1
|
Pilz N, Picone DS, Patzak A, Opatz OS, Lindner T, Fesseler L, Heinz V, Bothe TL. Cuff-based blood pressure measurement: challenges and solutions. Blood Press 2024; 33:2402368. [PMID: 39291896 DOI: 10.1080/08037051.2024.2402368] [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: 05/17/2024] [Revised: 09/03/2024] [Accepted: 09/04/2024] [Indexed: 09/19/2024]
Abstract
OBJECTIVE Accurate measurement of arterial blood pressure (BP) is crucial for the diagnosis, monitoring, and treatment of hypertension. This narrative review highlights the challenges associated with conventional (cuff-based) BP measurement and potential solutions. This work covers each method of cuff-based BP measurement, as well as cuffless alternatives, but is primarily focused on ambulatory BP monitoring. RESULTS Manual BP measurement requires stringent training and standardized protocols which are often difficult to ensure in stressful and time-restricted clinical office blood pressure monitoring (OBPM) scenarios. Home Blood pressure monitoring (HBPM) can identify white-coat and masked hypertension but strongly depends on patient adherence to measurement techniques and procedure. The widespread use of nonvalidated automated HBPM devices raises further concerns about measurement accuracy. Ambulatory blood pressure measurement (ABPM) may be used in addition to OBPM. It is recommended to diagnose white-coat and masked hypertension as well as nocturnal BP and dipping, which are the BP values most predictive for major adverse cardiac events. Nonetheless, ABPM is limited by its non-continuous nature and susceptibility to measurement artefacts. This leads to poor overall reproducibility of ABPM results, especially regarding clinical parameters such as BP variability or dipping patterns. CONCLUSIONS Cuff-based BP measurement, despite some limitations, is vital for cardiovascular health assessment in clinical practice. Given the wide range of methodological limitations, the paradigm's potential for improvement is not yet fully realized. There are impactful and easily incorporated opportunities for innovation regarding the enhancement of measurement accuracy and reliability as well as the clinical interpretation of the retrieved data. There is a clear need for continued research and technological advancement to improve BP measurement as the premier tool for cardiovascular disease detection and management.
Collapse
Affiliation(s)
- N Pilz
- Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - D S Picone
- Sydney School of Health Sciences, University of Sydney, Sydney, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - A Patzak
- Institute of Translational Physiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - O S Opatz
- Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - T Lindner
- Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - L Fesseler
- Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - V Heinz
- Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - T L Bothe
- Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Sydney School of Health Sciences, University of Sydney, Sydney, Australia
| |
Collapse
|
2
|
Kario K, Williams B, Tomitani N, McManus RJ, Schutte AE, Avolio A, Shimbo D, Wang JG, Khan NA, Picone DS, Tan I, Charlton PH, Satoh M, Mmopi KN, Lopez-Lopez JP, Bothe TL, Bianchini E, Bhandari B, Lopez-Rivera J, Charchar FJ, Tomaszewski M, Stergiou G. Innovations in blood pressure measurement and reporting technology: International Society of Hypertension position paper endorsed by the World Hypertension League, European Society of Hypertension, Asian Pacific Society of Hypertension, and Latin American Society of Hypertension. J Hypertens 2024; 42:1874-1888. [PMID: 39246139 DOI: 10.1097/hjh.0000000000003827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Accepted: 07/10/2024] [Indexed: 09/10/2024]
Abstract
Blood pressure (BP) is a key contributor to the lifetime risk of preclinical organ damage and cardiovascular disease. Traditional clinic-based BP readings are typically measured infrequently and under standardized/resting conditions and therefore do not capture BP values during normal everyday activity. Therefore, current hypertension guidelines emphasize the importance of incorporating out-of-office BP measurement into strategies for hypertension diagnosis and management. However, conventional home and ambulatory BP monitoring devices use the upper-arm cuff oscillometric method and only provide intermittent BP readings under static conditions or in a limited number of situations. New innovations include technologies for BP estimation based on processing of sensor signals supported by artificial intelligence tools, technologies for remote monitoring, reporting and storage of BP data, and technologies for BP data interpretation and patient interaction designed to improve hypertension management ("digital therapeutics"). The number and volume of data relating to new devices/technologies is increasing rapidly and will continue to grow. This International Society of Hypertension position paper describes the new devices/technologies, presents evidence relating to new BP measurement techniques and related indices, highlights standard for the validation of new devices/technologies, discusses the reliability and utility of novel BP monitoring devices, the association of these metrics with clinical outcomes, and the use of digital therapeutics. It also highlights the challenges and evidence gaps that need to be overcome before these new technologies can be considered as a user-friendly and accurate source of novel BP data to inform clinical hypertension management strategies.
Collapse
Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Bryan Williams
- University College London (UCL) and National Insitute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom
| | - Naoko Tomitani
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Aletta E Schutte
- School of Population Health, University of New South Wales; The George Institute for Global Health, Sydney, Australia
| | - Alberto Avolio
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Daichi Shimbo
- Hypertension Lab, Columbia University Irving Medical Center, New York, NY, USA
| | - Ji-Guang Wang
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, Department of Hypertension, Ruijin Hospital, The Shanghai Institute of Hypertension, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Nadia A Khan
- Center for Advancing Health Outcomes, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Dean S Picone
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Isabella Tan
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Peter H Charlton
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Michihiro Satoh
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Keneilwe Nkgola Mmopi
- Department of Biomedical Sciences, Faculty of Medicine. University of Botswana, Gaborone, Botswana
| | - Jose P Lopez-Lopez
- Masira Research Institute, Medical School, Universidad de Santander, Bucaramanga, Colombia
| | - Tomas L Bothe
- Charité - Universitätsmedizin Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Berlin, Germany
| | - Elisabetta Bianchini
- Institute of Clinical Physiology, Italian National Research Council, Pisa, Italy
| | - Buna Bhandari
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Jesús Lopez-Rivera
- Unidad de Hipertension arterial, V departamento, Hospital Central San Cristobal, Tachira, Venezuela
| | - Fadi J Charchar
- Health Innovation and Transformation Centre, Federation University Australia, Ballarat
- Department of Physiology, University of Melbourne, Melbourne, Australia
- Department of Cardiovascular Sciences, University of Leicester, Leicester
| | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Medicine, Biology and Health, University of Manchester, Manchester
- Manchester Royal Infirmary, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - George Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| |
Collapse
|
3
|
Divisón-Garrote JA, Juárez Gonzálvez P, Turégano-Yedro M, Pallarés-Carratalá V. Home blood pressure monitoring devices: what extra value do they bring? Expert Rev Med Devices 2024; 21:555-557. [PMID: 38953835 DOI: 10.1080/17434440.2024.2375374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 06/28/2024] [Indexed: 07/04/2024]
Affiliation(s)
- Juan Antonio Divisón-Garrote
- Primary Care, Casas Ibáñez Health Care Centre, Albacete, Spain
- Medical Degree, Department of Medicine, Universidad Católica Murcia (UCAM), Murcia, Spain
| | - Paula Juárez Gonzálvez
- Medical Degree, Department of Medicine, Universidad Católica Murcia (UCAM), Murcia, Spain
| | | | | |
Collapse
|
4
|
Kario K, Shiosakai K, Taguchi T. Antihypertensive effect of esaxerenone and correlation between brachial and wrist home monitoring devices in patients with nocturnal hypertension: A post hoc analysis of the EARLY-NH study. J Clin Hypertens (Greenwich) 2024; 26:842-849. [PMID: 38980252 PMCID: PMC11232449 DOI: 10.1111/jch.14857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/02/2024] [Accepted: 05/21/2024] [Indexed: 07/10/2024]
Abstract
Adequate management of nocturnal hypertension is crucial to reduce the risk of organ damage and cardiovascular events. The EARLY-NH study was a prospective, open-label, multicenter study conducted in Japanese patients with nocturnal hypertension who received esaxerenone treatment for 12 weeks. This post hoc analysis aimed to assess (1) the relationship between changes in morning home systolic blood pressure (SBP), bedtime home SBP, and nighttime home SBP based on changes in SBP and achievement rates of target SBP levels; and (2) the correlation between nighttime home SBP measurements using brachial and wrist home BP monitoring (HBPM) devices. This analysis evaluated 82 patients who completed the 12-week treatment period. Among those who achieved target morning home SBP (<135 mmHg) and target bedtime home SBP (<135 mmHg), the brachial HBPM device showed achievement rates of 63.6% and 56.4%, respectively, for target nighttime home SBP (<120 mmHg). The wrist device showed achievement rates of 66.7% and 63.4%, respectively, for the same targets. Significant correlations were observed between both devices for nighttime home SBP measurements at baseline (r = 0.790), Week 12 (r = 0.641), and change from baseline to Week 12 (r = 0.533) (all, p < .001). In this patient population, approximately 60% of individuals who reached target morning or bedtime home SBP levels <135 mmHg exhibited well-controlled nighttime home SBP. Although nighttime home SBP measurements obtained using both brachial and wrist HBPM devices displayed a significant correlation, the wrist device needs to be examined in more detail for clinical use.
Collapse
Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineShimotsukeJapan
| | | | - Takashi Taguchi
- Primary Medical Science DepartmentDaiichi Sankyo Co., Ltd.TokyoJapan
| |
Collapse
|
5
|
Peng Z, Liang Y, Liu X, Shao J, Hu N, Zhang X. New insights into the mechanisms of diabetic kidney disease: Role of circadian rhythm and Bmal1. Biomed Pharmacother 2023; 166:115422. [PMID: 37660646 DOI: 10.1016/j.biopha.2023.115422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 09/05/2023] Open
Abstract
It is common for diabetic kidney disease (DKD) to be complicated by abnormal blood glucose, blood lipids, and blood pressure rhythms. Thus, it is essential to examine diagnostic and treatment plans from the perspective of circadian disruption. This brief review discusses the clinical relevance of circadian rhythms in DKD and how the core clock gene encoding brain and muscle arnt-like protein 1 (BMAL1) functions owing to the importance of circadian rhythm disruption processes, including the excretion of urinary protein and irregular blood pressure, which occur in DKD. Exploring Bmal1 and its potential mechanisms and signaling pathways in DKD following contact with Sirt1 and NF-κB is novel and important. Finally, potential pharmacological and behavioral intervention strategies for DKD circadian rhythm disturbance are outlined. This review aids in unveiling novel, potential molecular targets for DKD based on circadian rhythms.
Collapse
Affiliation(s)
- Zhimei Peng
- Department of Nephrology, The Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China; Shenzhen Key Laboratory of Kidney Diseases, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China.
| | - Yanting Liang
- Department of Nephrology, The Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China.
| | - Xueying Liu
- Shenzhen Key Laboratory of Kidney Diseases, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China.
| | - Jie Shao
- Department of Nephrology, The Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China.
| | - Nan Hu
- Shenzhen Key Laboratory of Kidney Diseases, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China.
| | - Xinzhou Zhang
- Department of Nephrology, The Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China; Shenzhen Key Laboratory of Kidney Diseases, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China.
| |
Collapse
|
6
|
Champaneria MK, Patel RS, Oroszi TL. When blood pressure refuses to budge: exploring the complexity of resistant hypertension. Front Cardiovasc Med 2023; 10:1211199. [PMID: 37416924 PMCID: PMC10322223 DOI: 10.3389/fcvm.2023.1211199] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/25/2023] [Indexed: 07/08/2023] Open
Abstract
Resistant hypertension, defined as blood pressure that remains above goal despite using three or more antihypertensive medications, including a diuretic, affects a significant proportion of the hypertensive population and is associated with increased cardiovascular morbidity and mortality. Despite the availability of a wide range of pharmacological therapies, achieving optimal blood pressure control in patients with resistant hypertension remains a significant challenge. However, recent advances in the field have identified several promising treatment options, including spironolactone, mineralocorticoid receptor antagonists, and renal denervation. In addition, personalized management approaches based on genetic and other biomarkers may offer new opportunities to tailor therapy and improve outcomes. This review aims to provide an overview of the current state of knowledge regarding managing resistant hypertension, including the epidemiology, pathophysiology, and clinical implications of the condition, as well as the latest developments in therapeutic strategies and future prospects.
Collapse
|
7
|
Divisón-Garrote J, Velilla-Zancada S, Artigao-Rodenas L, García-Lerín A, Vicente-Molinero A, Piera Carbonell A, Alonso-Moreno F, Crespo-Sabarís R, Valls-Roca F, Martín-Rioboó E, Pallarés-Carratala V. Home blood pressure self-measurement: “Current situation and new perspectives”. HIPERTENSION Y RIESGO VASCULAR 2022; 40:85-97. [PMID: 36114104 DOI: 10.1016/j.hipert.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/27/2022] [Accepted: 07/31/2022] [Indexed: 11/27/2022]
Abstract
The method typically used to diagnose and monitor hypertensive patients has been to measure blood pressure in the physician's surgery; however, it is a well-known fact that this approach poses certain drawbacks, such as observer bias, failure to detect an alert reaction in the clinic, etc., difficulties that affect its accuracy as a diagnostic method. In recent years, the varying international scientific societies have persistently recommended the use of blood pressure measurements outside the clinic (at home or in the outpatient setting), using validated automatic devices. Data from some studies suggest that if we rely solely on in-office measurements, approximately 15-20% of the time we may be wrong when making decisions, both in terms of diagnosis and patient follow-up. Home blood pressure measurements are a simple and very affordable method that has a similar reproducibility and prognostic value as ambulatory blood pressure monitoring, the availability of which is currently very limited. Moreover, ambulatory self-measurements have the significant benefit of being able to improve control of hypertensive individuals. Healthcare professionals and patients should be aware of the methodology of home blood pressure measurement, its usefulness and limitations.
Collapse
|
8
|
Simple predictive score for nocturnal hypertension and masked nocturnal hypertension using home blood pressure monitoring in clinical practice. J Hypertens 2022; 40:1513-1521. [PMID: 35881451 DOI: 10.1097/hjh.0000000000003175] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The decision whether to measure night-time blood pressure (BP) is challenging as these values cannot be easily evaluated because of problems with measurement devices and related stress. Using the nationwide, practice-based Japan Morning Surge-Home BP Nocturnal BP study data, we developed a simple predictive score that physicians can use to diagnose nocturnal hypertension. METHODS We divided 2765 outpatients (mean age 63 years; hypertensive patients 92%) with cardiovascular risks who underwent morning, evening, and night-time home BP (HBP) measurements (0200, 0300, and 0400 h) into a calibration group ( n = 2212) and validation group ( n = 553). We used logistic-regression models in the calibration group to identify the predictive score for nocturnal hypertension (night-time HBP ≥120/70 mmHg) and then evaluated the score's predictive ability in the validation group. RESULTS In the logistic-regression model, male sex, increased BMI) (≥25 kg/m 2 ), diabetes, elevated urine-albumin creatinine ratio (UACR) (≥30 mg/g Cr), elevated office BP (≥140/90 mmHg) and home (average of morning and evening) BP (≥135/85 mmHg) had positive relationships with nocturnal hypertension. The predictive scores for nocturnal hypertension were 1 point (male, BMI, and UACR); 2 points (diabetes); 3 points (office BP ≥140/90 mmHg); 6 points (home BP ≥135/85 mmHg); total 14 points. Over 75% of the nocturnal hypertension cases in the validation group showed at least 10 points [AUC 0.691, 95% CI (0.647-0.735)]. We also developed a score for masked nocturnal hypertension, that is, nocturnal hypertension despite controlled daytime HBP. CONCLUSION We developed a simple predictive score for nocturnal hypertension that can be used in clinical settings and for diagnoses.
Collapse
|
9
|
Fujiwara T, McManus R, Kario K. Management of hypertension in the digital era: Perspectives and future directions. HIPERTENSION Y RIESGO VASCULAR 2022; 39:79-91. [DOI: 10.1016/j.hipert.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 12/24/2022]
|
10
|
Kokubo A, Kuwabara M, Ota Y, Tomitani N, Yamashita S, Shiga T, Kario K. Nocturnal blood pressure surge in seconds is a new determinant of left ventricular mass index. J Clin Hypertens (Greenwich) 2021; 24:271-282. [PMID: 34935266 PMCID: PMC8925009 DOI: 10.1111/jch.14383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 11/29/2022]
Abstract
Nocturnal blood pressure (BP) surge in seconds (sec‐surge), which is characterized as acute transient BP elevation over several tens of seconds, could be a predictor of target organ damage. However, it is not clear that the severity of sec‐surge is different between sec‐surges induced by sleep apnea (SA) (apnea/hypopnea detected by polysomnography (PSG) or oxygen desaturation) and those induced by non‐SA factors (rapid eye movement, micro arousal, etc.), and sec‐surge variables associate with left ventricular hypertrophy (LVH) independently of conventional BP variables. The authors assessed these points with 41 patients (mean age 63.2±12.6 years, 29% female) who underwent full PSG, beat‐by‐beat (BbB) BP, and cuff‐oscillometric BP measurement during the night. All patients were included for the analysis comparing sec‐surge severity between inducing factors (SA and non‐SA factors). There were no significant differences in the number of sec‐surges/night between SA‐related sec‐surges and non‐SA‐related sec‐surges (19.5±26.0 vs. 16.4±29.8 events/night). There were also no significant differences in the peak of sec‐surges, defined as the maximum systolic BPs (SBPs) in each sec‐surge, between SA‐related sec‐surges and non‐SA‐related sec‐surges (148.2±18.5 vs. 149.3±19.2 mm Hg). Furthermore, as a result of multiple regression analysis (n = 18), the peak of sec‐surge was significantly and strongly associated with the left ventricular mass index (standardized β = 0.62, p = .02), compared with the mean nocturnal SBPs measured by oscillometric method (β = −0.04, p = .87). This study suggests that peak of sec‐surge could be a better predictor of LVH compared to parameters derived from regular nocturnal oscillometric SBP.
Collapse
Affiliation(s)
- Ayako Kokubo
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.,Omron Healthcare Co., Ltd., Kyoto, Japan
| | - Mitsuo Kuwabara
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.,Omron Healthcare Co., Ltd., Kyoto, Japan
| | - Yuki Ota
- Omron Healthcare Co., Ltd., Kyoto, Japan
| | - Naoko Tomitani
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | | | - Toshikazu Shiga
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.,Omron Healthcare Co., Ltd., Kyoto, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| |
Collapse
|
11
|
Liu J, Su X, Nie Y, Zeng Z, Chen H. Dosing Time Matters? Nighttime vs. Daytime Administration of Nifedipine Gastrointestinal Therapeutic System (GITS) or Amlodipine on Non-dipper Hypertension: A Randomized Controlled Trial of NARRAS. Front Cardiovasc Med 2021; 8:755403. [PMID: 34912861 PMCID: PMC8666540 DOI: 10.3389/fcvm.2021.755403] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 11/04/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Non-dipper hypertension is often characterized by a blunted decrease of nocturnal blood pressure (BP) and is associated with increased risk of target organ damage and cardiovascular (CV) events, while the optimal treatment strategy is yet to be established. This trial was designed to evaluate whether nocturnal BP reduction and arterial stiffness improvement differ from antihypertensive agents and time of administration. Methods: Young and middle-aged adults (18-65 years) with non-dipper hypertension were randomly assigned to nifedipine GITS (gastrointestinal therapeutic system) 30 mg or amlodipine besylate 5 mg once daily for 8 weeks, either taken in the morning or at night. Dose was doubled at 4-week if BP is not at goal. Twenty-four hour ambulatory BP monitoring (ABPM) and arterial stiffness were evaluated before and after 8 weeks of pharmacotherapy. The primary efficacy measure was the average nighttime systolic BP reduction. Results: A total of 98 non-dipper hypertensive patients (mean age 46.3 years) were randomized during Dec, 2016 and Dec, 2020, of whom 72 (73%) patients completed all ABPM and follow-up evaluations. Nighttime systolic BP significantly reduced at 8 weeks vs. baseline with nifedipine GITS or amlodipine, irrespective of dosing at nighttime (-9.9 vs -9.9 mmHg, P > 0.05) or daytime (-11.5 vs. -10.9 mmHg, P > 0.05). No difference was seen between these two agents, when combining the data of nighttime and daytime dosing together (-10.8 vs. -10.5 mmHg, respectively, P = 0.898). Daytime, 24-h systolic BP, diastolic BP at different time and pulse wave velocity reduced significantly and comparably, and recovery of dipping rhythm were similar among groups. Conclusion: Nighttime dosing of long-acting antihypertensive preparations, nifedipine GITS or amlodipine demonstrated similar effects on nocturnal BP reduction, dipping rhythm restoration and arterial elasticity improvement in younger subjects with non-dipper hypertension. These effects were comparable with morning dosing.
Collapse
Affiliation(s)
- Jing Liu
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Xiaofeng Su
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Ying Nie
- Department of Internal Medicine, Beijing Jiaotong University Hospital, Beijing, China
| | - Zhihuan Zeng
- Department of Cardiology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Hongyan Chen
- Department of Internal Medicine, North China Electric Power University Hospital, Beijing, China
| |
Collapse
|
12
|
Chakraborty RN, Langade D, More S, Revandkar V, Birla A. Efficacy of Cilnidipine (L/N-type Calcium Channel Blocker) in Treatment of Hypertension: A Meta-Analysis of Randomized and Non-randomized Controlled Trials. Cureus 2021; 13:e19822. [PMID: 34963839 PMCID: PMC8695827 DOI: 10.7759/cureus.19822] [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] [Accepted: 11/22/2021] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Hypertension is one of the most common cardiovascular diseases, and the prevalence of hypertension continues to rise across the globe. National and international guidelines recommend angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), diuretics, and beta-blockers for the management of hypertension. CCBs are among the most used antihypertensive medications and Cilnidipine is a newer dihydropyridine CCB shown to have a prolonged antihypertensive property. OBJECTIVE This meta-analysis of comparative randomized and non-randomized clinical trials evaluated the effect of Cilnidipine monotherapy or combination therapy on systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse rate (PR) over 48 weeks of therapy. STUDY DESIGN PubMed (MEDLINE) and Google scholar databases were searched to identify studies designed to evaluate the effects of Cilnidipine in the treatment of hypertensive patients. The study criteria for inclusion into the meta-analysis were all prospective, randomized, and non-randomized clinical studies published till March 2021, studies published in a peer-reviewed journal, the inclusion of patients with hypertension, assessment of blood pressure and heart rate, and a follow-up of four weeks or longer. The initial search identified 82 potential articles; of these, 24 met the inclusion criteria. Studies with <4 weeks treatment period and those not having a CCB were excluded. OUTCOMES Change in SBP, DBP, and PR from baseline at the end of therapy compared between the Cilnidipine and other CCB's. RESULTS Cilnidipine caused a significant reduction (p<0.05) in SBP, DBP, and PR at end of therapy, whereas the reduction in SBP, DBP, and PR with Cilnidipine was similar to other CCB's (p>0.05). The results of this meta-analysis revealed that there were no significant differences in the efficacy in the treatment of hypertensive patients with Cilnidipine and the other therapies. CONCLUSION Cilnidipine has similar anti-hypertensive effects compared with other first-line antihypertensive drugs commonly used in practice. We recommend Cilnidipine as a novel first-line CCB for the management of hypertension either as a monotherapy or as a combination therapy.
Collapse
Affiliation(s)
| | - Deepak Langade
- Pharmacology, School of Medicine, D Y Patil University, Navi Mumbai, IND
| | - Shyam More
- Community Medicine, School of Medicine, D Y Patil University, Navi Mumbai, IND
| | - Vaibhav Revandkar
- Medical Affairs, J. B. Chemicals and Pharmaceutical Limited, Mumbai, IND
| | - Ashish Birla
- Medical Affairs, J. B. Chemicals and Pharmaceutical Limited, Mumbai, IND
| |
Collapse
|
13
|
Tomitani N, Kanegae H, Kario K. Comparison of nighttime measurement schedules using a wrist-type nocturnal home blood pressure monitoring device. J Clin Hypertens (Greenwich) 2021; 23:1144-1149. [PMID: 33724674 PMCID: PMC8678724 DOI: 10.1111/jch.14237] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/27/2022]
Abstract
We investigated the optimal nighttime home blood pressure (BP) measurement schedule for wrist BP monitoring. Fifty hypertensive patients (mean age 68.9 ± 11.3 years) self‐measured their nighttime BP hourly using a wrist‐type nocturnal home BP monitoring device at home on two consecutive nights. Using the average 7.2 ± 1.5 measurements per night, we compared the clock‐based index (average of three measurements at 2:00, 3:00, and 4:00 a.m.) and the bedtime‐based index (average of three measurements at 2, 3, and 4 h after bedtime). The clock‐based average was significantly higher than the bedtime‐based average for both systolic BP (2.7 ± 8.2 mmHg, P = .002) and diastolic BP (1.9 ± 5.1 mmHg, P < .001). Compared to the average of all measurements throughout a night (the same definition of ambulatory BP monitoring, ie, from the time point of going to bed to awakening), the clock‐based average was comparable (systolic/diastolic BP: −0.5 ± 5.5/−0.2 ± 3.7), whereas the bedtime‐based average was significantly lower (−3.3 ± 5.0/−2.1 ± 3.6). Thus, the repeated measurement of wrist‐measured nighttime BP at three clock‐based time points per night provided reliable values. Further prospective studies of larger populations are required to confirm the optimal nighttime BP measurement schedule for wrist BP monitoring for the prediction of cardiovascular events.
Collapse
Affiliation(s)
- Naoko Tomitani
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Hiroshi Kanegae
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.,Genki Plaza Medical Center for Health Care, Tokyo, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| |
Collapse
|