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Guirguis-Blake JM, Evans CV, Webber EM, Coppola EL, Perdue LA, Weyrich MS. Screening for Hypertension in Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2021; 325:1657-1669. [PMID: 33904862 DOI: 10.1001/jama.2020.21669] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Hypertension is a major risk factor for cardiovascular disease and can be modified through lifestyle and pharmacological interventions to reduce cardiovascular events and mortality. OBJECTIVE To systematically review the benefits and harms of screening and confirmatory blood pressure measurements in adults, to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMed, Cochrane Collaboration Central Registry of Controlled Trials, and CINAHL; surveillance through March 26, 2021. STUDY SELECTION Randomized clinical trials (RCTs) and nonrandomized controlled intervention studies for effectiveness of screening; accuracy studies for screening and confirmatory measurements (ambulatory blood pressure monitoring as the reference standard); RCTs and nonrandomized controlled intervention studies and observational studies for harms of screening and confirmation. DATA EXTRACTION AND SYNTHESIS Independent critical appraisal and data abstraction; meta-analyses and qualitative syntheses. MAIN OUTCOMES AND MEASURES Mortality; cardiovascular events; quality of life; sensitivity, specificity, positive and negative predictive values; harms of screening. RESULTS A total of 52 studies (N = 215 534) were identified in this systematic review. One cluster RCT (n = 140 642) of a multicomponent intervention including hypertension screening reported fewer annual cardiovascular-related hospital admissions for cardiovascular disease in the intervention group compared with the control group (difference, 3.02 per 1000 people; rate ratio, 0.91 [95% CI, 0.86-0.97]). Meta-analysis of 15 studies (n = 11 309) of initial office-based blood pressure screening showed a pooled sensitivity of 0.54 (95% CI, 0.37-0.70) and specificity of 0.90 (95% CI, 0.84-0.95), with considerable clinical and statistical heterogeneity. Eighteen studies (n = 57 128) of various confirmatory blood pressure measurement modalities were heterogeneous. Meta-analysis of 8 office-based confirmation studies (n = 53 183) showed a pooled sensitivity of 0.80 (95% CI, 0.68-0.88) and specificity of 0.55 (95% CI, 0.42-0.66). Meta-analysis of 4 home-based confirmation studies (n = 1001) showed a pooled sensitivity of 0.84 (95% CI, 0.76-0.90) and a specificity of 0.60 (95% CI, 0.48-0.71). Thirteen studies (n = 5150) suggested that screening was associated with no decrement in quality of life or psychological distress; evidence on absenteeism was mixed. Ambulatory blood pressure measurement was associated with temporary sleep disturbance and bruising. CONCLUSIONS AND RELEVANCE Screening using office-based blood pressure measurement had major accuracy limitations, including misdiagnosis; however, direct harms of measurement were minimal. Research is needed to determine optimal screening and confirmatory algorithms for clinical practice.
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Affiliation(s)
- Janelle M Guirguis-Blake
- Department of Family Medicine, University of Washington, Tacoma
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Corinne V Evans
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Elizabeth M Webber
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Erin L Coppola
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Leslie A Perdue
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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Bennett AN, Dyball DM, Boos CJ, Fear NT, Schofield S, Bull AMJ, Cullinan P. Study protocol for a prospective, longitudinal cohort study investigating the medical and psychosocial outcomes of UK combat casualties from the Afghanistan war: the ADVANCE Study. BMJ Open 2020; 10:e037850. [PMID: 33127630 PMCID: PMC7604820 DOI: 10.1136/bmjopen-2020-037850] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 07/16/2020] [Accepted: 09/21/2020] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The Afghanistan war (2003-2014) was a unique period in military medicine. Many service personnel survived injuries of a severity that would have been fatal at any other time in history; the long-term health outcomes of such injuries are unknown. The ArmeD SerVices TrAuma and RehabilitatioN OutComE (ADVANCE) study aims to determine the long-term effects on both medical and psychosocial health of servicemen surviving this severe combat related trauma. METHODS AND ANALYSIS ADVANCE is a prospective cohort study. 1200 Afghanistan-deployed male UK military personnel and veterans will be recruited and will be studied at 0, 3, 6, 10, 15 and 20 years. Half are personnel who sustained combat trauma; a comparison group of the same size has been frequency matched based on deployment to Afghanistan, age, sex, service, rank and role. Participants undergo a series of physical health tests and questionnaires through which information is collected on cardiovascular disease (CVD), CVD risk factors, musculoskeletal disease, mental health, functional and social outcomes, quality of life, employment and mortality. ETHICS AND DISSEMINATION The ADVANCE Study has approval from the Ministry of Defence Research Ethics Committee (protocol no:357/PPE/12) agreed 15 January 2013. Its results will be disseminated through manuscripts in clinical/academic journals and presentations at professional conferences, and through participant and stakeholder communications. TRIAL REGISTRATION NUMBER The ADVANCE Study is registered at ISRCTN ID: ISRCTN57285353.
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Affiliation(s)
- Alexander N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Daniel Mark Dyball
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK
- King's Centre for Military Health Research, King's College London, London, UK
| | - Christopher J Boos
- Department of Cardiology, University Hospital Dorset, NHS Trust, Poole, UK
| | - Nicola T Fear
- King's Centre for Military Health Research, King's College London, London, UK
- Academic Department for Military Mental Health, King's College London, London, UK
| | - Susie Schofield
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Anthony M J Bull
- Centre for Blast Injury Studies, Imperial College London, London, UK
| | - Paul Cullinan
- Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College, London, UK
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Short-term blood pressure variability outweighs average 24-h blood pressure in the prediction of cardiovascular events in hypertension of the young. J Hypertens 2019; 37:1419-1426. [DOI: 10.1097/hjh.0000000000002074] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Impact of age on the association between 24-h ambulatory blood pressure measurements and target organ damage. J Hypertens 2018; 36:1895-1901. [PMID: 29782391 DOI: 10.1097/hjh.0000000000001778] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the impact of age on the associations between hemodynamic components derived from 24-h ambulatory blood pressure (24-h ABPM) and target organ damage, in apparently healthy, nonmedicated individuals. METHODS Twenty-four-hour ABPM and target organ damage (left ventricular mass index, pulse wave velocity, urine albumin : creatinine ratio and carotid atherosclerotic plaques) were evaluated in 1408 individuals. Associations were examined in regression models, stratified for age [middle-aged (41 or 51 years) or elderly (61 or 71 years)], and adjusted for sex, smoking status, and total-cholesterol. RESULTS In middle-aged individuals, an increase of 10 mmHg in 24-h SBP was independently associated with an increase of 3.8 (2.7-4.8) g/m in LVMI. The effect was nearly doubled in the elderly subgroup, where the same increase resulted in an increase in LVMI of 6.3 (5.0-7.6) g/m (P for interaction <0.01). An increase of 10 mmHg of 24-h SBP was associated with a 6.7% increase in pulse wave velocity in middle-aged individuals and with an 9.1% increase in elderly individuals (P for interaction <0.01). An independent association between 24-h ABPM and urine albumin : creatinine ratio was only observed in the elderly subgroup. Associations between the presence of atherosclerotic plaques and components from 24-h ABPM except 24-h DBP were not modified by age (all P for interaction >0.26). CONCLUSION Age enhances the associations between hemodynamic components obtained from 24-h ABPM and measures of arterial stiffness, microvascular damage, and cardiac structure, but not atherosclerosis.
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Olesen TB, Stidsen JV, Blicher MK, Pareek M, Rasmussen S, Vishram-Nielsen JK, Olsen MH. Impact of Age and Target-Organ Damage on Prognostic Value of 24-Hour Ambulatory Blood Pressure. Hypertension 2017; 70:1034-1041. [DOI: 10.1161/hypertensionaha.117.09173] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 02/19/2017] [Accepted: 08/16/2017] [Indexed: 12/25/2022]
Abstract
Markers of target-organ damage and 24-hour ambulatory blood pressure (BP) measurement improve cardiovascular risk stratification. The prevalence of target-organ damage and raised BP increases with aging. The study aim was to evaluate the impact of age and target-organ damage on the prognostic value of ambulatory BP. Markers of target-organ damage and ambulatory BP were measured in 1408 healthy people aged 41 or 51 (middle-aged group), and 61 or 71 (older group) years. The primary outcome was cardiovascular events after 16 years of follow-up, with data obtained from national registries. The prognostic value of BP was evaluated with Cox regression models, adjusted for traditional risk factors and target-organ damage, including left ventricular mass, pulse wave velocity, carotid plaques, and urine albumin/creatinine ratio. A total of 323 events were observed. In comparison with traditional risk factors, adding systolic BP and presence of target-organ damage improved risk stratification by increasing concordance index from 0.711 to 0.728 (
P
=0.01). In middle-aged subjects with target-organ damage, increment in pulse pressure (hazard ratio, 1.70; 95% confidence interval, 1.31–2.21;
P
<0.01) and increment in average real variability (hazard ratio, 1.29; 95% confidence interval, 1.05–1.59;
P
=0.02) were associated with a greater risk of cardiovascular disease compared with subjects without target-organ damage: hazard ratio, 1.04 (95% confidence interval, 0.74–1.46;
P
=0.81);
P
for interaction, 0.02; and hazard ratio, 0.89 (95% confidence interval, 0.69–1.14;
P
=0.36);
P
for interaction, 0.01. Target-organ damage may be a marker of individual susceptibility to the harmful effects of pulse pressure and BP variability on the cardiovascular system in middle-aged individuals.
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Affiliation(s)
- Thomas B. Olesen
- From the Department of Endocrinology, Odense University Hospital, Denmark (T.B.O., J.V.S., M.K.B., M.P.); Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, University of Copenhagen, Denmark (S.R.); Research Centre for Prevention and Health, Glostrup Hospital, University of Copenhagen, Denmark (J.K.K.V.-N.); Department of Internal Medicine, Holbæk Hospital, Denmark (M.P., M.H.O.); and Centre for Individualized Medicine in Arterial Diseases, Odense University Hospital, Denmark
| | - Jacob V. Stidsen
- From the Department of Endocrinology, Odense University Hospital, Denmark (T.B.O., J.V.S., M.K.B., M.P.); Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, University of Copenhagen, Denmark (S.R.); Research Centre for Prevention and Health, Glostrup Hospital, University of Copenhagen, Denmark (J.K.K.V.-N.); Department of Internal Medicine, Holbæk Hospital, Denmark (M.P., M.H.O.); and Centre for Individualized Medicine in Arterial Diseases, Odense University Hospital, Denmark
| | - Marie K. Blicher
- From the Department of Endocrinology, Odense University Hospital, Denmark (T.B.O., J.V.S., M.K.B., M.P.); Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, University of Copenhagen, Denmark (S.R.); Research Centre for Prevention and Health, Glostrup Hospital, University of Copenhagen, Denmark (J.K.K.V.-N.); Department of Internal Medicine, Holbæk Hospital, Denmark (M.P., M.H.O.); and Centre for Individualized Medicine in Arterial Diseases, Odense University Hospital, Denmark
| | - Manan Pareek
- From the Department of Endocrinology, Odense University Hospital, Denmark (T.B.O., J.V.S., M.K.B., M.P.); Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, University of Copenhagen, Denmark (S.R.); Research Centre for Prevention and Health, Glostrup Hospital, University of Copenhagen, Denmark (J.K.K.V.-N.); Department of Internal Medicine, Holbæk Hospital, Denmark (M.P., M.H.O.); and Centre for Individualized Medicine in Arterial Diseases, Odense University Hospital, Denmark
| | - Susanne Rasmussen
- From the Department of Endocrinology, Odense University Hospital, Denmark (T.B.O., J.V.S., M.K.B., M.P.); Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, University of Copenhagen, Denmark (S.R.); Research Centre for Prevention and Health, Glostrup Hospital, University of Copenhagen, Denmark (J.K.K.V.-N.); Department of Internal Medicine, Holbæk Hospital, Denmark (M.P., M.H.O.); and Centre for Individualized Medicine in Arterial Diseases, Odense University Hospital, Denmark
| | - Julie K.K. Vishram-Nielsen
- From the Department of Endocrinology, Odense University Hospital, Denmark (T.B.O., J.V.S., M.K.B., M.P.); Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, University of Copenhagen, Denmark (S.R.); Research Centre for Prevention and Health, Glostrup Hospital, University of Copenhagen, Denmark (J.K.K.V.-N.); Department of Internal Medicine, Holbæk Hospital, Denmark (M.P., M.H.O.); and Centre for Individualized Medicine in Arterial Diseases, Odense University Hospital, Denmark
| | - Michael H. Olsen
- From the Department of Endocrinology, Odense University Hospital, Denmark (T.B.O., J.V.S., M.K.B., M.P.); Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, University of Copenhagen, Denmark (S.R.); Research Centre for Prevention and Health, Glostrup Hospital, University of Copenhagen, Denmark (J.K.K.V.-N.); Department of Internal Medicine, Holbæk Hospital, Denmark (M.P., M.H.O.); and Centre for Individualized Medicine in Arterial Diseases, Odense University Hospital, Denmark
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Alwan H, Pruijm M, Ponte B, Ackermann D, Guessous I, Ehret G, Staessen JA, Asayama K, Vuistiner P, Younes SE, Paccaud F, Wuerzner G, Pechere-Bertschi A, Mohaupt M, Vogt B, Martin PY, Burnier M, Bochud M. Epidemiology of masked and white-coat hypertension: the family-based SKIPOGH study. PLoS One 2014; 9:e92522. [PMID: 24663506 PMCID: PMC3963885 DOI: 10.1371/journal.pone.0092522] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 02/23/2014] [Indexed: 12/12/2022] Open
Abstract
Objective We investigated factors associated with masked and white-coat hypertension in a Swiss population-based sample. Methods The Swiss Kidney Project on Genes in Hypertension is a family-based cross-sectional study. Office and 24-hour ambulatory blood pressure were measured using validated devices. Masked hypertension was defined as office blood pressure<140/90 mmHg and daytime ambulatory blood pressure≥135/85 mmHg. White-coat hypertension was defined as office blood pressure≥140/90 mmHg and daytime ambulatory blood pressure<135/85 mmHg. Mixed-effect logistic regression was used to examine the relationship of masked and white-coat hypertension with associated factors, while taking familial correlations into account. High-normal office blood pressure was defined as systolic/diastolic blood pressure within the 130–139/85–89 mmHg range. Results Among the 652 participants included in this analysis, 51% were female. Mean age (±SD) was 48 (±18) years. The proportion of participants with masked and white coat hypertension was respectively 15.8% and 2.6%. Masked hypertension was associated with age (odds ratio (OR) = 1.02, p = 0.012), high-normal office blood pressure (OR = 6.68, p<0.001), and obesity (OR = 3.63, p = 0.001). White-coat hypertension was significantly associated with age (OR = 1.07, p<0.001) but not with education, family history of hypertension, or physical activity. Conclusions Our findings suggest that physicians should consider ambulatory blood pressure monitoring for older individuals with high-normal office blood pressure and/or who are obese.
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Affiliation(s)
- Heba Alwan
- Institute of Social and Preventive Medicine (IUMSP), University Hospital of Lausanne, Lausanne, Switzerland
| | - Menno Pruijm
- Service of Nephrology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Belen Ponte
- Service of Nephrology, Department of Specialties, University Hospital of Geneva, Geneva, Switzerland
| | - Daniel Ackermann
- Clinic for Nephrology, Hypertension and Clinical Pharmacology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Idris Guessous
- Institute of Social and Preventive Medicine (IUMSP), University Hospital of Lausanne, Lausanne, Switzerland
- Unit of Population Epidemiology, University Hospital of Geneva, Geneva, Switzerland
| | - Georg Ehret
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | - Jan A. Staessen
- Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Kei Asayama
- Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
- Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan
| | - Philippe Vuistiner
- Institute of Social and Preventive Medicine (IUMSP), University Hospital of Lausanne, Lausanne, Switzerland
| | - Sandrine Estoppey Younes
- Institute of Social and Preventive Medicine (IUMSP), University Hospital of Lausanne, Lausanne, Switzerland
| | - Fred Paccaud
- Institute of Social and Preventive Medicine (IUMSP), University Hospital of Lausanne, Lausanne, Switzerland
| | - Grégoire Wuerzner
- Service of Nephrology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Antoinette Pechere-Bertschi
- Department of Community Medicine and Primary Care and Emergency Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Markus Mohaupt
- Clinic for Nephrology, Hypertension and Clinical Pharmacology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Bruno Vogt
- Clinic for Nephrology, Hypertension and Clinical Pharmacology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Pierre-Yves Martin
- Service of Nephrology, Department of Specialties, University Hospital of Geneva, Geneva, Switzerland
| | - Michel Burnier
- Service of Nephrology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Murielle Bochud
- Institute of Social and Preventive Medicine (IUMSP), University Hospital of Lausanne, Lausanne, Switzerland
- * E-mail:
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