
- NHP, National Hypertension Project
- SBP, Systolic Blood Pressure
- SD, Standard Deviation
- TOD, Target Organ damage
- Uncontrolled hypertension
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Presta V, Figliuzzi I, D'Agostino M, Citoni B, Miceli F, Simonelli F, Coluccia R, Musumeci MB, Ferrucci A, Volpe M, Tocci G. Nocturnal blood pressure patterns and cardiovascular outcomes in patients with masked hypertension. J Clin Hypertens (Greenwich) 2018; 20:1238-1246. [PMID: 30058135 DOI: 10.1111/jch.13361] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 06/19/2018] [Accepted: 06/25/2018] [Indexed: 11/30/2022]
Abstract
Masked hypertension (MHT) is characterized by normal clinic and above normal 24-hour ambulatory blood pressure (BP) levels. We evaluated clinical characteristics and CV outcomes of different nocturnal patterns of MHT. We analyzed data derived from a large cohort of adult individuals, who consecutively underwent home, clinic, and ambulatory BP monitoring at our Hypertension Unit between January 2007 and December 2016. MHT was defined as clinic BP <140/90 mm Hg and 24-hour BP ≥ 130/80 mm Hg, and stratified into three groups according to dipping status: (a) dippers, (b) nondippers, and (c) reverse dippers. From an overall sample of 6695 individuals, we selected 2628 (46.2%) adult untreated individuals, among whom 153 (5.0%) had MHT. In this group, 67 (43.8%) were nondippers, 65 (42.5%) dippers, and 21 (13.7%) reverse dippers. No significant differences were found among groups regarding demographics, clinical characteristics, and prevalence of risk factors, excluding older age in reverse dippers compared to other groups (P < 0.001). Systolic BP levels were significantly higher in reverse dippers than in other groups at both 24-hour (135.6 ± 8.5 vs 130.4 ± 6.0 vs 128.2 ± 6.8 mm Hg, respectively; P < 0.001) and nighttime periods (138.2 ± 9.1 vs 125.0 ± 6.3 vs 114.5 ± 7.7 mm Hg; P < 0.001). Reverse dipping was associated with a significantly higher risk of stroke, even after correction for age, gender, BMI, dyslipidemia, and diabetes (OR 18.660; 95% IC [1.056-33.813]; P = 0.046). MHT with reverse dipping status was associated with higher burden of BP and relatively high risk of stroke compared to both dipping and nondipping profiles, although a limited number of CV outcomes have been recorded during the follow-up.
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Affiliation(s)
- Vivianne Presta
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy
| | - Ilaria Figliuzzi
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy
| | - Michela D'Agostino
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy
| | - Barbara Citoni
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy
| | - Francesca Miceli
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy
| | - Francesca Simonelli
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy
| | | | - Maria Beatrice Musumeci
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy
| | - Andrea Ferrucci
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy
| | - Massimo Volpe
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - Giuliano Tocci
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
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8
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Sheppard JP, Martin U, Gill P, Stevens R, Hobbs FR, Mant J, Godwin M, Hanley J, McKinstry B, Myers M, Nunan D, McManus RJ. Prospective external validation of the Predicting Out-of-OFfice Blood Pressure (PROOF-BP) strategy for triaging ambulatory monitoring in the diagnosis and management of hypertension: observational cohort study. BMJ 2018; 361:k2478. [PMID: 29950396 PMCID: PMC6020747 DOI: 10.1136/bmj.k2478] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To prospectively validate the Predicting Out-of-OFfice Blood Pressure (PROOF-BP) algorithm to triage patients with suspected high blood pressure for ambulatory blood pressure monitoring (ABPM) in routine clinical practice. DESIGN Prospective observational cohort study. SETTING 10 primary care practices and one hospital in the UK. PARTICIPANTS 887 consecutive patients aged 18 years or more referred for ABPM in routine clinical practice. All underwent ABPM and had the PROOF-BP applied. MAIN OUTCOME MEASURES The main outcome was the proportion of participants whose hypertensive status was correctly classified using the triaging strategy compared with the reference standard of daytime ABPM. Secondary outcomes were the sensitivity, specificity, and area under the receiver operator characteristic curve (AUROC) for detecting hypertension. RESULTS The mean age of participants was 52.8 (16.2) years. The triaging strategy correctly classified hypertensive status in 801 of the 887 participants (90%, 95% confidence interval 88% to 92%) and had a sensitivity of 97% (95% confidence interval 96% to 98%) and specificity of 76% (95% confidence interval 71% to 81%) for hypertension. The AUROC was 0.86 (95% confidence interval 0.84 to 0.89). Use of triaging, rather than uniform referral for ABPM in routine practice, would have resulted in 435 patients (49%, 46% to 52%) being referred for ABPM and the remainder managed on the basis of their clinic measurements. Of these, 69 (8%, 6% to 10%) would have received treatment deemed unnecessary had they received ABPM. CONCLUSIONS In a population of patients referred for ABPM, this new triaging approach accurately classified hypertensive status for most, with half the utilisation of ABPM compared with usual care. This triaging strategy can therefore be recommended for diagnosis or management of hypertension in patients where ABPM is being considered, particularly in settings with limited resources.
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Affiliation(s)
- James P Sheppard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care, OX2 6GG Oxford, UK
| | - Una Martin
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Paramjit Gill
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Richard Stevens
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care, OX2 6GG Oxford, UK
| | - Fd Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care, OX2 6GG Oxford, UK
| | | | | | | | | | | | - David Nunan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care, OX2 6GG Oxford, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care, OX2 6GG Oxford, UK
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Manto A, Dzudie A, Halle MP, Aminde LN, Abanda MH, Ashuntantang G, Blackett KN. Agreement between home and ambulatory blood pressure measurement in non-dialysed chronic kidney disease patients in Cameroon. Pan Afr Med J 2018; 29:71. [PMID: 29875952 PMCID: PMC5987084 DOI: 10.11604/pamj.2018.29.71.12078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 11/14/2017] [Indexed: 11/11/2022] Open
Abstract
Introduction home blood pressure measurement (HBPM) is not entirely capable of replacing ambulatory blood pressure (BP) measurement (ABPM), but is superior to office blood pressure measurement (OBPM). Although availability, cost, energy and lack of training are potential limitations for a wide use of HBPM in Sub-Saharan Africa (SSA), the method may add value for assessing efficacy and compliance in specific populations. We assessed the agreement between HBPM and ABPM in chronic kidney disease (CKD) patients in Douala, Cameroon. Methods from March to August 2014, we conducted a cross sectional study in non-dialyzed CKD patients with hypertension. Using the same devices and methods, the mean of nine office and eighteen home (during three consecutive days) blood pressure readings were recorded. Each patient similarly had a 24-hour ABPM. Kappa statistic was used to assess qualitative agreement between measurement techniques. Results forty-six patients (mean age: 56.2 ± 11.4 years, 28 men) were included. The prevalence of optimal blood pressure control was 26, 28 and 32% for OBPM, HBPM and ABPM respectively. Compared with ABPM, HBPM was more effective than OBPM, for the detection of non-optimal BP control (Kappa statistic: 0.49 (95% CI: 0.36 - 0.62) vs. 0.22 (95%CI: 0.21 - 0.35); sensitivity: 60 vs 40%; specificity: 87 vs. 81%). Conclusion HBPM potentially averts some proportion of BP misclassification in non-dialyzed hypertensive CKD patients in Cameroon.
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Affiliation(s)
- Audrey Manto
- Clinical Research Education, Networking and Consultancy (CRENC), Douala, Cameroon
| | - Anastase Dzudie
- Clinical Research Education, Networking and Consultancy (CRENC), Douala, Cameroon.,Department of Medicine, Douala General Hospital, Douala, Cameroon.,Soweto Cardiovascular Research Group and NIH Millennium Fogarty Chronic Disease Leadership Program, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Marie Patrice Halle
- Department of Medicine, Douala General Hospital, Douala, Cameroon.,Department of Clinical Sciences, Faculty of Medicine and Pharmaceutical Science, University of Douala, Cameroon
| | - Léopold Ndemnge Aminde
- Clinical Research Education, Networking and Consultancy (CRENC), Douala, Cameroon.,School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | | | - Gloria Ashuntantang
- Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon.,Department of Internal Medicine, Yaounde General Hospital, Yaounde, Cameroon
| | - Kathleen Ngu Blackett
- Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon.,Department of Medicine, Yaounde Teaching Hospital, Yaounde, Cameroon
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Trudel X, Milot A, Gilbert-Ouimet M, Duchaine C, Guénette L, Dalens V, Brisson C. Effort-Reward Imbalance at Work and the Prevalence of Unsuccessfully Treated Hypertension Among White-Collar Workers. Am J Epidemiol 2017; 186:456-462. [PMID: 28486615 DOI: 10.1093/aje/kwx116] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 10/03/2016] [Indexed: 01/01/2023] Open
Abstract
We examined the association between effort-reward imbalance (ERI) exposure at work and unsuccessfully treated hypertension among white-collar workers from a large cohort in Quebec City, Canada. The study used a repeated cross-sectional design involving 3 waves of data collection (2000-2009). The study sample was composed of 474 workers treated for hypertension, accounting for 739 observations. At each observation, ERI was measured using validated scales, and ambulatory blood pressure (BP) was measured every 15 minutes during the working day. Unsuccessfully treated hypertension was defined as daytime ambulatory BP of at least 135/85 mm Hg and was further divided into masked and sustained hypertension. Adjusted prevalence ratios and 95% confidence intervals were estimated. Participants in the highest tertile of ERI exposure had a higher prevalence of unsuccessfully treated hypertension (prevalence ratio = 1.45, 95% confidence interval: 1.16, 1.81) after adjustment for gender, age, education, family history of cardiovascular diseases, body mass index, diabetes, smoking, sedentary behaviors, and alcohol intake. The present study supports the effect of adverse psychosocial work factors from the ERI model on BP control in treated workers. Reducing these frequent exposures at work might lead to substantial benefits on BP control at the population level.
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11
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Asayama K. Observational study and participant-level meta-analysis on antihypertensive drug treatment-related cardiovascular risk. Hypertens Res 2017; 40:856-860. [PMID: 28446803 DOI: 10.1038/hr.2017.60] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 03/11/2017] [Accepted: 03/13/2017] [Indexed: 11/09/2022]
Abstract
Although antihypertensive therapy reduces cardiovascular risk, individuals who are treated with antihypertensive medication generally have a worse prognosis for cardiovascular disease than untreated people. We recently evaluated the impact of conventional blood pressure level based on two Japanese individual participant databases and found that conventional blood pressure at baseline was not or was weakly associated with cardiovascular events among patients under antihypertensive drug medication. In the general population in Ohasama and the Hypertension Objective Treatment Based on Measurement by Electrical Devices of Blood Pressures study, self-measured home blood pressure significantly predicted cardiovascular outcomes in patients under antihypertensive treatment. Hypertension is a chronic disease, and blood pressure must be evaluated with repeated measurements over a long period of time. Therefore, although not proven by a randomized controlled trial, it is likely that the long-term management of hypertension by antihypertensive drug treatment should be based on self-measured home blood pressure. We should also pay careful attention to the residual cardiovascular risk in treated patients.
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Affiliation(s)
- Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.,Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan
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12
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Predicting out-of-office blood pressure level using repeated measurements in the clinic: an observational cohort study. J Hypertens 2016; 32:2171-8; discussion 2178. [PMID: 25144295 PMCID: PMC4222615 DOI: 10.1097/hjh.0000000000000319] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Identification of people with lower (white-coat effect) or higher (masked effect) blood pressure at home compared to the clinic usually requires ambulatory or home monitoring. This study assessed whether changes in SBP with repeated measurement at a single clinic predict subsequent differences between clinic and home measurements. METHODS This study used an observational cohort design and included 220 individuals aged 35-84 years, receiving treatment for hypertension, but whose SBP was not controlled. The characteristics of change in SBP over six clinic readings were defined as the SBP drop, the slope and the quadratic coefficient using polynomial regression modelling. The predictive abilities of these characteristics for lower or higher home SBP readings were investigated with logistic regression and repeated operating characteristic analysis. RESULTS The single clinic SBP drop was predictive of the white-coat effect with a sensitivity of 90%, specificity of 50%, positive predictive value of 56% and negative predictive value of 88%. Predictive values for the masked effect and those of the slope and quadratic coefficient were slightly lower, but when the slope and quadratic variables were combined, the sensitivity, specificity, positive and negative predictive values for the masked effect were improved to 91, 48, 24 and 97%, respectively. CONCLUSION Characteristics obtainable from multiple SBP measurements in a single clinic in patients with treated hypertension appear to reasonably predict those unlikely to have a large white-coat or masked effect, potentially allowing better targeting of out-of-office monitoring in routine clinical practice.
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Prevalence of masked uncontrolled hypertension according to the number of office blood pressure measurements. Rev Clin Esp 2015; 215:425-30. [DOI: 10.1016/j.rce.2015.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 04/20/2015] [Accepted: 06/17/2015] [Indexed: 11/18/2022]
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Prevalence of masked uncontrolled hypertension according to the number of office blood pressure measurements. Rev Clin Esp 2015. [DOI: 10.1016/j.rceng.2015.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kario K, Saito I, Kushiro T, Teramukai S, Ishikawa Y, Kobayashi F, Shimada K. Effects of olmesartan-based treatment on masked, white-coat, poorly controlled, and well-controlled hypertension: HONEST study. J Clin Hypertens (Greenwich) 2014; 16:442-50. [PMID: 24766515 PMCID: PMC4237560 DOI: 10.1111/jch.12323] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 02/26/2014] [Accepted: 03/05/2014] [Indexed: 11/28/2022]
Abstract
The authors examined the effects of olmesartan‐based treatment on clinic systolic blood pressure (CSBP) and morning home systolic blood pressure (HSBP) in 21,340 patients with masked hypertension (MH), white‐coat hypertension (WCH), poorly controlled hypertension (PCH), and well‐controlled hypertension (CH) using data from the Home Blood Pressure Measurement With Olmesartan Naive Patients to Establish Standard Target Blood Pressure (HONEST) study. MH, WCH, PCH, and CH were defined using CSBP 140 mm Hg and MHSBP 135 mm Hg as cutoff values at baseline. At 16 weeks, the MH, WCH, PCH, and CH groups had changes in CSBP by −1.0, −15.2, −23.1, and 1.8 mm Hg, and changes in morning HSBP by −12.5, 1.0, −20.3, and 2.0 mm Hg, respectively. In conclusion, in “real‐world” clinical practice, olmesartan‐based treatment decreased high morning HBP or CBP without excessive decreases in normal morning HBP or CBP according to patients' BP status.
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Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, School of Medicine, Tochigi, Japan
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Unmasking masked hypertension: prevalence, clinical implications, diagnosis, correlates and future directions. J Hum Hypertens 2014; 28:521-8. [PMID: 24573133 DOI: 10.1038/jhh.2014.9] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 12/27/2013] [Accepted: 01/23/2014] [Indexed: 12/17/2022]
Abstract
'Masked hypertension' is defined as having non-elevated clinic blood pressure (BP) with elevated out-of-clinic average BP, typically determined by ambulatory BP monitoring. Approximately 15-30% of adults with non-elevated clinic BP have masked hypertension. Masked hypertension is associated with increased risks of cardiovascular morbidity and mortality compared with sustained normotension (non-elevated clinic and ambulatory BP), which is similar to or approaching the risk associated with sustained hypertension (elevated clinic and ambulatory BP). The confluence of increased cardiovascular risk and a failure to be diagnosed by the conventional approach of clinic BP measurement makes masked hypertension a significant public health concern. However, many important questions remain. First, the definition of masked hypertension varies across studies. Further, the best approach in the clinical setting to exclude masked hypertension also remains unknown. It is unclear whether home BP monitoring is an adequate substitute for ambulatory BP monitoring in identifying masked hypertension. Few studies have examined the mechanistic pathways that may explain masked hypertension. Finally, scarce data are available on the best approach to treating individuals with masked hypertension. Herein, we review the current literature on masked hypertension including definition, prevalence, clinical implications, special patient populations, correlates, issues related to diagnosis, treatment and areas for future research.
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Komori T, Eguchi K, Kabutoya T, Ishikawa J, Hoshide S, Kario K. Left ventricular diastolic function evaluated by the E/e’ ratio is impaired in patients with masked uncontrolled hypertension. Clin Exp Hypertens 2014; 36:538-44. [DOI: 10.3109/10641963.2014.881839] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Alessi A, Brandão AA, de Paiva AMG, Nogueira ADR, Feitosa A, Gonzaga CDC, Amodeo C, Mion D, de Souza DDSM, Barbosa E, Lima Junior E, Nobre F, Fuchs FD, Chaves Junior H, Schneider JC, Gemelli J, Villela-Martin JF, Scala LCN, Gomes MAM, Malachias MVB, de Morais NS, Moreira Filho O, Passarelli Junior O, Jardim PCBV, Miranda RD, Póvoa R, Fuchs SC, Baiocchi S, Jardim TV, Barroso WKS. I Brazilian position paper on prehypertension, white coat hypertension and masked hypertension: diagnosis and management. Arq Bras Cardiol 2014; 102:110-8. [PMID: 24676366 PMCID: PMC3987343 DOI: 10.5935/abc.20140011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 12/03/2013] [Accepted: 12/03/2013] [Indexed: 01/22/2023] Open
Affiliation(s)
- Alexandre Alessi
- Brazilian Society of Cardiology Arterial Hypertension Department
| | | | | | | | - Audes Feitosa
- Brazilian Society of Cardiology Arterial Hypertension Department
| | | | - Celso Amodeo
- Brazilian Society of Cardiology Arterial Hypertension Department
| | - Decio Mion
- Brazilian Society of Cardiology Arterial Hypertension Department
| | | | - Eduardo Barbosa
- Brazilian Society of Cardiology Arterial Hypertension Department
| | | | - Fernando Nobre
- Brazilian Society of Cardiology Arterial Hypertension Department
| | | | | | | | - João Gemelli
- Brazilian Society of Cardiology Arterial Hypertension Department
| | | | | | | | | | | | | | | | | | | | - Rui Póvoa
- Brazilian Society of Cardiology Arterial Hypertension Department
| | | | - Sergio Baiocchi
- Brazilian Society of Cardiology Arterial Hypertension Department
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El diagnóstico exacto de la hipertensión: la influencia del factor humano a pesar de las tomas repetidas. REVISTA COLOMBIANA DE CARDIOLOGÍA 2013. [DOI: 10.1016/s0120-5633(13)70082-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Redon J, Bilo G, Parati G. The effects of telmisartan alone or in combination with hydrochlorothiazide on morning home blood pressure control: The SURGE 2 practice-based study. Blood Press 2013; 22:377-85. [DOI: 10.3109/08037051.2013.789643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Effect of the angiotensin II receptor antagonist olmesartan on morning home blood pressure in hypertension: HONEST study at 16 weeks. J Hum Hypertens 2013; 27:721-8. [PMID: 23863805 PMCID: PMC3831295 DOI: 10.1038/jhh.2013.68] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 04/29/2013] [Accepted: 06/11/2013] [Indexed: 11/08/2022]
Abstract
Morning home blood pressure (BP) levels are more closely associated with cardiovascular risk than clinic BP levels. However, control of morning home BP has been worse than that of clinic BP in clinical practice. We examined the effects of olmesartan-based treatment using data (n=21 341) from the first 16 weeks of the Home BP measurement with Olmesartan Naive patients to Establish Standard Target blood pressure (HONEST) study, a prospective observational study for olmesartan-naive patients with essential hypertension. After 16-week olmesartan-based treatment, the clinic and morning home systolic BP (SBP) lowered from 151.6±16.4 and 153.6±19.0 mm Hg to 135.0±13.7 and 135.5±13.7 mm Hg, respectively (P<0.0001). The achievement percentage of target morning home SBP (<135 mm Hg) in all patients, those with diabetes mellitus (DM), and those with chronic kidney disease (CKD) increased from 13.5, 16.4 and 17.2% to 50.8, 47.9 and 48.8%, respectively, and the proportion of patients with well-controlled hypertension (clinic SBP<140 mm Hg and morning home SBP<135 mm Hg) increased from 7.9, 9.2 and 10.2% to 38.9, 34.5 and 36.3%, respectively. After 16-week olmesartan-based treatment, the proportion of patients with masked and white coat hypertension changed from 11.8 to 24.2% and 5.6 to 11.9%. In conclusion, both clinic and morning home BP in all, DM and CKD patients improved with 16-week olmesartan-based treatment in the ‘real world', and the results showed a sustained 24-hour BP-lowering effect of olmesartan. Decrease in clinic and home BP resulted in an increased rate of masked and white coat hypertension, and further management is needed in those patients.
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Imai Y. Clinical significance of home blood pressure and its possible practical application. Clin Exp Nephrol 2013; 18:24-40. [DOI: 10.1007/s10157-013-0831-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 06/14/2013] [Indexed: 10/26/2022]
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Barochiner J, Cuffaro PE, Aparicio LS, Alfie J, Rada MA, Morales MS, Galarza CR, Waisman GD. Predictors of masked hypertension among treated hypertensive patients: an interesting association with orthostatic hypertension. Am J Hypertens 2013; 26:872-8. [PMID: 23482377 DOI: 10.1093/ajh/hpt036] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Masked hypertension (MH) entails an increased cardiovascular risk. Therefore, it is important to identify those individuals who would benefit the most from out-of-office blood pressure (BP) measurement. We sought to determine the prevalence and identify predictors of MH among adult hypertensive patients under treatment. METHODS Treated hypertensive patients aged ≥ 18 years underwent office (duplicate sitting and standing BP in 1 visit) and home BP measurements (duplicate measurements for 4 days in the morning, afternoon, and evening; at least 16 measurements) and completed a questionnaire regarding risk factors and history of cardiovascular disease. MH was defined as normal office BP (<140/90mm Hg) with elevated home BP (≥135/85mm Hg, average of all readings discarding first day measurements). Patients with a systolic BP rise upon standing ≥5mm Hg were considered to have orthostatic hypertension (OHT). Variables indentified as relevant predictors of MH were entered into a multivariable logistic regression analysis model. RESULTS Three hundred and four patients were included (mean age = 66.7 ±13.8; 67.4% women). The prevalence of MH in the whole population was 12.4% and was 20.9% among patients with office-controlled hypertension. Factors independently associated with MH were age (odds ratio (OR) = 1.08, 95% confidence interval (CI) = 1.03-1.14), high-normal office systolic BP (OR = 5.61, 95% CI = 1.39-22.57), history of peripheral artery disease (PAD) (OR = 8.83, 95% CI = 1.5-51.84), moderate alcohol consumption (OR = 0.08, 95% CI = 0.01-0.73), and OHT (OR = 3.65, 95% CI = 1.27 to 10.51). CONCLUSIONS Easily measurable parameters such as age, office systolic BP, history of PAD, and OHT may help to detect a population at risk of MH that would benefit from home BP monitoring.
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Affiliation(s)
- Jessica Barochiner
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
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The Importance of 24-Hour Ambulatory Blood Pressure Monitoring in Patients at Risk of Cardiovascular Events. High Blood Press Cardiovasc Prev 2013; 20:13-8. [DOI: 10.1007/s40292-013-0006-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 10/28/2012] [Indexed: 11/25/2022] Open
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Imai Y, Kario K, Shimada K, Kawano Y, Hasebe N, Matsuura H, Tsuchihashi T, Ohkubo T, Kuwajima I, Miyakawa M. The Japanese Society of Hypertension Guidelines for Self-monitoring of Blood Pressure at Home (Second Edition). Hypertens Res 2012; 35:777-95. [PMID: 22863910 DOI: 10.1038/hr.2012.56] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yutaka Imai
- Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmacological Sciences, Sendai, Japan
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Ohta Y, Tsuchihashi T, Kiyohara K. Consequence of Masked Hypertension in Treated Hypertensive Outpatients: 1-Year Follow-Up Study. Clin Exp Hypertens 2011; 33:270-4. [DOI: 10.3109/10641963.2010.549266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
The diagnosis of masked hypertension has been made easier with the widespread availability of home blood pressure monitoring devices with levels of accuracy comparable to ambulatory blood pressure monitoring. The negative impact of masked hypertension on cardiovascular morbidity and mortality is evidenced by numerous well-designed clinic-based and population-based studies. The relationship of masked hypertension and target organ damage is also well documented. These two factors, combined with the robust evidence of reduced cardiovascular morbidity and mortality achieved with blood pressure treatment, makes the argument for actively identifying patients with masked hypertension and prescribing treatment similar to that for patients with sustained hypertension. In this paper, we review the evidence for the cardiovascular prognosis of masked hypertension compared with sustained hypertension, we review its impact on target organ damage, we propose an algorithm for the treatment of patients with masked hypertension, and we point out the pitfalls in adopting such an approach.
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Berlowitz DR, Franklin S. The clock is ticking: the case for achieving more rapid control of hypertension. J Clin Hypertens (Greenwich) 2010; 12:323-7. [PMID: 20546372 DOI: 10.1111/j.1751-7176.2010.00274.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Stroke risk in treated hypertension based on home blood pressure: the Ohasama study. Am J Hypertens 2010; 23:508-14. [PMID: 20186131 DOI: 10.1038/ajh.2010.15] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Several observational studies have shown that treated hypertensives are characterized as having worse prognosis than nonhypertensives. However, there is little evidence based on home blood pressure (home BP) measurement. We compare the risk of stroke between untreated individuals and those taking antihypertensive medication based on home BP and casual-screening BP (casual BP) in the general population. METHODS The study included 1,690 untreated and 700 treated subjects aged >or=35 years. We measured home BP and casual BP at the beginning of the study. The risk of first stroke was examined by using the Cox proportional hazards model. RESULTS During 11.9 years of follow-up, we observed 242 first-time stroke cases. Treated subjects had significantly higher risk for stroke than untreated subjects based on home BP (relative hazard (RH) = 1.48) as well as on casual BP (RH = 1.78), adjusted for systolic BP values and characteristics. When subjects were classified into six categories based on BP (optimal, normal, high normal, and grade 1-3 hypertension), RHs in treated hypertensives linearly increased (trend P < 0.01) based on home BP. However, there was no consistent association for casual BP (trend P: not significant) in treated subjects. Stroke risk was linearly increased regardless of the BP information source in untreated subjects (home BP: trend P < 0.01, casual BP: trend P < 0.01). CONCLUSION The results suggest a strong association between elevated home BP and increased risk of stroke. Home BP is a better tool to assess stroke risk, especially in treated hypertensives.
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Practice and awareness of physicians regarding home blood pressure measurement in Japan. Hypertens Res 2010; 33:428-34. [DOI: 10.1038/hr.2010.10] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Home and Office Blood Pressure Control among Treated Hypertensive Patients in Japan: Findings from the Japan Home versus Office Blood Pressure Measurement Evaluation (J-HOME) Study. Pharmaceuticals (Basel) 2010; 3:419-432. [PMID: 27713260 PMCID: PMC4033918 DOI: 10.3390/ph3020419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 01/29/2010] [Accepted: 02/02/2010] [Indexed: 11/25/2022] Open
Abstract
Appropriate control of blood pressure (BP) is essential for prevention of future cardiovascular events. However, BP control among treated hypertensive patients has been insufficient. Recently, the usefulness of self-measured BP at home (home BP measurement) for the management of hypertension has been reported in many studies. We evaluated BP control both at home and in the office among treated hypertensive patients in primary care settings in Japan (the J-HOME study). We found poor control of home and office BPs and clarified some factors affecting control. We also examined factors associated with the magnitude of the white-coat effect, the morning–evening BP difference, and home heart rate in this J-HOME study.
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Obara T, Ohkubo T, Asayama K, Kikuya M, Metoki H, Inoue R, Komai R, Murai K, Hashimoto J, Totsune K, Imai Y. Prevalence of Masked Hypertension in Subjects Treated with Antihypertensive Drugs as Assessed by Morning versus Evening Home Blood Pressure Measurements: The J-HOME Study. Clin Exp Hypertens 2009; 30:277-87. [DOI: 10.1080/10641960802071018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Stroke risk and antihypertensive drug treatment in the general population: the Japan arteriosclerosis longitudinal study. J Hypertens 2009; 27:357-64. [DOI: 10.1097/hjh.0b013e32831967ca] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Prevalence, causes, and consequences of masked hypertension: a meta-analysis. Am J Hypertens 2008; 21:969-75. [PMID: 18583985 DOI: 10.1038/ajh.2008.221] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Masked hypertension (MH) is a relatively newly detected condition of which little is known. More information about MH may help to improve overall antihypertensive health care. We aimed to investigate the prevalence, potential causes, and associated consequences of MH. METHODS We searched published literature using MEDLINE, EMBASE, and the Cochrane database completed with references cited in reviews and original study articles. We restricted our research to articles written in the English, German, French, and Spanish language. Studies were included only when the prevalence of MH was reported, office blood pressure (BP) values were given, and methods of BP measurements were described in detail. All data were extracted independently by two readers with a standardized protocol and data-collection form. RESULTS The prevalence of MH averaged 16.8% (95% confidence interval 13.0-20.5%). The MH prevalence was 7% for children and 19% for adults. MH prevalences did not differ significantly when determined with self or ambulatory BP measurement (21.1% vs. 16.8%; P = 0.42). Subjects with MH had significantly higher left ventricular mass index (LVMI) values than normotensives (110 vs. 98 g/m2; P < 0.01) but similar values as sustained hypertensives (109 g/m2). In addition, patients with MH were more often smokers than normotensives (mean difference 18%; P < 0.03). CONCLUSIONS MH strikes about a quarter of the patients who were initially classified as normotensives (based on office BP measurements) and of treated hypertensives. Patients with MH seem to have a similar cardiovascular risk as sustained hypertensives but they may remain undetected. The presence of MH seems to be a matter of a coincidently low office BP value not related to certain subject characteristics although the chance of its presence may be increased by smoking and antihypertensive treatment.
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Papadopoulos DP, Makris TK. Masked hypertension definition, impact, outcomes: a critical review. J Clin Hypertens (Greenwich) 2008; 9:956-63. [PMID: 18046102 DOI: 10.1111/j.1524-6175.2007.07418.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The phenomenon of masked hypertension (MH) is defined as a clinical condition in which a patient's office blood pressure (BP) level is <140/90 mm Hg but ambulatory or home BP readings are in the hypertensive range. The prevalence in the population is about the same as that of isolated office hypertension; about 1 in 7 or 8 persons with a normal office BP level may fall into this category. The high prevalence of MH would suggest the necessity for measuring out-of-office BP in persons with apparently normal or well-controlled office BP. Reactivity to daily life stressors and behavioral factors such as smoking, alcohol use, contraceptive use in women, and sedentary habits can selectively influence MH. MH should be searched for in individuals who are at increased risk for cardiovascular complications including patients with kidney disease or diabetes. Individuals with MH have been shown to have a greater-than-normal prevalence of organ damage, particularly with an increased prevalence of metabolic risk factors, left ventricular mass index, carotid intima-media thickness, and impaired large artery distensibility compared with patients with a truly normal BP level in and out of the clinic or office. Also, outcome studies have suggested that MH increases cardiovascular risk, which appears to be close to that of in-office and out-of-office hypertension. The aim of this review was to define the entity of MH, to describe its prevalence in the general population, and to discuss its correlation with cardiovascular events.
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Chavanu K, Merkel J, Quan AM. Role of ambulatory blood pressure monitoring in the management of hypertension. Am J Health Syst Pharm 2008; 65:209-18. [PMID: 18216005 DOI: 10.2146/ajhp060663] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Tamaki S, Nakamura Y, Teramura M, Sakai H, Takayama T, Okabayashi T, Kawashima T, Horie M. The factors contributing to whether or not hypertensive patients bring their home blood pressure record to the outpatient clinic. Intern Med 2008; 47:1561-5. [PMID: 18797113 DOI: 10.2169/internalmedicine.47.0710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE We investigated the factors contributing to whether or not hypertensive patients brought their home blood pressure records to the outpatient clinic. METHOD We studied 325 hypertensive patients [169 men (66.3+/-11.4 years old) and 156 women (68.1+/-11.2 years old)] who had received medical treatment for hypertension in our outpatient clinic from June to August 2006. RESULTS Of the 325 patients studied, 206 (63.4%, 101 men, 105 women) brought their home blood pressure records to our outpatient clinic. Logistic analysis showed age [odds ratio (OR) =0.95; 95% confidence interval (CI): 0.93-0.98; p=0.0002], systolic blood pressure in outpatient clinic (OR=1.02; 95% CI: 1.00-1.04; p=0.0488) and the number of medicines prescribed (OR=1.94; 95% CI: 1.37-2.75; p=0.0002) were independent factors contributing to whether or not hypertensive patients bring along their home blood pressure records to the outpatient clinic. CONCLUSION The contributing factors determining whether the patients bring their home blood pressure records to the outpatient clinic were: younger age, higher systolic blood pressure in the outpatient clinic, and a higher number of antihypertensive drugs. In conclusion, our results suggest that physicians should further motivate older patients, with well-controlled blood pressure in the outpatient clinic, to bring their home blood pressure records to the outpatient clinic.
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Affiliation(s)
- Shinji Tamaki
- Division of Cardiology, Department of Medicine, Kohka Public Hospital.
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Abstract
The prevalence and clinical significance of masked hypertension (MHT) in diabetics have infrequently been described. The authors assessed the association of MHT (defined using a clinic blood pressure [BP] <140/90 mm Hg and daytime ambulatory BP > or = 135/85 mm Hg) with microvascular and macrovascular end organ damage in 81 clinically normotensive Japanese diabetic persons. The prevalence of silent cerebral infarcts (SCIs), increased left ventricular mass, and albuminuria were evaluated. Of 81 patients, 38 (46.9%) were classified as having MHT and showed significantly more SCIs (mean +/- SE: 2.5+/-0.5 vs 1.1+/-0.2; P=.017), and more albuminuria (39% vs 16%; P=.025), but no increase in left ventricular mass index, than the normotensive persons in office and on ambulatory BP monitoring group. The prevalence of MHT in this diabetic population was high (47%). Diabetic patients with MHT showed evidence of brain and kidney damage. Hence, out-of-office monitoring of BP may be indicated in diabetics whose BP is normal in the clinic.
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Affiliation(s)
- Thomas G Pickering
- Center for Behavioral Cardiovascular Health, Division of General Medicine, Columbia University Medical Center, New York 10032, USA.
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Boreu QF, de Tuero GC, Rodríguez-Poncelas A, Albertos MS, Zafra MS, Radó MAB. Proportion of isolated clinical hypertension in primary care settings. Comparison of target organ damage in patients with isolated clinical hypertension and patients with sustained arterial hypertension. Blood Press 2007; 16:354-61. [PMID: 17852096 DOI: 10.1080/08037050701538089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The aim of this study was to determine the proportion of isolated clinical hypertension (ICH) in newly diagnosed hypertensive patients, and to compare the incidence of target organ damage (TOD) in ICH and sustained hypertension patients. Participants. In a multi-centre study involving 14 primary care centres in Girona, Spain, 140 researchers recruited 214 newly diagnosed hypertensive patients 15-75 years of age, without history of cardiovascular events. Period of study. 2004-6. Method. Self-blood pressure monitoring (SBPM) and ambulatory blood pressure monitoring (ABPM). Evaluation. Anamnesis including blood pressure, physical examination and analysis (creatinine, albumin/creatinine index), electrocardiogram (left ventricular hypertrophy) and retinography (fundus damage). Results. In 129 (60.3%) subjects with sustained hypertension and 85 (39.7%) with ICH, no significant differences were found relative to gender, age, body mass index or blood pressure (155/90 vs 154/90 mmHg, respectively). Cholesterol levels were significant differences between both groups (5.97 mmol/l in sustained hypertension vs 5.64 mmol/l in ICH, p = 0.029). The proportion of ICH was approximately 40%. TOD incidence in sustained hypertensives was similar to that of ICH patients.
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Abstract
Early diagnosis of hypertension is one benefit of home blood pressure monitoring. Home measurement may also be used for the detection of masked hypertension. Home blood pressure readings have a strong correlation with risk, and the method has many advantages over office measurement in the management of hypertension, especially in patients with chronic kidney disease or diabetes. The present article provides practical advice on incorporating home blood pressure monitoring into practice. Patient education and training are discussed, as are tips to aid in the selection of devices for blood pressure measurement at home.
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Affiliation(s)
- Donald W McKay
- Division of BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador.
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McKay DW, Myers MG, Bolli P, Chockalingam A. Masked hypertension: a common but insidious presentation of hypertension. Can J Cardiol 2006; 22:617-20. [PMID: 16755318 PMCID: PMC2560871 DOI: 10.1016/s0828-282x(06)70285-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
A patient has masked hypertension when his office blood pressure is less than 140/90 mmHg but his ambulatory or home blood pressure readings are in the hypertensive range. Several recent studies have demonstrated that cardiovascular risk is similar between those with masked hypertension and those with sustained hypertension. The prevalence of masked hypertension in Canada is not known, but data from other countries suggest rates greater than 8%. Physicians need to use careful clinical judgment to identify and treat subjects with masked hypertension. The present review discusses masked hypertension, its importance to clinical practice and some aspects of patient management.
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Affiliation(s)
- D W McKay
- Division of Basic Medical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada.
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From measurement to profiles, phenomena and indices: a workshop of the European Society of Hypertension. Blood Press Monit 2005. [DOI: 10.1097/00126097-200512000-00001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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