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Shin J, Wang JG, Chia YC, Kario K, Chen CH, Cheng HM, Fujiwara T, Hoshide S, Huynh MV, Li Y, Nagai M, Nailes J, Park S, Siddique S, Sison J, Soenarta AA, Sogunuru GP, Tay JC, Teo BW, Tomitani N, Tsoi K, Turana Y, Verma N, Wang TD, Zhang Y. The HOPE Asia Network consensus on blood pressure measurements corresponding to office measurements: Automated office, home, and ambulatory blood pressures. J Clin Hypertens (Greenwich) 2023. [PMID: 37878534 DOI: 10.1111/jch.14729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/28/2023] [Accepted: 09/06/2023] [Indexed: 10/27/2023]
Abstract
For adopting recently introduced hypertension phenotypes categorized using office and out of office blood pressure (BP) for the diagnosis of hypertension and antihypertension drug therapy, it is mandatory to define the corresponding out of office BP with the specific target BP recommended by the major guidelines. Such conditions include white-coat hypertension (WCH), masked hypertension (MH), white-coat uncontrolled hypertension (WUCH), and masked uncontrolled hypertension (MUCH). Here, the authors review the relevant literature and discuss the related issue to facilitate the use of corresponding BPs for proper diagnosis of WCH, MH, WUCH, and MUCH in the setting of standard target BP as well as intensive target BP. The methodology of deriving the corresponding BP has evolved from statistical methods such as standard deviation, percentile value, and regression to an outcome-based approach using pooled international cohort study data and comparative analysis in randomized clinical trials for target BPs such as the SPRINT and STEP studies. Corresponding BPs to 140/90 and 130/80 mm Hg in office BP is important for safe and strict achievement of intensive BP targets. The corresponding home, daytime, and 24-h BPs to 130/80 mm Hg in office BP are 130/80, 130/80, and 125/75 mm Hg, respectively. However, researchers have found some discrepancies among the home corresponding BPs. As tentative criterion for de-escalation of antihypertensive therapy as shown in European guidelines was 120 mm Hg in office BP, corresponding home, daytime, and 24-h systolic BPs to 120 mm Hg in office systolic BP are 120, 120, and 115 mm Hg, respectively.
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Affiliation(s)
- Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Ji-Guang Wang
- Department of Cardiovascular Medicine, The Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yook-Chin Chia
- Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Selangor Darul Ehsan, Malaysia
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Chen-Huan Chen
- Department of Medicine, National Yang-Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| | - Hao-Min Cheng
- Department of Medicine, National Yang-Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| | - Takeshi Fujiwara
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Minh Van Huynh
- Department of Internal Medicine, University of Medicine and Pharmacy, Hue University, ., Vietnam
| | - Yan Li
- Department of Cardiovascular Medicine, The Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Michiaki Nagai
- Department of Internal Medicine, General Medicine and Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Jennifer Nailes
- University of the East Ramon Magsaysay Memorial Medical Center Inc., Quezon City, Philippines
| | - Sungha Park
- Division of Cardiology, Cardiovascular Hospital, Yonsei Health System, Seoul, South Korea
| | | | - Jorge Sison
- Section of Cardiology, Department of Medicine, Medical Center Manila, Manila, Philippines
| | - Arieska Ann Soenarta
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia-National Cardiovascular Center, Harapan Kita, Jakarta, Indonesia
| | - Guru Prasad Sogunuru
- Fortis Hospitals, Chennai, Tamil Nadu, India
- College of Medical Sciences, Kathmandu University, Bharatpur, Nepal
| | - Jam Chin Tay
- Department of General Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Boon Wee Teo
- Division of Nephrology Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Naoko Tomitani
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Kelvin Tsoi
- JC School of Public Health and Primary Care, JC Institute of Ageing, SH Big Data Decision Analytics Research Centre, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Yuda Turana
- Faculty of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Narsingh Verma
- Indian Society of Hypertension, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Tzung-Dau Wang
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Yuqing Zhang
- Divisions of Hypertension and Heart Failure, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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2
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Lewandowska K, Wasiliew S, Kukfisz A, Hofman M, Woźniak P, Radziemski A, Stryczyński Ł, Lipski D, Tykarski A, Uruski P. Target Blood Pressure Values in Ambulatory Blood Pressure Monitoring. High Blood Press Cardiovasc Prev 2023; 30:29-36. [PMID: 36396904 PMCID: PMC9908722 DOI: 10.1007/s40292-022-00552-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/12/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION 2018 ESC/ESH guidelines have recommended 24-h ambulatory blood pressure monitoring to assess hypotensive therapy in many circumstances. Recommended target blood pressure in office blood pressure measurements is between 120/70 and 130/80 mmHg. Such targets for 24-h ambulatory blood pressure monitoring lacks. AIM We aimed to define target values of blood pressure in 24-h ambulatory blood pressure monitoring in hypertensive patients. METHODS Office blood pressure measurements and 24-h ambulatory blood pressure monitoring data were collected from 1313 hypertensive patients and sorted following increasing systolic (SBP)/diastolic (DBP) blood pressure in office blood pressure measurements. The corresponding 24-h ambulatory blood pressure monitoring to office blood pressure measurements values were calculated. RESULTS Values 130/80 mmHg in office blood pressure measurements correspond in 24-h ambulatory blood pressure monitoring: night-time SBP/DBP mean: 113.74/66.95 mmHg; daytime SBP/DBP mean: 135.02/81.78 mmHg and 24-h SBP/DBP mean: 130.24/78.73 mmHg. Values 120/70 mmHg in office blood pressure measurements correspond in 24-h ambulatory blood pressure monitoring: night-time SBP/DBP mean: 109.50/63.43 mmHg; daytime SBP/DBP mean: 131.01/78.47 mmHg and 24-h SBP/DBP mean: 126.36/75.31 mmHg. CONCLUSIONS The proposed blood pressure target values in 24-h ambulatory blood pressure monitoring complement the therapeutic target indicated in the ESC/ESH recommendations and improves 24-h ambulatory blood pressure monitoring usefulness in clinical practice.
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Affiliation(s)
- Katarzyna Lewandowska
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Długa 1/2, 61-848, Poznan, Poland.
| | - Stanisław Wasiliew
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Długa 1/2, 61-848, Poznan, Poland
| | - Agata Kukfisz
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Długa 1/2, 61-848, Poznan, Poland
| | - Michał Hofman
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Długa 1/2, 61-848, Poznan, Poland
| | - Patrycja Woźniak
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Długa 1/2, 61-848, Poznan, Poland
| | - Artur Radziemski
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Długa 1/2, 61-848, Poznan, Poland
| | - Łukasz Stryczyński
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Długa 1/2, 61-848, Poznan, Poland
| | - Dawid Lipski
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Długa 1/2, 61-848, Poznan, Poland
| | - Andrzej Tykarski
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Długa 1/2, 61-848, Poznan, Poland
| | - Paweł Uruski
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Długa 1/2, 61-848, Poznan, Poland
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3
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Chen JX, Zhou YF, Geng T, Chen S, Chen S, Wang G, Zhang YB, Wang Y, Tu ZZ, Liu G, Wu S, Pan A. Low Concordance Between Blood Pressures Measured in Periodic Health Examinations and in a Workplace-Based Hypertension Management Program. PHENOMICS (CHAM, SWITZERLAND) 2022; 2:419-429. [PMID: 36939804 PMCID: PMC9712859 DOI: 10.1007/s43657-022-00067-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 10/15/2022]
Abstract
Poor adherence to standard protocols of blood pressure (BP) measurement in routine clinical practice leads to higher readings than "research-quality" measurements. Whether this phenomenon exists in periodic health examinations was unknown. We aimed to explore the concordance between BP measurements in periodic health examinations and those measured following a standard measurement protocol. We used data from the Kailuan Study, an ongoing longitudinal cohort study in China, of which participants received biennial health examinations in health management centers. In addition, BPs were measured following standard protocols in a workplace-based hypertension management program nested in the Kailuan Study. We compared BP readings of the same person between the two settings using generalized linear mixed-effects models. A total of 3988 men (the mean age was 44.9 years) had at least two BP measurements both in health examinations and management program with a time interval between the two settings that less than 90 days. The mean systolic blood pressures (SBP) and diastolic blood pressures (DBP) in health examinations were 4.2 (95% CI 3.9-4.5) mm Hg and 3.3 (95% CI 3.1-3.5) mm Hg higher than those in the management program, respectively. Bland-Altman analyses showed the wide agreement intervals ranging from - 27.7- to 36.5-mm Hg for SBP and - 18.3- to 24.7-mm Hg for DBP. In conclusion, BP measurements in periodic health examinations were generally higher than BPs measured following a standard protocol. Our findings highlight the importance of standard BP measurement to avoid overestimation of hypertension prevalence and treatment initiation. Supplementary Information The online version contains supplementary material available at 10.1007/s43657-022-00067-w.
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Affiliation(s)
- Jun-Xiang Chen
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030 Hubei China
| | - Yan-Feng Zhou
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030 Hubei China
| | - Tingting Geng
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030 Hubei China
| | - Simiao Chen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, 44883 Heidelberg, Germany
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, 57 Xinhua East Road, Tangshan, 063000 Hebei China
| | - Guodong Wang
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, 57 Xinhua East Road, Tangshan, 063000 Hebei China
| | - Yan-Bo Zhang
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030 Hubei China
| | - Yi Wang
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030 Hubei China
| | - Zhou-Zheng Tu
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030 Hubei China
| | - Gang Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430040 Hubei China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, 57 Xinhua East Road, Tangshan, 063000 Hebei China
| | - An Pan
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030 Hubei China
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4
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Filippone EJ, Foy AJ, Naccarelli GV. Controversies in Hypertension I: The Optimal Assessment of Blood Pressure Load and Implications for Treatment. Am J Med 2022; 135:1043-1050. [PMID: 35636476 DOI: 10.1016/j.amjmed.2022.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 11/01/2022]
Abstract
The most important factor in treating hypertension is assessing an individual patient's true blood pressure load, the cornerstone being research-grade office determination. Office blood pressure should be supplemented with out-of-office measurement, including home and ambulatory monitoring (if available), which we consider complementary and not interchangeable. Controversy remains for initiation of treatment of white coat hypertension, where cardiovascular risk lies between normotension and sustained hypertension; antihypertensive therapy should be considered unless low cardiovascular risk, wherein pressures should be followed for progression to sustained hypertension. Available data do not support intensification of therapy for the white coat effect due to the similar cardiovascular risk to controlled hypertension. Given the higher cardiovascular risk of the masked effect, initiation of therapy for masked hypertension and intensification for masked uncontrolled hypertension are indicated, acknowledging the dearth of supporting data. Optimally, randomized controlled trials are needed to determine the benefit of treating the 4 incongruous phenotypes between office and out-of-office measurements, that is, those with white coat or masked effects. We make no recommendations regarding chronotherapy pending results of ongoing trials.
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Affiliation(s)
- Edward J Filippone
- Division of Nephrology, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Hershey, Pa.
| | - Andrew J Foy
- Department of Medicine, Penn State University Heart and Vascular Institute, Penn State M.S Hershey Medical Center and College of Medicine, Hershey, Pa
| | - Gerald V Naccarelli
- Department of Medicine, Penn State University Heart and Vascular Institute, Penn State M.S Hershey Medical Center and College of Medicine, Hershey, Pa
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5
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The Role of Ambulatory Blood Pressure Monitoring in Current Clinical Practice. Heart Lung Circ 2022; 31:1333-1340. [DOI: 10.1016/j.hlc.2022.06.670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/22/2022] [Accepted: 06/13/2022] [Indexed: 11/23/2022]
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6
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Virtual management of hypertension: lessons from the COVID-19 pandemic-International Society of Hypertension position paper endorsed by World Hypertension League and European Society of Hypertension. J Hypertens 2022; 40:1435-1448. [PMID: 35579481 DOI: 10.1097/hjh.0000000000003205] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The coronavirus disease 2019 pandemic caused an unprecedented shift from in person care to delivering healthcare remotely. To limit infectious spread, patients and providers rapidly adopted distant evaluation with online or telephone-based diagnosis and management of hypertension. It is likely that virtual care of chronic diseases including hypertension will continue in some form into the future. The purpose of the International Society of Hypertension's (ISH) position paper is to provide practical guidance on the virtual management of hypertension to improve its diagnosis and blood pressure control based on the currently available evidence and international experts' opinion for nonpregnant adults. Virtual care represents the provision of healthcare services at a distance with communication conducted between healthcare providers, healthcare users and their circle of care. This statement provides consensus guidance on: selecting blood pressure monitoring devices, accurate home blood pressure assessments, delivering patient education virtually, health behavior modification, medication adjustment and long-term virtual monitoring. We further provide recommendations on modalities for the virtual assessment and management of hypertension across the spectrum of resource availability and patient ability.
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7
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Cheng Y, Li Y, Wang J. Ambulatory blood pressure monitoring for the management of hypertension. Chin Med J (Engl) 2022; 135:1027-1035. [PMID: 35202040 PMCID: PMC9276356 DOI: 10.1097/cm9.0000000000002028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Ambulatory blood pressure monitoring (ABPM) has become indispensable in the current management of hypertension. ABPM is particularly useful in the accurate diagnosis of hypertension. Its diagnostic thresholds had been recently established based on hard clinical outcomes. Cross-classification of patients according to office and ambulatory blood pressure identifies white-coat, masked, and sustained hypertension. ABPM is also useful in cardiovascular (CV) risk assessment. It provides information on daytime and nighttime blood pressure and circadian rhythm, particularly nighttime blood pressure dipping. Nighttime blood pressure is predictive of CV risk independent of office and daytime blood pressure. Isolated nocturnal hypertension is a special form of masked hypertension, with normal daytime but elevated nocturnal blood pressure. It also helps in the evaluation of blood pressure fluctuation and variation, such as morning blood pressure surge and reading-to-reading blood pressure variability. ABPM may derive several other indexes, such as ambulatory blood pressure index and salt sensitivity index, which may be useful in CV evaluations.
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Affiliation(s)
- Yibang Cheng
- Department of Cardiovascular Medicine, Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
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8
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Weber T, Protogerou AD, Agharazii M, Argyris A, Aoun Bahous S, Banegas JR, Binder RK, Blacher J, Araujo Brandao A, Cruz JJ, Danninger K, Giannatasio C, Graciani A, Hametner B, Jankowski P, Li Y, Maloberti A, Mayer CC, McDonnell BJ, McEniery CM, Antonio Mota Gomes M, Machado Gomes A, Lorenza Muiesan M, Nemcsik J, Paini A, Rodilla E, Schutte AE, Sfikakis PP, Terentes-Printzios D, Vallée A, Vlachopoulos C, Ware L, Wilkinson I, Zweiker R, Sharman JE, Wassertheurer S. Twenty-Four-Hour Central (Aortic) Systolic Blood Pressure: Reference Values and Dipping Patterns in Untreated Individuals. Hypertension 2021; 79:251-260. [PMID: 34775789 PMCID: PMC8654125 DOI: 10.1161/hypertensionaha.121.17765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Supplemental Digital Content is available in the text. Central (aortic) systolic blood pressure (cSBP) is the pressure seen by the heart, the brain, and the kidneys. If properly measured, cSBP is closer associated with hypertension-mediated organ damage and prognosis, as compared with brachial SBP (bSBP). We investigated 24-hour profiles of bSBP and cSBP, measured simultaneously using Mobilograph devices, in 2423 untreated adults (1275 women; age, 18–94 years), free from overt cardiovascular disease, aiming to develop reference values and to analyze daytime-nighttime variability. Central SBP was assessed, using brachial waveforms, calibrated with mean arterial pressure (MAP)/diastolic BP (cSBPMAP/DBPcal), or bSBP/diastolic blood pressure (cSBPSBP/DBPcal), and a validated transfer function, resulting in 144 509 valid brachial and 130 804 valid central measurements. Averaged 24-hour, daytime, and nighttime brachial BP across all individuals was 124/79, 126/81, and 116/72 mm Hg, respectively. Averaged 24-hour, daytime, and nighttime values for cSBPMAP/DBPcal were 128, 128, and 125 mm Hg and 115, 117, and 107 mm Hg for cSBPSBP/DBPcal, respectively. We pragmatically propose as upper normal limit for 24-hour cSBPMAP/DBPcal 135 mm Hg and for 24-hour cSBPSBP/DBPcal 120 mm Hg. bSBP dipping (nighttime-daytime/daytime SBP) was −10.6 % in young participants and decreased with increasing age. Central SBPSBP/DBPcal dipping was less pronounced (−8.7% in young participants). In contrast, cSBPMAP/DBPcal dipping was completely absent in the youngest age group and less pronounced in all other participants. These data may serve for comparison in various diseases and have potential implications for refining hypertension diagnosis and management. The different dipping behavior of bSBP versus cSBP requires further investigation.
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Affiliation(s)
- Thomas Weber
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W., R.K.B., K.D.)
| | - Athanase D Protogerou
- Cardiovascular Prevention and Research Unit, Clinic-Laboratory of Pathophysiology and First Department of Propeadeutic Internal Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Greece (A.D.P., A.A., P.P.S.)
| | - Mohsen Agharazii
- Centre de Recherche Du CHU de Québec, Université Laval, Canada (M.A.)
| | - Antonis Argyris
- Cardiovascular Prevention and Research Unit, Clinic-Laboratory of Pathophysiology and First Department of Propeadeutic Internal Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Greece (A.D.P., A.A., P.P.S.)
| | - Sola Aoun Bahous
- Lebanese American University School of Medicine, Byblos, Lebanon (S.A.B.)
| | - Jose R Banegas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ and CIBER in Epidemiology and Public Health, Spain (J.R.B., J.J.C., A.G.)
| | - Ronald K Binder
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W., R.K.B., K.D.)
| | - Jacques Blacher
- AP-HP Centre-Université de Paris, Hôpital Hôtel-Dieu, Centre de diagnostic et de thérapeutique, France (J.B., A.V.)
| | | | - Juan J Cruz
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ and CIBER in Epidemiology and Public Health, Spain (J.R.B., J.J.C., A.G.)
| | - Kathrin Danninger
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W., R.K.B., K.D.)
| | - Cristina Giannatasio
- School of Medicine and Surgery, Milano-Bicocca University and Cardiology 4, ASST GOM Niguarda, Milan, Italy (C.G., A.M.)
| | - Auxiliadora Graciani
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ and CIBER in Epidemiology and Public Health, Spain (J.R.B., J.J.C., A.G.)
| | - Bernhard Hametner
- Austrian Institute of Technology, Vienna, Austria (B.H., C.C.M., S.W.)
| | - Piotr Jankowski
- Institute of Cardiology, Jagellonian University, Krakow, Poland (P.J.)
| | - Yan Li
- Centre for Vascular Evaluations, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L.)
| | - Alessandro Maloberti
- School of Medicine and Surgery, Milano-Bicocca University and Cardiology 4, ASST GOM Niguarda, Milan, Italy (C.G., A.M.)
| | - Christopher C Mayer
- Austrian Institute of Technology, Vienna, Austria (B.H., C.C.M., S.W.).,Experimental Medicine and Immunotherapeutics, Addenbrooke's Hospital, University of Cambridge, United Kingdom (C.M.M., I.W.)
| | - Barry J McDonnell
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, United Kingdom (B.J.M.)
| | - Carmel M McEniery
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W., R.K.B., K.D.)
| | | | | | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, Centro per la Prevenzione e Cura dell'ipertensione Arteriosa, University of Brescia and ASST Spedali Civili, Italy (M.L.M., A.P.)
| | - Janos Nemcsik
- Department of Family Medicine, Semmelweis University, Budapest, Hungary (J.N.)
| | - Anna Paini
- Department of Clinical and Experimental Sciences, Centro per la Prevenzione e Cura dell'ipertensione Arteriosa, University of Brescia and ASST Spedali Civili, Italy (M.L.M., A.P.)
| | - Enrique Rodilla
- Universidad Cardenal Herrera-CEU, CEU Universities, Hospital de Sagunto, Valencia, Spain (E.R.)
| | - Aletta E Schutte
- School of Population Health, University of New South Wales, Sydney, Australia (A.E.S.).,The George Institute for Global Health, Sydney, Australia (A.E.S.).,Hypertension in Africa Research Team, SAMRC Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa (A.E.S.)
| | - Petros P Sfikakis
- Cardiovascular Prevention and Research Unit, Clinic-Laboratory of Pathophysiology and First Department of Propeadeutic Internal Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Greece (A.D.P., A.A., P.P.S.)
| | - Dimitrios Terentes-Printzios
- First Department of Cardiology, Hippokration General Hospital, National and Kapodistrian University of Athens, Greece (D.T.-P., C.V.)
| | - Alexandre Vallée
- AP-HP Centre-Université de Paris, Hôpital Hôtel-Dieu, Centre de diagnostic et de thérapeutique, France (J.B., A.V.)
| | - Charalambos Vlachopoulos
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W., R.K.B., K.D.).,SAMRC/Wits Developmental Pathways for Health Research Unit, South Africa (L.W.)
| | - Lisa Ware
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, South Africa (L.W.)
| | - Ian Wilkinson
- Experimental Medicine and Immunotherapeutics, Addenbrooke's Hospital, University of Cambridge, United Kingdom (C.M.M., I.W.)
| | - Robert Zweiker
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W., R.K.B., K.D.)
| | - James E Sharman
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W., R.K.B., K.D.)
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- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W., R.K.B., K.D.)
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9
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Dillon GA, Stanhewicz AE, Serviente C, Greaney JL, Alexander LM. Hydrogen sulfide-dependent microvascular vasodilation is improved following chronic sulfhydryl-donating antihypertensive pharmacotherapy in adults with hypertension. Am J Physiol Heart Circ Physiol 2021; 321:H728-H734. [PMID: 34477463 DOI: 10.1152/ajpheart.00404.2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Hypertension is characterized by systemic microvascular endothelial dysfunction, in part due to a functional absence of hydrogen sulfide (H2S)-mediated endothelium-dependent dilation. Treatment with a sulfhydryl-donating ACE inhibitor (SH-ACE inhibitor) improves endothelial function in preclinical models of hypertension. To date, no studies have directly assessed the effects of SH-ACE-inhibitor treatment on H2S-dependent vasodilation in humans with hypertension. We hypothesized that SH-ACE-inhibitor treatment would improve H2S-mediated endothelium-dependent vasodilation. Ten adults with hypertension [1 woman and 9 men; 56 ± 9 yr; systolic blood pressure (SBP): 141 ± 8.5 mmHg; diastolic blood pressure (DBP): 90.3 ± 6 mmHg] were treated (16 wk) with the SH-ACE-inhibitor captopril. Red blood cell flux (laser-Doppler flowmetry) was measured continuously during graded intradermal microdialysis perfusion of the endothelium-dependent agonist acetylcholine (ACh; 10-10 to 10-1 M) alone (control) and in combination with an inhibitor of enzymatic H2S production [10-3 M aminooxyacetate (AOAA)] preintervention and postintervention. Cutaneous vascular conductance (CVC; flux/mmHg) was calculated and normalized to the site-specific maximal CVC (0.028 M sodium nitroprusside and local heat to 43°C). Area under the curve was calculated using the trapezoid method. The 16-wk SH-ACE-inhibitor treatment resulted in a reduction of blood pressure (systolic BP: 129 ± 10 mmHg; diastolic BP: 81 ± 9 mmHg, both P < 0.05). Preintervention, inhibition of H2S production had no effect on ACh-induced vasodilation (316 ± 40 control vs. 322 ± 35 AU AOAA; P = 0.82). Captopril treatment improved ACh-induced vasodilation (316 ± 40 pre vs. 399 ± 55 AU post; P = 0.04) and increased the H2S-dependent component of ACh-induced vasodilation (pre: -6.6 ± 65.1 vs. post: 90.2 ± 148.3 AU, P = 0.04). These data suggest that SH-ACE-inhibitor antihypertensive treatment improves cutaneous microvascular endothelium-dependent vasodilation in adults with hypertension, in part via H2S-dependent mechanisms.NEW & NOTEWORTHY This is the first study to prospectively assess the effects of sulfhydryl antihypertensive treatment on microvascular endothelial function in adults with hypertension. Our data suggest that 16 wk of SH-ACE-inhibitor antihypertensive treatment improves cutaneous microvascular endothelium-dependent vasodilation in middle-aged adults with hypertension, in part via H2S-dependent mechanisms.
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Affiliation(s)
- Gabrielle A Dillon
- Noll Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania.,Center for Healthy Aging, The Pennsylvania State University, University Park, Pennsylvania
| | - Anna E Stanhewicz
- Noll Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania.,Department of Health and Human Physiology, The University of Iowa, Iowa City, Iowa
| | - Corinna Serviente
- Noll Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania.,Center for Healthy Aging, The Pennsylvania State University, University Park, Pennsylvania.,Institute for Applied Life Sciences, University of Massachusetts Amherst, Amherst, Massachusetts.,Department of Kinesiology, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Jody L Greaney
- Noll Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania.,Department of Kinesiology, University of Texas Arlington, Arlington, Texas
| | - Lacy M Alexander
- Noll Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania.,Center for Healthy Aging, The Pennsylvania State University, University Park, Pennsylvania
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10
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Rodríguez-Lesmes P. Estimating the gains of early detection of hypertension over the marginal patient. PLoS One 2021; 16:e0254260. [PMID: 34242312 PMCID: PMC8270433 DOI: 10.1371/journal.pone.0254260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 06/23/2021] [Indexed: 11/19/2022] Open
Abstract
This study estimated the potential impact of early diagnosis programs on health outcomes in England. Specifically, if advising individuals to visit their family doctor due to a suspected case of mild hypertension would result in (i) an increase in the diagnosis and treatment of high blood pressure; (ii) an improved lifestyle reflected in objective measures such as the body-mass-index and blood pressure levels; (iii) a reduced probability of the onset of other cardiovascular diseases, such as diabetes. To address potential selection bias in screening, a feature of the English Longitudinal Study of Ageing is exploited, motivating a regression discontinuity design. If respondents' blood pressure measurements are above a standard clinical threshold, they are advised to visit their family doctor to confirm hypertension. Two years after the protocol, there is evidence of an increase in diagnosis (5.7 pp, p-val = 0.06) and medication use (6 pp, p-val = 0.007) for treating the condition. However, four years after the protocol, the difference in diagnosis and medication disappeared (4 pp, p-val = 0.384; 3.4 pp, p-val = 0.261). Moreover, there are no differences on observed blood pressure levels (systolic 0.026 mmHg, p-val = 0.815; diastolic -0.336 mmHg, p-val = 0.765), or Body-Mass-Index ((0.771, p-val = 0.154)). There are also no differences on diagnosis of diabetes (1.7 pp, p-val = 0.343) or heart related conditions (3.6 pp, p-value = 0.161). In conclusion, the nudge produces an earlier diagnosis of around two years, but there are no perceivable gains in health outcomes after four years.
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11
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Bowen L, Pealing L, Tucker K, McManus RJ, Chappell LC. Adherence with blood pressure self-monitoring in women with pregnancy hypertension, and comparisons to clinic readings: A secondary analysis of OPTIMUM-BP. Pregnancy Hypertens 2021; 25:68-74. [PMID: 34082300 PMCID: PMC8372528 DOI: 10.1016/j.preghy.2021.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/16/2021] [Accepted: 05/24/2021] [Indexed: 11/16/2022]
Abstract
Chronic hypertension and gestational hypertension groups had good adherence to self monitoring of blood pressure (SMBP). There was no evidence of adherence varying in different socio-demographic groups. The differences between SMBP and clinic BP readings were small.
Objectives To assess adherence to self-monitoring of blood pressure (SMBP), and differences between SMBP and clinic readings, in a self-monitoring intervention for managing pregnancy hypertension. Study design OPTIMUM-BP was an unmasked randomised controlled clinical trial. 154 women with pregnancy hypertension from four maternity units in England were recruited and randomised to SMBP or usual care. This secondary analysis included 91 women randomised to self-monitoring who provided BP readings. Trial instructions were for daily SMBP. Main outcome measures Adherence was calculated as proportion of days on which SMBP readings were taken. Proportion of weeks in which at least 4 and at least 2 SMBP readings were taken was also calculated. Mean differences between clinic and SMBP measurements were calculated. Results Self-monitored BP data were available for 49 women with chronic hypertension and 42 women with gestational hypertension. Median percentage of days with SMBP readings was 77% (IQR 51, 89) in the chronic hypertension group and 85% (IQR 52, 95) in the gestational hypertension group. Adherence did not vary by different socio-demographic groups. Mean difference (95% CI) between clinic and SMBP for systolic BP was 0.99 mmHg (−1.44, 3.41; chronic hypertension) and 3.76 mmHg (0.75, 6.78; gestational hypertension) and for diastolic BP was 3.03 mmHg (0.93, 5.12; chronic hypertension) and 3.27 mmHg (0.56, 5.98; gestational hypertension). Conclusions Adherence to self-monitoring was good and differences between SMBP and clinic readings were small. These findings offer reassurance about the use of self-monitoring at a time when it is being increasingly implemented in maternity settings.
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Affiliation(s)
- Liza Bowen
- Department of Population Health Sciences, King's College London, London, UK
| | - Louise Pealing
- Department of Primary Care, Health Sciences, University of Oxford, UK
| | - Katherine Tucker
- Department of Primary Care, Health Sciences, University of Oxford, UK
| | - Richard J McManus
- Department of Primary Care, Health Sciences, University of Oxford, UK
| | - Lucy C Chappell
- Women and Children's Health, School of Life Course Sciences, King's College London, London, UK.
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12
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Huang QF, Yang WY, Asayama K, Zhang ZY, Thijs L, Li Y, O’Brien E, Staessen JA. Ambulatory Blood Pressure Monitoring to Diagnose and Manage Hypertension. Hypertension 2021; 77:254-264. [PMID: 33390042 PMCID: PMC7803442 DOI: 10.1161/hypertensionaha.120.14591] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This review portrays how ambulatory blood pressure (BP) monitoring was established and recommended as the method of choice for the assessment of BP and for the rational use of antihypertensive drugs. To establish much-needed diagnostic ambulatory BP thresholds, initial statistical approaches evolved into longitudinal studies of patients and populations, which demonstrated that cardiovascular complications are more closely associated with 24-hour and nighttime BP than with office BP. Studies cross-classifying individuals based on ambulatory and office BP thresholds identified white-coat hypertension, an elevated office BP in the presence of ambulatory normotension as a low-risk condition, whereas its counterpart, masked hypertension, carries a hazard almost as high as ambulatory combined with office hypertension. What clinically matters most is the level of the 24-hour and the nighttime BP, while other BP indexes derived from 24-hour ambulatory BP recordings, on top of the 24-hour and nighttime BP level, add little to risk stratification or hypertension management. Ambulatory BP monitoring is cost-effective. Ambulatory and home BP monitoring are complimentary approaches. Their interchangeability provides great versatility in the clinical implementation of out-of-office BP measurement. We are still waiting for evidence from randomized clinical trials to prove that out-of-office BP monitoring is superior to office BP in adjusting antihypertensive drug treatment and in the prevention of cardiovascular complications. A starting research line, the development of a standardized validation protocol for wearable BP monitoring devices, might facilitate the clinical applicability of ambulatory BP monitoring.
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Affiliation(s)
- Qi-Fang Huang
- From the Department of Cardiovascular Medicine, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital (Q.-F.H., Y.L.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen-Yi Yang
- Department of Cardiology, Shanghai General Hospital (W.-Y.Y), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A.)
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan (K.A.)
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (K.A., Z.-Y.Z., L.T., J.A.S)
| | - Zhen-Yu Zhang
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (K.A., Z.-Y.Z., L.T., J.A.S)
| | - Lutgarde Thijs
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (K.A., Z.-Y.Z., L.T., J.A.S)
| | - Yan Li
- From the Department of Cardiovascular Medicine, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital (Q.-F.H., Y.L.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Eoin O’Brien
- Conway Institute, University College Dublin, Ireland (E.O.B.)
| | - Jan A. Staessen
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (K.A., Z.-Y.Z., L.T., J.A.S)
- Research Institute Alliance for the Promotion of Preventive Medicine (www.appremed.org), Mechelen, Belgium (J.A.S)
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13
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Pivonello R, Bancos I, Feelders RA, Kargi AY, Kerr JM, Gordon MB, Mariash CN, Terzolo M, Ellison N, Moraitis AG. Relacorilant, a Selective Glucocorticoid Receptor Modulator, Induces Clinical Improvements in Patients With Cushing Syndrome: Results From A Prospective, Open-Label Phase 2 Study. Front Endocrinol (Lausanne) 2021; 12:662865. [PMID: 34335465 PMCID: PMC8317576 DOI: 10.3389/fendo.2021.662865] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/25/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION/PURPOSE Relacorilant is a selective glucocorticoid receptor modulator (SGRM) with no progesterone receptor activity. We evaluated the efficacy and safety of relacorilant in patients with endogenous Cushing syndrome (CS). MATERIALS AND METHODS A single-arm, open-label, phase 2, dose-finding study with 2 dose groups (NCT02804750, https://clinicaltrials.gov/ct2/show/NCT02804750) was conducted at 19 sites in the U.S. and Europe. Low-dose relacorilant (100-200 mg/d; n = 17) was administered for 12 weeks or high-dose relacorilant (250-400 mg/d; n = 18) for 16 weeks; doses were up-titrated by 50 mg every 4 weeks. Outcome measures included proportion of patients with clinically meaningful changes in hypertension and/or hyperglycemia from baseline to last observed visit. For patients with hypertension, clinical response was defined as a ≥5-mmHg decrease in mean systolic or diastolic blood pressure, measured by a standardized and validated 24-h ABPM. For patients with hyperglycemia, clinical response was defined ad-hoc as ≥0.5% decrease in HbA1c, normalization or ≥50-mg/dL decrease in 2-h plasma glucose value on oral glucose tolerance test, or decrease in daily insulin (≥25%) or sulfonylurea dose (≥50%). RESULTS 35 adults with CS and hypertension and/or hyperglycemia (impaired glucose tolerance or type 2 diabetes mellitus) were enrolled, of which 34 (24 women/10 men) received treatment and had postbaseline data. In the low-dose group, 5/12 patients (41.7%) with hypertension and 2/13 patients (15.4%) with hyperglycemia achieved response. In the high-dose group, 7/11 patients (63.6%) with hypertension and 6/12 patients (50%) with hyperglycemia achieved response. Common (≥20%) adverse events included back pain, headache, peripheral edema, nausea, pain at extremities, diarrhea, and dizziness. No drug-induced vaginal bleeding or hypokalemia occurred. CONCLUSIONS The SGRM relacorilant provided clinical benefit to patients with CS without undesirable antiprogesterone effects or drug-induced hypokalemia.
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Affiliation(s)
- Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
| | - Irina Bancos
- Department of Internal Medicine, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, United States
| | - Richard A. Feelders
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Atil Y. Kargi
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Miami, Miami, FL, United States
| | - Janice M. Kerr
- Department of Endocrinology, Division of Endocrinology, Metabolism and Diabetes, University of Colorado Denver, Aurora, CO, United States
| | - Murray B. Gordon
- Allegheny Neuroendocrinology Center, Allegheny General Hospital, Pittsburgh, PA, United States
| | - Cary N. Mariash
- Methodist Research Institute, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Massimo Terzolo
- Department of Clinical and Biological Sciences, Internal Medicine 1 – San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - Noel Ellison
- Biostatistics, Trialwise, Inc, Houston, TX, United States
| | - Andreas G. Moraitis
- Drug Research and Development, Corcept Therapeutics, Menlo Park, CA, United States
- *Correspondence: Andreas G. Moraitis,
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14
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Awasthi A, Singh SK, Kumar B, Gulati M, Kumar R, Wadhwa S, Khursheed R, Corrie L, Kr A, Kumar R, Patni P, Kaur J, Vishwas S, Yadav A. Treatment Strategies Against Diabetic Foot Ulcer: Success so Far and the Road Ahead. Curr Diabetes Rev 2021; 17:421-436. [PMID: 33143613 DOI: 10.2174/1573399816999201102125537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Diabetic foot ulcer (DFU) is one of the leading complications of type-2 diabetes mellitus. It is associated with neuropathy and peripheral arterial disease of the lower limb in patients with diabetes. There are four stages of wound healing, namely hemostasis phase, inflammatory phase, proliferative phase and maturation phase. In the case of DFU, all these stages are disturbed which lead to delay in healing and consequently to lower limb amputation. Conventional dosage forms like tablets, creams, ointments, gels and capsules have been used for the treatment of diabetic foot ulcer for many years. INTRODUCTION In this review, the global prevalence as well as etiopathogenesis related to diabetic foot ulcer have been discussed. The potential role of various synthetic and herbal drugs, as well as their conventional dosage forms in the effective management of DFU have been discussed in detail. METHODS Structured search of bibliographic databases from previously published peer-reviewed research papers was explored and data has been represented in terms of various approaches that are used for the treatment of DFU. RESULTS About 148 papers, including both research and review articles, were included in this review to produce a comprehensive as well as a readily understandable article. A series of herbal and synthetic drugs have been discussed along with their current status of treatment in terms of dose and mechanism of action. CONCLUSION DFU has become one of the most common complications in patients having diabetes for more than ten years. Hence, understanding the root cause and its successful treatment is a big challenge because it depends upon multiple factors such as the judicious selection of drugs as well as proper control of blood sugar level. Most of the drugs that have been used so far either belong to the category of antibiotics, antihyperglycaemic or they have been repositioned. In clinical practice, much focus has been given to dressings that have been used to cover the ulcer. The complete treatment of DFU is still a farfetched dream to be achieved and it is expected that combination therapy of herbal and synthetic drugs with multiple treatment pathways could be able to offer better management of DFU.
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Affiliation(s)
- Ankit Awasthi
- School of Pharmaceutical Sciences, Lovely Professional University Phagwara, 144411, Punjab, India
| | - Sachin Kumar Singh
- School of Pharmaceutical Sciences, Lovely Professional University Phagwara, 144411, Punjab, India
| | - Bimlesh Kumar
- School of Pharmaceutical Sciences, Lovely Professional University Phagwara, 144411, Punjab, India
| | - Monica Gulati
- School of Pharmaceutical Sciences, Lovely Professional University Phagwara, 144411, Punjab, India
| | - Rajesh Kumar
- School of Pharmaceutical Sciences, Lovely Professional University Phagwara, 144411, Punjab, India
| | - Sheetu Wadhwa
- School of Pharmaceutical Sciences, Lovely Professional University Phagwara, 144411, Punjab, India
| | - Rubiya Khursheed
- School of Pharmaceutical Sciences, Lovely Professional University Phagwara, 144411, Punjab, India
| | - Leander Corrie
- School of Pharmaceutical Sciences, Lovely Professional University Phagwara, 144411, Punjab, India
| | - Arya Kr
- School of Pharmaceutical Sciences, Lovely Professional University Phagwara, 144411, Punjab, India
| | - Rajan Kumar
- School of Pharmaceutical Sciences, Lovely Professional University Phagwara, 144411, Punjab, India
| | - Pooja Patni
- School of Pharmaceutical Sciences, Lovely Professional University Phagwara, 144411, Punjab, India
| | - Jaskiran Kaur
- School of Pharmaceutical Sciences, Lovely Professional University Phagwara, 144411, Punjab, India
| | - Sukriti Vishwas
- School of Pharmaceutical Sciences, Lovely Professional University Phagwara, 144411, Punjab, India
| | - Ankit Yadav
- School of Pharmaceutical Sciences, Lovely Professional University Phagwara, 144411, Punjab, India
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15
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Drawz PE, Agarwal A, Dwyer JP, Horwitz E, Lash J, Lenoir K, McWilliams A, Oparil S, Rahbari-Oskoui F, Rahman M, Parkulo MA, Pemu P, Raj DS, Rocco M, Soman S, Thomas G, Tuot DS, Whelton PK, Pajewski NM. Concordance Between Blood Pressure in the Systolic Blood Pressure Intervention Trial and in Routine Clinical Practice. JAMA Intern Med 2020; 180:1655-1663. [PMID: 33044494 PMCID: PMC7551238 DOI: 10.1001/jamainternmed.2020.5028] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
IMPORTANCE There are concerns with translating results from the Systolic Blood Pressure Intervention Trial (SPRINT) into clinical practice because the standardized protocol used to measure blood pressure (BP) may not be consistently applied in routine clinical practice. OBJECTIVES To evaluate the concordance between BPs obtained in routine clinical practice and those obtained using the SPRINT protocol and whether concordance varied by target trial BP. DESIGN, SETTING, AND PARTICIPANTS This observational prognostic study linking outpatient vital sign information from electronic health records (EHRs) with data from 49 of the 102 SPRINT sites was conducted from November 8, 2010, to August 20, 2015, among 3074 adults 50 years or older with hypertension without diabetes or a history of stroke. Statistical analysis was performed from May 21, 2019, to March 20, 2020. MAIN OUTCOMES AND MEASURES Blood pressures measured in routine clinical practice and SPRINT. RESULTS Participant-level EHR data was obtained for 3074 participants (2482 men [80.7%]; mean [SD] age, 68.5 [9.1] years) with 3 or more outpatient and trial BP measurements. In the period from the 6-month study visit to the end of the study intervention, the mean systolic BP (SBP) in the intensive treatment group from outpatient BP recorded in the EHR was 7.3 mm Hg higher (95% CI, 7.0-7.6 mm Hg) than BP measured at trial visits; the mean difference between BP recorded in the outpatient EHR and trial SBP was smaller for participants in the standard treatment group (4.6 mm Hg [95% CI, 4.4-4.9 mm Hg]). Bland-Altman analyses demonstrated low agreement between outpatient BP recorded in the EHR and trial BP, with wide agreement intervals ranging from approximately -30 mm Hg to 45 mm Hg in both treatment groups. In addition, the difference between BP recorded in the EHR and trial BP varied widely by site. CONCLUSIONS AND RELEVANCE Outpatient BPs measured in routine clinical practice were generally higher than BP measurements taken in SPRINT, with greater mean SBP differences apparent in the intensive treatment group. There was a consistent high degree of heterogeneity between the BPs recorded in the EHR and trial BPs, with significant variability over time, between and within the participants, and across clinic sites. These results highlight the importance of proper BP measurement technique and an inability to apply 1 common correction factor (ie, approximately 10 mm Hg) to approximate research-quality BP estimates when BP is not measured appropriately in routine clinical practice. TRIAL REGISTRATION SPRINT ClinicalTrials.gov Identifier: NCT01206062.
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Affiliation(s)
- Paul E Drawz
- Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis
| | - Anil Agarwal
- Division of Nephrology, The Ohio State University Wexner Medical Center, Columbus
| | - Jamie P Dwyer
- Division of Nephrology/Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Edward Horwitz
- Division of Nephrology and Hypertension, MetroHealth Medical Center, Case Western Reserve University. Cleveland, Ohio
| | - James Lash
- Division of Nephrology, Department of Medicine, University of Illinois, Chicago
| | - Kristin Lenoir
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Andrew McWilliams
- Department of Internal Medicine, Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham
| | - Frederic Rahbari-Oskoui
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Mahboob Rahman
- Division of Nephrology and Hypertension, Department of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Mark A Parkulo
- Division of Community Internal Medicine and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida
| | - Priscilla Pemu
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Dominic S Raj
- Division of Kidney Diseases and Hypertension, George Washington University, Washington, DC
| | - Michael Rocco
- Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Sandeep Soman
- Division of Nephrology and Hypertension, Henry Ford Health System, Detroit, Michigan
| | - George Thomas
- Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Ohio
| | - Delphine S Tuot
- Division of Nephrology, University of California, San Francisco
| | - Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Nicholas M Pajewski
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
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16
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Zhang DY, Cheng YB, Guo QH, Shan XL, Wei FF, Lu F, Sheng CS, Huang QF, Yang CH, Li Y, Wang JG. Treatment of Masked Hypertension with a Chinese Herbal Formula. Circulation 2020; 142:1821-1830. [DOI: 10.1161/circulationaha.120.046685] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background:
Masked hypertension is associated with adverse cardiovascular outcomes. Nonetheless, no randomized controlled trials exist in the treatment of masked hypertension. The aim of this randomized, placebo-controlled trial was to investigate the efficacy and safety of blood pressure (BP)–lowering treatment with a Chinese herbal formula, gastrodia-uncaria granules, in patients with masked hypertension.
Methods:
Patients with an office BP of <140/90 mm Hg and daytime ambulatory BP of 135 to 150 mm Hg systolic or 85 to 95 mm Hg diastolic were randomly assigned 1:1 to the treatment of gastrodia-uncaria granules or placebo 5 to 10 g twice daily for 4 weeks. The primary efficacy variable was the change in daytime ambulatory BP.
Results:
At baseline, office and daytime BP of the 251 participants (mean age, 50.4 years; 53.4% men; mean body mass index 24.5 kg/m
2
; and 2.8%, 1.6%, and 30.7% with cardiovascular disease, diabetes, and smoking, respectively) averaged 129/82 and 135/89 mm Hg, respectively. In the intention-to-treat analysis, daytime systolic/diastolic BP was reduced by 5.44/3.39 and 2.91/1.60 mm Hg in the gastrodia-uncaria granules and placebo groups, respectively. The between-group difference in BP reductions was significant for the daytime (2.52/1.79 mm Hg;
P
≤0.025) and 24-hour BP (2.33/1.49 mm Hg;
P
≤0.012), but not for the clinic and nighttime BPs (
P
≥0.162). The per-protocol analysis in 229 patients produced similar results. Only 1 adverse event (sleepiness during the day) was reported, and no serious adverse event occurred.
Conclusions:
BP-lowering treatment with Chinese traditional medicine gastrodia-uncaria granules is efficacious for patients with masked hypertension.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02156024.
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Affiliation(s)
- Dong-Yan Zhang
- Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, National Key Laboratory of Medical Genomics, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (D.-Y.Z., Y.-B.C., Q.-H.G., X.-L.S., F.-F.W., C.-S.S., Q.-F.H., Y.L., J.-G.W.)
| | - Yi-Bang Cheng
- Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, National Key Laboratory of Medical Genomics, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (D.-Y.Z., Y.-B.C., Q.-H.G., X.-L.S., F.-F.W., C.-S.S., Q.-F.H., Y.L., J.-G.W.)
| | - Qian-Hui Guo
- Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, National Key Laboratory of Medical Genomics, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (D.-Y.Z., Y.-B.C., Q.-H.G., X.-L.S., F.-F.W., C.-S.S., Q.-F.H., Y.L., J.-G.W.)
| | - Xiao-Li Shan
- Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, National Key Laboratory of Medical Genomics, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (D.-Y.Z., Y.-B.C., Q.-H.G., X.-L.S., F.-F.W., C.-S.S., Q.-F.H., Y.L., J.-G.W.)
| | - Fang-Fei Wei
- Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, National Key Laboratory of Medical Genomics, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (D.-Y.Z., Y.-B.C., Q.-H.G., X.-L.S., F.-F.W., C.-S.S., Q.-F.H., Y.L., J.-G.W.)
| | - Feng Lu
- Department of Cardiovascular Diseases, Shandong Provincial Hospital of Traditional Chinese Medicine, Jinan, China (F.L., C.-H.Y.)
| | - Chang-Sheng Sheng
- Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, National Key Laboratory of Medical Genomics, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (D.-Y.Z., Y.-B.C., Q.-H.G., X.-L.S., F.-F.W., C.-S.S., Q.-F.H., Y.L., J.-G.W.)
| | - Qi-Fang Huang
- Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, National Key Laboratory of Medical Genomics, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (D.-Y.Z., Y.-B.C., Q.-H.G., X.-L.S., F.-F.W., C.-S.S., Q.-F.H., Y.L., J.-G.W.)
| | - Chuan-Hua Yang
- Department of Cardiovascular Diseases, Shandong Provincial Hospital of Traditional Chinese Medicine, Jinan, China (F.L., C.-H.Y.)
| | - Yan Li
- Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, National Key Laboratory of Medical Genomics, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (D.-Y.Z., Y.-B.C., Q.-H.G., X.-L.S., F.-F.W., C.-S.S., Q.-F.H., Y.L., J.-G.W.)
| | - Ji-Guang Wang
- Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, National Key Laboratory of Medical Genomics, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (D.-Y.Z., Y.-B.C., Q.-H.G., X.-L.S., F.-F.W., C.-S.S., Q.-F.H., Y.L., J.-G.W.)
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Bawa-Allah A, Mashao MM, Nyundu TF, Phukubje EM, Nkosi BG, Ngema MV, Mlambo BW, Maseko MJ. SERUM LIPID PROFILE AND ARTERIAL STIFFNESS IN NON-DIPPERS. INTERNATIONAL JOURNAL OF MEDICINE AND MEDICAL RESEARCH 2020. [DOI: 10.11603/ijmmr.2413-6077.2020.1.11014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background. A non-dipping blood pressure profile (NDP) is associated with increased arterial stiffness and other cardiovascular target organ damage. Serum lipid profiles have been shown to be important determinants of arterial stiffness.
Objective. The aim of the research was to assess serum lipid profiles and arterial stiffness in non-dippers.
Methods. This cross-sectional study was conducted involving 796 (288 males and 508 females) participants of black African origin. A twenty-four-hour ambulatory BP monitoring was done using a Spacelabs 90207 (Spacelabs Inc., Redmond, Washington, USA) monitor. Carotid-Femoral pulse wave velocity measurements were performed using a high fidelity SPC-301 micromanometer (Millar instruments Inc., Houston, TX).
Results. Of the 288 males, 140 were classified as non-dippers. Of the 508 females, 273 were classified as non-dippers. In the general population, males had higher triglycerides when compared with females 1.46±0.96 vs 1.13±1.02, p<0.0001. Additionally, dipper males had higher serum TRGL when compared with dipper females 1.32±0.98 vs 1.06±0.58, p = 0.0012. Non-dipper males also had higher serum TRGL when compared with non-dipper females 1.61±2.05 vs 1.19±1.14, p=0.0078. Serum HDLc was lower in the non-dipper male group when compared to the non-dipper female group (p=0.008). In both male and female groups, non-dippers had higher CFPWV when compared with dippers; 7.53±3.60 vs 5.74±2.47, p<0.0001 and 6.64±2.52 vs 5.98±2.23, p=0.0021 respectively. However, non-dipper males had significantly higher CFPWV when compared with non-dipper females (7.53±3.60 vs 6.64±2.52, p=0.0031).
Conclusions. Therapies targeting a reduction of serum triglycerides levels might be beneficial in improving arterial compliance with or without the presence of non-dipping.
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Dillon GA, Greaney JL, Shank S, Leuenberger UA, Alexander LM. AHA/ACC-defined stage 1 hypertensive adults do not display cutaneous microvascular endothelial dysfunction. Am J Physiol Heart Circ Physiol 2020; 319:H539-H546. [PMID: 32734817 DOI: 10.1152/ajpheart.00179.2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In 2017, the American Heart Association (AHA) and American College of Cardiology (ACC) redefined stage 1 hypertension to systolic blood pressure (BP) 130-139 mmHg or diastolic BP 80-89 mmHg; however, the degree to which microvascular endothelial dysfunction is evident in adults with stage 1 hypertension remains equivocal. We tested the hypotheses that cutaneous microvascular endothelial dysfunction would be present in adults with stage 1 hypertension (HTN1) compared with normotensive adults (NTN; BP <120/<80 mmHg) but would be less severe compared with adults with stage 2 hypertension (HTN2; systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg) and that this graded impairment would be mediated by reductions in nitric oxide (NO)-dependent dilation. This retrospective analysis included 20 NTN (5 men; 45-64 yr; BP 94-114/60-70 mmHg), 22 HTN1 (11 men; 40-74 yr; BP 110-134/70-88 mmHg), and 44 HTN2 (27 men; 40-74 yr; BP 128-180/80-110 mmHg). BP and nocturnal dipping status were also assessed using 24-h ambulatory BP monitoring. Red cell flux (laser Doppler flowmetry) was measured during intradermal microdialysis perfusion of acetylcholine (ACh; 10-10 to 10-1M) alone and concurrently with the nonspecific nitric oxide (NO) synthase inhibitor NG-nitro-l-arginine methyl ester (l-NAME; 15 mM). ACh-induced dilation was impaired in HTN2 (P < 0.01), but not in HTN1 (P = 0.85), compared with NTN. Furthermore, reductions in NO-dependent dilation were evident in HTN2 (P < 0.01) but not in HTN1 (P = 0.76). Regardless of BP, endothelium-dependent dilation was impaired in nondippers (nighttime drop in systolic BP <10%) compared with dippers (nighttime drop in systolic BP ≥10%, P < 0.05). In conclusion, functional impairments in NO-mediated endothelium-dependent dilation were not evident in HTN1. However, regardless of BP classification, the lack of a nocturnal dip in BP was associated with blunted endothelium-dependent dilation.NEW & NOTEWORTHY This is the first study to pharmacologically assess the mechanistic regulation of endothelial function in adults with hypertension, classified according to the 2017 clinical guidelines set for by the American Heart Association (AHA) and American College of Cardiology (ACC). Compared with that in normotensive adults, nitric oxide-mediated endothelium-dependent dilation is impaired in adults with stage 2, but not stage 1, hypertension. Adults lacking a nighttime dip in blood pressure demonstrated reductions in endothelium-dependent dilation.
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Affiliation(s)
- Gabrielle A Dillon
- Noll Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania
| | - Jody L Greaney
- Noll Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania.,Department of Kinesiology, University of Texas Arlington, Arlington, Texas
| | - Sean Shank
- Noll Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania
| | - Urs A Leuenberger
- Department of Medicine, Pennsylvania State College of Medicine, Hershey, Pennsylvania
| | - Lacy M Alexander
- Noll Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania
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19
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Hypertension, white-coat hypertension and masked hypertension in Australia: findings from the Australian Diabetes, Obesity, and Lifestyle Study 3. J Hypertens 2020; 37:1615-1623. [PMID: 31058796 DOI: 10.1097/hjh.0000000000002087] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND METHOD The Australian Diabetes, Obesity, and Lifestyle Study is a national, population-based examination of ∼11 000 adults with a third follow-up phase at 12 years. The aim was to use ambulatory blood pressure monitoring (ABPM) in a subsample (n = 508) of the main Australian Diabetes third follow-up cohort to determine the proportion with established, masked or white-coat hypertension in city and regional centers and the effectiveness of diagnosis and treatment. RESULTS Mean age was 58.9 years, BMI was 27.6 kg/m with 53% women. The mean clinic BP was 127/73 mmHg and mean 24-h BP was 121/73 mmHg. Using regression analysis estimations, the predicted ABPM daytime equivalent for the hypertension threshold values of 140/90 mmHg were 136/90 mmHg. There were 43% classified as hypertensive due to either ABPM 24-h more than 130/80 mmHg (17%) or taking antihypertensive therapy (25%). Ambulatory SBP/DBP were higher in men (24-h + 6.4/4.9 mmHg, P < 0.001) compared with women. There was only 3% with white-coat but 21% with masked hypertension indicating 24% misdiagnosis. Based on ABPM, 9% were treated and still hypertensive, which was three times more common in men (14%) than women (4%). Thus 36% had not reached target. There were no differences between urban and rural participants. Based on ABPM, nearly half the participants were hypertensive while only a quarter were taking antihypertensive therapy. CONCLUSION The findings highlight the importance of out-of-office BP assessments and the considerable gaps in effectively diagnosing and treating hypertension.
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20
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Kim BK, Rhee MY. Impact of 2018 ESC/ESH and 2017 ACC/AHA Hypertension Guidelines: Difference in Prevalence of White-Coat and Masked Hypertension. Healthcare (Basel) 2020; 8:healthcare8020122. [PMID: 32375221 PMCID: PMC7348809 DOI: 10.3390/healthcare8020122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/24/2020] [Accepted: 04/30/2020] [Indexed: 12/02/2022] Open
Abstract
Our study evaluated whether there were differences in the prevalence of white-coat hypertension (WH) and masked hypertension (MH) based on the 2018 ESC/ESH and 2017 ACC/AHA hypertension guidelines in Korea. The motivation was the lowering of the diagnostic threshold for hypertension in the 2017 ACC/AHA guidelines. Of 319 participants without antihypertensive drug history and with suspected hypertension based on outpatient clinic blood pressure (BP) measured by physicians, 263 participants (51.6 ± 9.6 years; 125 men) who had valid research-grade office BP and 24-h ambulatory BP measurements were enrolled. WH prevalence based on daytime ambulatory BP among normotensive individuals was lower with the ESC/ESH guidelines than the ACC/AHA guidelines (29.0% vs. 71.4%, p < 0.001). However, MH prevalence based on daytime ambulatory BP among hypertensive individuals was higher based on the ESC/ESH guidelines (21.6% vs. 1.8%, p < 0.001). Seventy percent of WH cases (2017 ACC/AHA guidelines) and 95.2% of MH cases (2018 ESC/ESH guidelines) occurred in individuals with systolic BP of 130–139 mmHg and/or diastolic BP of 80–89 mmHg. The diagnostic threshold of the 2017 ACC/AHA guidelines yielded a higher prevalence of WH compared to that of the 2018 ESC/ESH guidelines. However, the prevalence of MH was higher with the 2018 ESC/ESH guidelines than with the 2017 ACC/AHA guidelines. The high prevalence of WH and MH in people with a systolic BP of 130–139 mmHg or diastolic BP of 80–89 mmHg suggests the need for a more active out-of-office BP measurement in this patient group.
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Affiliation(s)
- Byong-Kyu Kim
- Division of Cardiology, Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju Hospital, Gyeongju 38067, Korea;
| | - Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, 27 Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi 10326, Korea
- Correspondence: ; Tel.: +82-31-961-5775; Fax: +82-31-961-7786
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21
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Muntner P, Carey RM, Jamerson K, Wright JT, Whelton PK. Rationale for Ambulatory and Home Blood Pressure Monitoring Thresholds in the 2017 American College of Cardiology/American Heart Association Guideline. Hypertension 2019; 73:33-38. [PMID: 30571569 DOI: 10.1161/hypertensionaha.118.11946] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Paul Muntner
- From the Department of Epidemiology, University of Alabama at Birmingham (P.M.)
| | - Robert M Carey
- Department of Medicine, University of Virginia, Charlottesville (R.M.C.)
| | - Kenneth Jamerson
- Department of Medicine, University of Michigan, Ann Arbor (K.J.)
| | - Jackson T Wright
- Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.)
| | - Paul K Whelton
- Department of Epidemiology, Tulane University, New Orleans, LA (P.K.W.)
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22
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Cheng YB, Thijs L, Zhang ZY, Kikuya M, Yang WY, Melgarejo JD, Boggia J, Wei FF, Hansen TW, Yu CG, Asayama K, Ohkubo T, Dolan E, Stolarz-Skrzypek K, Malyutina S, Casiglia E, Lind L, Filipovský J, Maestre GE, Imai Y, Kawecka-Jaszcz K, Sandoya E, Narkiewicz K, Li Y, O'Brien E, Wang JG, Staessen JA. Outcome-Driven Thresholds for Ambulatory Blood Pressure Based on the New American College of Cardiology/American Heart Association Classification of Hypertension. Hypertension 2019; 74:776-783. [PMID: 31378104 PMCID: PMC6739146 DOI: 10.1161/hypertensionaha.119.13512] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 07/02/2019] [Indexed: 01/10/2023]
Abstract
The new American College of Cardiology/American Heart Association guideline reclassified office blood pressure and proposed thresholds for ambulatory blood pressure (ABP). We derived outcome-driven ABP thresholds corresponding with the new office blood pressure categories. We performed 24-hour ABP monitoring in 11 152 participants (48.9% women; mean age, 53.0 years) representative of 13 populations. We determined ABP thresholds resulting in multivariable-adjusted 10-year risks similar to those associated with elevated office blood pressure (120/80 mm Hg) and stages 1 and 2 of office hypertension (130/80 and 140/90 mm Hg). Over 13.9 years (median), 2728 (rate per 1000 person-years, 17.9) people died, 1033 (6.8) from cardiovascular disease; furthermore, 1988 (13.8), 893 (6.0), and 795 (5.4) cardiovascular and coronary events and strokes occurred. Using a composite cardiovascular end point, systolic/diastolic outcome-driven thresholds indicating elevated 24-hour, daytime, and nighttime ABP were 117.9/75.2, 121.4/79.6, and 105.3/66.2 mm Hg. For stages 1 and 2 ambulatory hypertension, thresholds were 123.3/75.2 and 128.7/80.7 mm Hg for 24-hour ABP, 128.5/79.6 and 135.6/87.1 mm Hg for daytime ABP, and 111.7/66.2 and 118.1/72.5 mm Hg for nighttime ABP. ABP thresholds derived from other end points were similar. After rounding, approximate thresholds for elevated 24-hour, daytime, and nighttime ABP were 120/75, 120/80, and 105/65 mm Hg, and for stages 1 and 2, ambulatory hypertension 125/75 and 130/80 mm Hg, 130/80 and 135/85 mm Hg, and 110/65 and 120/70 mm Hg. Outcome-driven ABP thresholds corresponding to elevated blood pressure and stages 1 and 2 of hypertension are similar to those proposed by the current American College of Cardiology/American Heart Association guideline.
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Affiliation(s)
- Yi-Bang Cheng
- From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, China (Y.-B.C., Y.L., J.-G.W.)
| | - Lutgarde Thijs
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., Z.-Y.Z., W.-Y.Y., F.-F.W., C.-G.Y., J.A.S.)
| | - Zhen-Yu Zhang
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., Z.-Y.Z., W.-Y.Y., F.-F.W., C.-G.Y., J.A.S.)
| | - Masahiro Kikuya
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (M.K., K.A., T.O.)
| | - Wen-Yi Yang
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., Z.-Y.Z., W.-Y.Y., F.-F.W., C.-G.Y., J.A.S.)
| | - Jesus D Melgarejo
- Laboratorio de Neurociencias and Instituto de Enfermedades Cardiovasculares, Universidad del Zulia, Maracaibo, Venezuela (J.D.M., G.E.M.)
| | - José Boggia
- Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.)
| | - Fang-Fei Wei
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., Z.-Y.Z., W.-Y.Y., F.-F.W., C.-G.Y., J.A.S.)
| | - Tine W Hansen
- Steno Diabetes Center, Copenhagen, Gentofte, and Center for Health, Capital Region of Denmark, Denmark (T.W.H.)
| | - Cai-Guo Yu
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., Z.-Y.Z., W.-Y.Y., F.-F.W., C.-G.Y., J.A.S.)
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (M.K., K.A., T.O.)
- Department of Planning for Drug Development and Clinical Evaluation, Tohoku Institute for Management of Blood Pressure, Sendai, Japan (K.A., T.O., Y.I.)
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (M.K., K.A., T.O.)
- Department of Planning for Drug Development and Clinical Evaluation, Tohoku Institute for Management of Blood Pressure, Sendai, Japan (K.A., T.O., Y.I.)
| | - Eamon Dolan
- Stroke and Hypertension Unit, Blanchardstown, Dublin, Ireland (E.D.)
| | - Katarzyna Stolarz-Skrzypek
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.S.-S., K.K.-J)
| | - Sofia Malyutina
- Institute of Internal and Preventive Medicine, Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russian Federation (S.M.)
| | | | - Lars Lind
- Section of Geriatrics, Department of Public Health and Caring Sciences, Uppsala University, Sweden (L.L.)
| | - Jan Filipovský
- Faculty of Medicine, Charles University, Pilsen, Czech Republic (J.F.)
| | - Gladys E Maestre
- Laboratorio de Neurociencias and Instituto de Enfermedades Cardiovasculares, Universidad del Zulia, Maracaibo, Venezuela (J.D.M., G.E.M.)
- Department of Neurosciences and Department of Human Genetics, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.)
| | - Yutaka Imai
- Department of Planning for Drug Development and Clinical Evaluation, Tohoku Institute for Management of Blood Pressure, Sendai, Japan (K.A., T.O., Y.I.)
| | - Kalina Kawecka-Jaszcz
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.S.-S., K.K.-J)
| | - Edgardo Sandoya
- Asociación Española Primera de Socorros Mutuos, Montevideo, Uruguay (E.S.)
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Hypertension Unit, Medical University of Gdańsk, Poland (K.N.)
| | - Yan Li
- From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, China (Y.-B.C., Y.L., J.-G.W.)
| | - Eoin O'Brien
- Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Ireland (E.O.)
| | - Ji-Guang Wang
- From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, China (Y.-B.C., Y.L., J.-G.W.)
| | - Jan A Staessen
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., Z.-Y.Z., W.-Y.Y., F.-F.W., C.-G.Y., J.A.S.)
- Cardiovascular Research Institute Maastricht, Maastricht University, the Netherlands (J.A.S.)
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23
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019; 138:e484-e594. [PMID: 30354654 DOI: 10.1161/cir.0000000000000596] [Citation(s) in RCA: 220] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Paul K Whelton
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Robert M Carey
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Wilbert S Aronow
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Donald E Casey
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Karen J Collins
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Cheryl Dennison Himmelfarb
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sondra M DePalma
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Samuel Gidding
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Kenneth A Jamerson
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Daniel W Jones
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Eric J MacLaughlin
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Paul Muntner
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Bruce Ovbiagele
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sidney C Smith
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Crystal C Spencer
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Randall S Stafford
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sandra J Taler
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Randal J Thomas
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Kim A Williams
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Jeff D Williamson
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Jackson T Wright
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
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24
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Lv LJ, Ji WJ, Wu LL, Miao J, Wen JY, Lei Q, Duan DM, Chen H, Hirst JE, Henry A, Zhou X, Niu JM. Thresholds for Ambulatory Blood Pressure Monitoring Based on Maternal and Neonatal Outcomes in Late Pregnancy in a Southern Chinese Population. J Am Heart Assoc 2019; 8:e012027. [PMID: 31267796 PMCID: PMC6662146 DOI: 10.1161/jaha.119.012027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background In contrast to the general population, outcome‐derived thresholds for diagnosing ambulatory hypertension in pregnancy are not yet available. We aimed to identify and compare outcome‐derived ambulatory blood pressure (BP) monitoring thresholds for adverse perinatal outcomes by using approaches related and not related to clinic BP in a southern Chinese population. Methods and Results Ambulatory BP monitoring was performed in a cohort of 1768 high‐risk participants in late pregnancy who were not taking antihypertensive medications. Participants were followed for composite maternal (severe complications) and neonatal (pregnancy loss, advanced neonatal care, and small for gestational age) outcomes. Modeling of clinic BP–unrelated approaches revealed a nonlinear threshold effect of ambulatory diastolic BP on the composite outcome, with increased risk for daytime ≥79 mm Hg and 24‐hour measurement ≥76 mm Hg. For other ambulatory BP components showing linear associations with outcome, the following thresholds were identified: 131 mm Hg for daytime systolic, 121 mm Hg for nighttime systolic, 130 mm Hg for 24‐hour systolic, and 73 mm Hg for night‐time diastolic BP. These thresholds unrelated to clinic BP were lower than the equivalents yielding a similar probability of outcome to clinic BP of 140/90 mm Hg and were comparable with equivalents to clinic BP of 130/80 mm Hg. Conclusions Using an outcome‐derived approach unrelated to clinic BP, we identified rounded thresholds to define ambulatory hypertension in at‐risk women in late pregnancy in a southern Chinese population as follows: 130/80 mm Hg for daytime, 120/75 mm Hg for nighttime, and 130/75 mm Hg for 24‐hour measurement. For wider clinical applicability and to align both nonpregnancy and pregnancy ambulatory BP monitoring with an outcomes‐based approach, prospective, multiethnic, international studies from early pregnancy onward will be required.
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Affiliation(s)
- Li-Juan Lv
- 1 Medical Genetics Centre Guangdong Women and Children Hospital Guangzhou Guangdong Province China
| | - Wen-Jie Ji
- 3 Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury Pingjin Hospital Tianjin China
| | - Lin-Lin Wu
- 4 Shenzhen Maternity and Child Healthcare Hospital Southern Medical University Shenzhen Guangdong Province China
| | - Jun Miao
- 3 Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury Pingjin Hospital Tianjin China
| | - Ji-Ying Wen
- 2 Department of Obstetrics Guangdong Women and Children Hospital Guangzhou Guangdong Province China
| | - Qiong Lei
- 2 Department of Obstetrics Guangdong Women and Children Hospital Guangzhou Guangdong Province China
| | - Dong-Mei Duan
- 2 Department of Obstetrics Guangdong Women and Children Hospital Guangzhou Guangdong Province China
| | - Huan Chen
- 5 The George Institute for Global Health at Peking University Health Science Center (PUHSC) Beijing China
| | - Jane E Hirst
- 6 The George Institute for Global Health Nuffield Department of Women's & Reproductive Health University of Oxford United Kingdom.,7 Oxford University Hospitals NHS Foundation Trust Oxford UK
| | - Amanda Henry
- 8 School of Women's and Children's Health UNSW Medicine UNSW Sydney Sydney Australia.,9 The George Institute for Global Health Sydney Australia
| | - Xin Zhou
- 3 Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury Pingjin Hospital Tianjin China.,10 Department of Cardiology Tianjin Medical University General Hospital Tianjin China
| | - Jian-Min Niu
- 4 Shenzhen Maternity and Child Healthcare Hospital Southern Medical University Shenzhen Guangdong Province China
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25
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Vongpatanasin W, Ayers C, Lodhi H, Das SR, Berry JD, Khera A, Victor RG, Lin FC, Viera AJ, Yano Y, de Lemos JA. Diagnostic Thresholds for Blood Pressure Measured at Home in the Context of the 2017 Hypertension Guideline. Hypertension 2019; 72:1312-1319. [PMID: 30571225 DOI: 10.1161/hypertensionaha.118.11657] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Most guidelines have recommended lower home blood pressure (BP) threshold when clinic BP threshold of 140/90 mm Hg is used for diagnosis of hypertension. However, home BP thresholds to define hypertension have never been determined in the general population in the United States. We identified home BP thresholds for stage 1 (BP ≥130/80 mm Hg) hypertension using a regression-based approach in the DHS (Dallas Heart Study; n=5768) and the NCMH study (North Carolina Masked Hypertension; n=420). Home BP thresholds were also assessed using outcome-derived approach based on the composite of all-cause mortality or cardiovascular events in the DHS cohort. For this approach, BP thresholds were identified only for systolic BP because diastolic BP was not associated with the outcome. Among untreated participants, the regression-derived thresholds for home BP corresponding to clinic BP for stage 1 hypertension were 129/80 mm Hg in blacks, 130/80 mm Hg in whites, and 126/78 mm Hg in Hispanics, respectively. The results are similar in the North Carolina cohort. The 11-year composite cardiovascular and mortality events corresponding to clinic systolic BP >130 mm Hg were higher in blacks than in whites and Hispanics (13.3% versus 5.98% versus 5.52%, respectively). Using a race/ethnicity-specific composite outcome in the untreated DHS participants, the outcome-derived home systolic BP thresholds corresponding to stage 1 hypertension were 130 mm Hg in blacks, 129 mm Hg in whites, and 131 mm Hg in Hispanics, respectively. Our data based on both regression-derived and outcome approach support home BP threshold of 130/80 mm Hg for diagnosis of hypertension in blacks, whites, and Hispanics.
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Affiliation(s)
- Wanpen Vongpatanasin
- From the Hypertension Section, Department of Internal Medicine (W.V., H.L.), University of Texas Southwestern Medical Center, Dallas.,Division of Cardiology (W.V., C.A., S.R.D., J.D.B., A.K., J.A.d.L.), University of Texas Southwestern Medical Center, Dallas
| | - Colby Ayers
- Division of Cardiology (W.V., C.A., S.R.D., J.D.B., A.K., J.A.d.L.), University of Texas Southwestern Medical Center, Dallas.,Department of Clinical Sciences (C.A.), University of Texas Southwestern Medical Center, Dallas
| | - Hamza Lodhi
- From the Hypertension Section, Department of Internal Medicine (W.V., H.L.), University of Texas Southwestern Medical Center, Dallas
| | - Sandeep R Das
- Division of Cardiology (W.V., C.A., S.R.D., J.D.B., A.K., J.A.d.L.), University of Texas Southwestern Medical Center, Dallas
| | - Jarett D Berry
- Division of Cardiology (W.V., C.A., S.R.D., J.D.B., A.K., J.A.d.L.), University of Texas Southwestern Medical Center, Dallas
| | - Amit Khera
- Division of Cardiology (W.V., C.A., S.R.D., J.D.B., A.K., J.A.d.L.), University of Texas Southwestern Medical Center, Dallas
| | - Ronald G Victor
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA (R.G.V.)
| | - Feng-Chang Lin
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (F.-C.L.)
| | - Anthony J Viera
- Department of Community and Family Medicine, Duke University, Durham, NC (A.J.V., Y.Y.)
| | - Yuichiro Yano
- Department of Community and Family Medicine, Duke University, Durham, NC (A.J.V., Y.Y.)
| | - James A de Lemos
- Division of Cardiology (W.V., C.A., S.R.D., J.D.B., A.K., J.A.d.L.), University of Texas Southwestern Medical Center, Dallas
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26
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Muntner P, Shimbo D, Carey RM, Charleston JB, Gaillard T, Misra S, Myers MG, Ogedegbe G, Schwartz JE, Townsend RR, Urbina EM, Viera AJ, White WB, Wright JT. Measurement of Blood Pressure in Humans: A Scientific Statement From the American Heart Association. Hypertension 2019; 73:e35-e66. [PMID: 30827125 PMCID: PMC11409525 DOI: 10.1161/hyp.0000000000000087] [Citation(s) in RCA: 672] [Impact Index Per Article: 134.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The accurate measurement of blood pressure (BP) is essential for the diagnosis and management of hypertension. This article provides an updated American Heart Association scientific statement on BP measurement in humans. In the office setting, many oscillometric devices have been validated that allow accurate BP measurement while reducing human errors associated with the auscultatory approach. Fully automated oscillometric devices capable of taking multiple readings even without an observer being present may provide a more accurate measurement of BP than auscultation. Studies have shown substantial differences in BP when measured outside versus in the office setting. Ambulatory BP monitoring is considered the reference standard for out-of-office BP assessment, with home BP monitoring being an alternative when ambulatory BP monitoring is not available or tolerated. Compared with their counterparts with sustained normotension (ie, nonhypertensive BP levels in and outside the office setting), it is unclear whether adults with white-coat hypertension (ie, hypertensive BP levels in the office but not outside the office) have increased cardiovascular disease risk, whereas those with masked hypertension (ie, hypertensive BP levels outside the office but not in the office) are at substantially increased risk. In addition, high nighttime BP on ambulatory BP monitoring is associated with increased cardiovascular disease risk. Both oscillometric and auscultatory methods are considered acceptable for measuring BP in children and adolescents. Regardless of the method used to measure BP, initial and ongoing training of technicians and healthcare providers and the use of validated and calibrated devices are critical for obtaining accurate BP measurements.
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27
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Esme M, Yavuz BB, Yavuz B, Asil S, Tuna Dogrul R, Sumer F, Kilic MK, Kizilarslanoglu MC, Varan HD, Sagir A, Balci C, Halil M, Cankurtaran M. Masked Hypertension is Associated With Cognitive Decline in Geriatric Age-Geriatric MASked Hypertension and Cognition (G-MASH-cog) Study. J Gerontol A Biol Sci Med Sci 2019; 73:248-254. [PMID: 28958009 DOI: 10.1093/gerona/glx150] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 08/07/2017] [Indexed: 11/13/2022] Open
Abstract
Background Masked hypertension is described as high ambulatory blood pressure measurements (ABPM) where office blood pressure measurements are normal. Effect of hypertension on cognitive functions is well known. However, the effect of masked hypertension on cognitive functions is unclear. The aim of this study is to examine the relationship between masked hypertension and cognitive functions. Methods One hundred-two normotensive patients admitted to the Geriatric Medicine outpatient clinic were included. Exclusion criteria were hypertension, dementia, major depression, and usage of antihypertensive medication. All patients underwent ABPM procedures and average daytime blood pressure, mean blood pressure at night and the 24-hour average blood pressure measurements were recorded. Comprehensive geriatric assessment tests and neuropsychological tests were administered. The diagnosis of masked hypertension was based on the definitions in the 2013 guideline of the European Society of Cardiology. Results Forty-four patients (43%) were diagnosed with masked hypertension. Patients with masked hypertension had significantly lower scores on Mini-Mental State Examination (MMSE) test, Quick Mild Cognitive Impairment Test (QMCI), and Categorical Fluency Test than the normotensive patients (p = .011; p = .046; and p = .004; respectively). Montreal Cognitive Assessment Scale test score was lower in masked hypertension, although this was not statistically significant. Conclusion This study may indicate that geriatric patients with masked hypertension, compared to normotensive patients have decreased cognitive functions. Masked hypertension should be kept in mind while assessing older adults. When masked hypertension is detected, cognitive assessment is essential to diagnose possible cognitive dysfunction at early stage.
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Affiliation(s)
- Mert Esme
- Faculty of Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Burcu Balam Yavuz
- Faculty of Medicine, Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Bunyamin Yavuz
- Department of Cardiology, Medical Park Hospital, Ankara, Turkey
| | - Serkan Asil
- Faculty of Medicine, Department of Cardiology, Hacettepe University, Ankara, Turkey
| | - Rana Tuna Dogrul
- Faculty of Medicine, Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Fatih Sumer
- Faculty of Medicine, Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Mustafa Kemal Kilic
- Faculty of Medicine, Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Muhammet Cemal Kizilarslanoglu
- Faculty of Medicine, Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Hacer Dogan Varan
- Faculty of Medicine, Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Aykut Sagir
- Faculty of Medicine, Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Cafer Balci
- Faculty of Medicine, Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Meltem Halil
- Faculty of Medicine, Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Mustafa Cankurtaran
- Faculty of Medicine, Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
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28
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Hameed MA, Dasgupta I. Medication adherence and treatment-resistant hypertension: a review. Drugs Context 2019; 8:212560. [PMID: 30774692 PMCID: PMC6365088 DOI: 10.7573/dic.212560] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/28/2018] [Accepted: 01/02/2019] [Indexed: 12/11/2022] Open
Abstract
Nonadherence is a common reason for treatment failure and treatment resistance. No matter how it is defined, it is a major issue in the management of chronic illnesses. There are numerous methods to assess adherence, each with its own strengths and weaknesses; however, no single method is considered the best. Nonadherence is common in patients with hypertension, and it is present in a large proportion of patients with uncontrolled blood pressure taking three or more antihypertensive agents. Availability of procedure-based treatment options for these patients has shed further light on this important issue with development of new methods to assess adherence. There is, however, no consensus on the management of nonadherence, which reflects the complex interplay of factors responsible for it.
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Affiliation(s)
- Mohammed Awais Hameed
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,University Hospitals Birmingham NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, UK
| | - Indranil Dasgupta
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,University Hospitals Birmingham NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, UK
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29
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Muntner P, Einhorn PT, Cushman WC, Whelton PK, Bello NA, Drawz PE, Green BB, Jones DW, Juraschek SP, Margolis KL, Miller ER, Navar AM, Ostchega Y, Rakotz MK, Rosner B, Schwartz JE, Shimbo D, Stergiou GS, Townsend RR, Williamson JD, Wright JT, Appel LJ. Blood Pressure Assessment in Adults in Clinical Practice and Clinic-Based Research: JACC Scientific Expert Panel. J Am Coll Cardiol 2019; 73:317-335. [PMID: 30678763 PMCID: PMC6573014 DOI: 10.1016/j.jacc.2018.10.069] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 10/14/2018] [Accepted: 10/15/2018] [Indexed: 11/21/2022]
Abstract
The accurate measurement of blood pressure (BP) is essential for the diagnosis and management of hypertension. Restricted use of mercury devices, increased use of oscillometric devices, discrepancies between clinic and out-of-clinic BP, and concerns about measurement error with manual BP measurement techniques have resulted in uncertainty for clinicians and researchers. The National Heart, Lung, and Blood Institute of the U.S. National Institutes of Health convened a working group of clinicians and researchers in October 2017 to review data on BP assessment among adults in clinical practice and clinic-based research. In this report, the authors review the topics discussed during a 2-day meeting including the current state of knowledge on BP assessment in clinical practice and clinic-based research, knowledge gaps pertaining to current BP assessment methods, research and clinical needs to improve BP assessment, and the strengths and limitations of using BP obtained in clinical practice for research and quality improvement activities.
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Affiliation(s)
- Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Paula T Einhorn
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda, Maryland
| | - William C Cushman
- Preventive Medicine Section, Medical Service, Veterans Affairs Medical Center, Memphis, Tennessee
| | - Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Natalie A Bello
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Paul E Drawz
- Division of Renal Diseases & Hypertension, University of Minnesota, Minneapolis, Minnesota
| | - Beverly B Green
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Daniel W Jones
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Stephen P Juraschek
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | - Edgar R Miller
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Yechiam Ostchega
- National Center for Health Statistics of the Centers for Disease Control and Prevention, Hyattsville, Maryland
| | | | - Bernard Rosner
- Department of Medicine, Brigham's and Women's Hospital, Harvard University, Boston, Massachusetts
| | - Joseph E Schwartz
- Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, New York
| | - Daichi Shimbo
- The Hypertension Center, Columbia University Medical Center, New York, New York
| | - George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Raymond R Townsend
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeff D Williamson
- Department of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Jackson T Wright
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Lawrence J Appel
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
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30
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Davison WJ, Myint PK, Clark AB, Potter JF. Blood pressure differences between home monitoring and daytime ambulatory values and their reproducibility in treated hypertensive stroke and TIA patients. Am Heart J 2019; 207:58-65. [PMID: 30415084 DOI: 10.1016/j.ahj.2018.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 09/18/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Guidelines recommend ambulatory or home blood pressure monitoring to improve hypertension diagnosis and monitoring. Both these methods are ascribed the same threshold values, but whether they produce similar results has not been established in certain patient groups. METHODS Adults with mild/moderate stroke or transient ischemic attack (N = 80) completed 2 sets of ambulatory and home blood pressure monitoring. Systolic and diastolic blood pressure values from contemporaneous measurements were compared, and the limits of agreement were assessed. Exploratory analyses for predictive factors of any difference were conducted. RESULTS Daytime ambulatory blood pressure values were consistently lower than home values, the mean difference in systolic blood pressure for initial ambulatory versus first home monitoring was -6.6 ± 13.5 mm Hg (P≤.001), and final ambulatory versus second home monitoring was -7.1 ± 11.0mm Hg (P≤.001). Mean diastolic blood pressure differences were -2.1 ± 8.5mm Hg (P=.03) and -2.0 ± 7.2mm Hg (P=.02). Limits of agreement for systolic blood pressure were -33.0 to 19.9mm Hg and -28.7 to 14.5mm Hg for the 2 comparisons and for DBP were -18.8 to 14.5mm Hg and -16.1 to 12.2mm Hg, respectively. The individual mean change in systolic blood pressure difference was 11.0 ± 8.3mm Hg across the 2 comparisons. No predictive factors for these differences were identified. CONCLUSIONS Daytime ambulatory systolic and diastolic blood pressure values were significantly lower than home monitored values at both time points. Differences between the 2 methods were not reproducible for individuals. Using the same threshold value for both out-of-office measurement methods may not be appropriate in patients with cerebrovascular disease.
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Affiliation(s)
- William J Davison
- Ageing and Stroke Medicine Section, Norwich Medical School, Bob Champion Research and Education Building, James Watson Rd, Norwich Research Park, University of East Anglia, Norwich, UK
| | - Phyo Kyaw Myint
- Ageing Clinical & Experimental Research Team (ACER), Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Allan B Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - John F Potter
- Ageing and Stroke Medicine Section, Norwich Medical School, Bob Champion Research and Education Building, James Watson Rd, Norwich Research Park, University of East Anglia, Norwich, UK.
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31
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Lithovius R, Gordin D, Forsblom C, Saraheimo M, Harjutsalo V, Groop PH. Ambulatory blood pressure and arterial stiffness in individuals with type 1 diabetes. Diabetologia 2018; 61:1935-1945. [PMID: 29797021 DOI: 10.1007/s00125-018-4648-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/23/2018] [Indexed: 12/31/2022]
Abstract
AIMS/HYPOTHESIS This study aimed to assess the use of ambulatory BP monitoring (ABPM) to identify the presence of masked, nocturnal and white-coat hypertension in individuals with type 1 diabetes, patterns that could not be detected by regular office-based BP monitoring alone. We also analysed associations between BP patterns and arterial stiffness in order to identify individuals at cardiovascular risk. METHODS This substudy included 140 individuals with type 1 diabetes from the Helsinki metropolitan area, who attended the Finnish Diabetic Nephropathy Study (FinnDiane) Centre in Helsinki between January 2013 and August 2017. Twenty-four hour ABPM and pulse wave analysis were performed simultaneously using a validated non-invasive brachial oscillometric device (Mobil-O-Graph). Definitions of hypertension were based on the European Society of Hypertension guidelines. Masked hypertension was defined as normal office BP (BP obtained using a standardised automated BP device) but elevated 24 h ABPM, and white-coat hypertension as elevated office BP but normal 24 h ABPM. RESULTS A total of 38% of individuals were normotensive and 33% had sustained hypertension, while 23% had masked and 6% had white-coat hypertension. About half of the cohort had increased absolute levels of night-time BP, half of whom were untreated. In the ambulatory setting, central BP and pulse wave velocity (PWV) were higher in participants with masked hypertension than in those with normotension (p ≤ 0.001). In a multivariable linear regression model adjusted for age, sex, BMI, antihypertensive treatment and eGFR, masked hypertension was independently associated with higher 24 h PWV (β 0.50 [95% CI 0.34, 0.66]), but not with PWV obtained during resting conditions (adjusted β 0.28 [95% CI -0.53, 1.10]), using normotension as the reference group. CONCLUSIONS/INTERPRETATION ABPM analysis revealed that one-quarter of the participants with type 1 diabetes had masked hypertension; these individuals would not have been detected by office BP alone. Moreover, arterial stiffness was increased in individuals with masked hypertension. These findings support the use of ABPM to identify individuals at risk of cardiovascular disease.
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Affiliation(s)
- Raija Lithovius
- Folkhälsan Institute of Genetics, Folkhälsan Research Centre, Biomedicum Helsinki, Haartmaninkatu 8, FIN-00290, Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Daniel Gordin
- Folkhälsan Institute of Genetics, Folkhälsan Research Centre, Biomedicum Helsinki, Haartmaninkatu 8, FIN-00290, Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
- Dianne Nunnally Hoppes Laboratory Section of Vascular Cell Biology, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - Carol Forsblom
- Folkhälsan Institute of Genetics, Folkhälsan Research Centre, Biomedicum Helsinki, Haartmaninkatu 8, FIN-00290, Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Markku Saraheimo
- Folkhälsan Institute of Genetics, Folkhälsan Research Centre, Biomedicum Helsinki, Haartmaninkatu 8, FIN-00290, Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Valma Harjutsalo
- Folkhälsan Institute of Genetics, Folkhälsan Research Centre, Biomedicum Helsinki, Haartmaninkatu 8, FIN-00290, Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
- The Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Centre, Biomedicum Helsinki, Haartmaninkatu 8, FIN-00290, Helsinki, Finland.
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
- Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia.
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2018. [DOI: 10.1161/hyp.0000000000000065 10.1016/j.jacc.2017.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Myers MG. Automated Office Blood Pressure Measurement. Korean Circ J 2018; 48:241-250. [PMID: 29625508 PMCID: PMC5889975 DOI: 10.4070/kcj.2018.0066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 03/06/2018] [Indexed: 12/17/2022] Open
Abstract
Manual blood pressure (BP) recorded in routine clinical practice is relatively inaccurate and associated with higher readings compared to BP measured in research studies in accordance with standardized measurement guidelines. The increase in routine office BP is the result of several factors, especially the presence of office staff, which tends to make patients nervous and also allows for conversation to occur. With the disappearance of the mercury sphygmomanometer because of environmental concerns, there is greater use of oscillometric BP recorders, both in the office setting and elsewhere. Although oscillometric devices may reduce some aspects of observer BP measurement error in the clinical setting, they are still associated with higher BP readings, known as white coat hypertension (for diagnosis) or white coat effect (with treated hypertension). Now that fully automated sphygmomanometers are available which are capable of recording several readings with the patient resting quietly, there is no longer any need to have office staff present when BP is being recorded. Such readings are called automated office blood pressure (AOBP) and they are both more accurate than conventional manual office BP and not associated with the white coat phenomena. AOBP readings are also similar to the awake ambulatory BP and home BP, both of which are relatively good predictors of cardiovascular risk. The available evidence suggests that AOBP should now replace manual or electronic office BP readings when screening patients for hypertension and also after antihypertensive drug therapy is initiated.
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Affiliation(s)
- Martin G Myers
- Division of Cardiology, Schulich Heart Program, Sunnybrook Health Sciences Centre and Department of Medicine, University of Toronto, Toronto, ON, Canada.
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Bhatnagar A, Pein U, Markau S, Weigand K, Fornara P, Girndt M, Seibert E. Influence of SPRINT Study Type Automated Office Blood Pressure Measurements on Hypertension Diagnosis in Kidney Transplant Patients. Kidney Blood Press Res 2018. [DOI: 10.1159/000487900] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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35
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Pääkkö TJW, Perkiömäki JS, Kesäniemi YA, Ylitalo AS, Lumme JA, Huikuri HV, Ukkola OH. Increasing ambulatory pulse pressure predicts the development of left ventricular hypertrophy during long-term follow-up. J Hum Hypertens 2018; 32:180-189. [PMID: 29416118 DOI: 10.1038/s41371-018-0034-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 11/09/2017] [Accepted: 12/12/2017] [Indexed: 01/19/2023]
Abstract
Ambulatory blood pressure (ABP) has been shown to have an association with left ventricular hypertrophy (LVH). We evaluated the association between ABP characteristics and the development of LVH during long-term follow-up (20 years) in 420 middle-aged subjects from OPERA cohort. ABP measurements (ABPM) were recorded and echocardiographic examinations were performed at baseline and revisit. Anthropometrics were measured and laboratory analyses performed at visit. The questionnaire presented to all participants elicited detailed information about their habits. Left ventricular mass index (LVMI) was calculated according to Troys method. Baseline LVMI was a significant independent predictor of LVMI change (p < 0.001). None of the baseline continuous ABPM predicted the change in LVMI. A greater increase in daytime and night-time systolic blood pressure (BP) (p from 0.006 to 0.048) and 24 h, daytime and night-time pulse pressure (PP) (p from 0.005 to 0.034) predicted a greater increase in LVMI. Especially the increase in night-time SBP (p = 0.006) and PP (p = 0.005) predicted a greater increase in LVMI. We also considered circadian BP profiles among subjects, whose ABPM at baseline and echocardiographic measurements both at baseline and follow-up were available. Diastolic non-dippers were observed to show a greater increase in LVMI compared to diastolic dippers (10.6 ± 33.0 g/m2 vs. 7.0 ± 28.8 g/m2, p = 0.032), when baseline LVMI and in-office DBP were taken account. These findings suggest that an increasing ambulatory PP increases and a diastolic non-dipping status may increase the risk for the development of LVH during later life course.
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Affiliation(s)
- Tero J W Pääkkö
- Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland.
| | - Juha S Perkiömäki
- Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | | | - Antti S Ylitalo
- Lappi Central Hospital, Rovaniemi, University of Oulu, Oulu, Finland
| | - Jarmo A Lumme
- Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Heikki V Huikuri
- Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Olavi H Ukkola
- Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
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Abstract
PURPOSE OF REVIEW The appropriate treatment targets for individuals with elevated blood pressure (BP) have received increased attention in light of recent clinical trial results. However, it is well known that the method used to measure BP can have a significant impact on the observed BP. In this review, we summarize the existing literature on the impact of BP measurement technique on observed BP readings. RECENT FINDINGS Manual BPs obtained in-clinic routinely differ from those obtained using automated devices. Further, clinic-based readings (either manual or automated) typically correlate poorly with readings from ambulatory BP monitoring or home-based devices. However, few studies utilize randomization or sound experimental design to explore differences in BP readings by method or technique. While numerous studies report differences in BP by method, most lack statistical rigor and therefore provide limited insight into the true effect of technique on BP measurements.
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Kinsara AJ. Ambulatory blood pressure monitoring in daily practice. Indian Heart J 2017; 69:788-789. [PMID: 29174260 PMCID: PMC5717310 DOI: 10.1016/j.ihj.2017.09.223] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/24/2017] [Accepted: 09/29/2017] [Indexed: 11/17/2022] Open
Abstract
Ambulatory blood pressure monitoring is a useful diagnostic tool that still underutilized by community physicians. It is a cost effective, diagnostic and prognostic tool that had been emphasized by the guidelines.
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Affiliation(s)
- Abdulhalim Jamal Kinsara
- King Saud bin Abdulaziz University for Health Sciences, COM-J, King Abdul Aziz Medical City-WR, King Faisal Cardiac Center, Mail Code 6599, P.O. Box 9515, Jeddah 21423, Saudi Arabia.
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2017; 71:e13-e115. [PMID: 29133356 DOI: 10.1161/hyp.0000000000000065] [Citation(s) in RCA: 1577] [Impact Index Per Article: 225.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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39
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2017; 71:e127-e248. [PMID: 29146535 DOI: 10.1016/j.jacc.2017.11.006] [Citation(s) in RCA: 3129] [Impact Index Per Article: 447.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Principles of Blood Pressure Measurement - Current Techniques, Office vs Ambulatory Blood Pressure Measurement. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 956:85-96. [PMID: 27417699 DOI: 10.1007/5584_2016_49] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Blood pressure measurement has a long history and a crucial role in clinical medicine. Manual measurement using a mercury sphygmomanometer and a stethoscope remains the Gold Standard. However, this technique is technically demanding and commonly leads to faulty values. Automatic devices have helped to improve and simplify the technical aspects, but a standardised procedure of obtaining comparable measurements remains problematic and may therefore limit their validity in clinical practice. This underlines the importance of less error-prone measurement methods such as ambulatory or home blood pressure measurements and automated office blood pressure measurements. These techniques may help to uncover patients with otherwise unrecognised or overestimated arterial hypertension. Additionally these techniques may yield a better prognostic value.
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Pääkkö TJW, Renko RJ, Perkiömäki JS, Kesäniemi YA, Ylitalo AS, Lumme JA, Huikuri HV, Ruskoaho H, Vuolteenaho O, Ukkola OH. Ambulatory Pulse Pressure Predicts the Development of Left Ventricular Diastolic Dysfunction in Over 20 Years of Follow-up. Am J Hypertens 2017; 30:985-992. [PMID: 28911024 DOI: 10.1093/ajh/hpx087] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 05/03/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Ambulatory blood pressure (ABP) has been shown to have an association with left ventricular diastolic dysfunction (LVDD) in cross-sectional assessments. We evaluated the association between ABP measurement (ABPM) and the development of LVDD during over 20 years of follow up in 414 middle-aged subjects from OPERA cohort. METHODS ABPM, clinical, and anthropometric measurements were performed in baseline. Echocardiographic measurements were performed at baseline and during follow-up and E/E' ≥15 was considered indicating significant LVDD. RESULTS Several baseline clinical characteristics (age, female gender, short stature, body mass index, prevalence of diabetes, in-office systolic BP (SBP), in-office pulse pressure (PP), N-terminal pro-atrial natriuretic peptide, and the use of antihypertensive therapy) were associated with the development of LVDD. Baseline 24-hour mean, daytime mean or nighttime mean SBP or diastolic BP were not associated with the development of LVDD, neither were different circadian BP profiles. Instead 24-hour mean, daytime mean and nighttime mean PP showed significant association with the development of LVDD (P from <0.001 to 0.001) even after adjustment with significant baseline clinical characteristics (P from 0.001 to 0.016). CONCLUSION These findings suggest that ambulatory PP has an independent predictive value in the development of LVDD during over 20 years of follow-up.
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Affiliation(s)
- Tero J W Pääkkö
- Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Reko J Renko
- Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Juha S Perkiömäki
- Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | | | - Antti S Ylitalo
- Lappi Central Hospital, Rovaniemi, University of Oulu, Oulu, Finland
| | - Jarmo A Lumme
- Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Heikki V Huikuri
- Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Heikki Ruskoaho
- Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Olli Vuolteenaho
- Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Olavi H Ukkola
- Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
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Chen Y, Liu JH, Zhen Z, Zuo Y, Lin Q, Liu M, Zhao C, Wu M, Cao G, Wang R, Tse HF, Yiu KH. Assessment of left ventricular function and peripheral vascular arterial stiffness in patients with dipper and non-dipper hypertension. J Investig Med 2017; 66:319-324. [PMID: 28935634 PMCID: PMC5800354 DOI: 10.1136/jim-2017-000513] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2017] [Indexed: 11/25/2022]
Abstract
A non-dipper pattern of high blood pressure is associated with increased risk of organ damage and cardiovascular disease in patients with hypertension. The aim of the study was to evaluate the left ventricular (LV) remodeling and function and arterial stiffness in a dipper/non-dipper pattern of high blood pressure in patients with hypertension. A total of 183 hypertensive patients with no history of adverse cardiovascular events were divided into two groups based on 24 hours ambulatory blood pressure monitoring (ABPM): 66 patients with a dipper pattern and 117 patients with non-dipper pattern. Detailed transthoracic echocardiogram was performed and analyzed with advance speckle tracking 3-orthogonal direction strain analysis to assess LV systolic function and tissue Doppler-derived E/E′ for LV diastolic function assessment. Cardio ankle vascular index (CAVI) was used to evaluate arterial stiffness. Compared with patients with dipper hypertension, those with non-dipper hypertension had increased LV mass index, higher prevalence of eccentric and concentric LV hypertrophy, more impaired LV diastolic and systolic function and peripheral arterial stiffness. Multivariable analysis revealed that a non-dipper pattern was independently associated with LV systolic dysfunction evaluated by speckle tracking-derived strain analysis. In conclusion, a non-dipper pattern of hypertension is an independent risk factor for LV systolic dysfunction. Treatment that could reverse this non-dipper pattern may reduce cardiac damage in these patients.
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Affiliation(s)
- Yan Chen
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.,Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, ShenZhen, China
| | - Ju-Hua Liu
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.,Department of Geriatric, Affiliated Hospital of North Sichuan Medical College, Hong Kong, China
| | - Zhe Zhen
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Yuan Zuo
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Qingshan Lin
- Division of Radiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, Hong Kong, China
| | - Mingya Liu
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, ShenZhen, China
| | - Chunting Zhao
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, ShenZhen, China
| | - Min Wu
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, ShenZhen, China
| | - Gaozhen Cao
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, ShenZhen, China
| | - Run Wang
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, ShenZhen, China
| | - Hung-Fat Tse
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.,Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, ShenZhen, China.,Faculty of Medicine, Research Centre of Heart, Brain, Hormone and Healthy Aging, The University of Hong Kong, Hong Kong, China
| | - Kai-Hang Yiu
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.,Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, ShenZhen, China.,Faculty of Medicine, Research Centre of Heart, Brain, Hormone and Healthy Aging, The University of Hong Kong, Hong Kong, China
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Schwartz CL, Clark C, Koshiaris C, Gill PS, Greenfield SM, Haque SM, Heer G, Johal A, Kaur R, Mant J, Martin U, Mohammed MA, Wood S, McManus RJ. Interarm Difference in Systolic Blood Pressure in Different Ethnic Groups and Relationship to the "White Coat Effect": A Cross-Sectional Study. Am J Hypertens 2017; 30:884-891. [PMID: 28475667 PMCID: PMC5861584 DOI: 10.1093/ajh/hpx073] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 04/05/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Interarm differences (IADs) ≥10 mm Hg in systolic blood pressure (BP) are associated with greater incidence of cardiovascular disease. The effect of ethnicity and the white coat effect (WCE) on significant systolic IADs (ssIADs) are not well understood. METHODS Differences in BP by ethnicity for different methods of BP measurement were examined in 770 people (300 White British, 241 South Asian, 229 African-Caribbean). Repeated clinic measurements were obtained simultaneously in the right and left arm using 2 BPTru monitors and comparisons made between the first reading, mean of second and third and mean of second to sixth readings for patients with, and without known hypertension. All patients had ambulatory BP monitoring (ABPM). WCE was defined as systolic clinic BP ≥10 mm Hg higher than daytime ABPM. RESULTS No significant differences were seen in the prevalence of ssIAD between ethnicities whichever combinations of BP measurement were used and regardless of hypertensive status. ssIADs fell between the 1st measurement (161, 22%), 2nd/3rd (113, 16%), and 2nd–6th (78, 11%) (1st vs. 2nd/3rd and 2nd–6th, P < 0.001). Hypertensives with a WCE were more likely to have ssIADs on 1st, (odds ratio [OR] 1.73 (95% confidence interval 1.04–2.86); 2nd/3rd, (OR 3.05 (1.68–5.53); and 2nd–6th measurements, (OR 2.58 (1.22–5.44). Nonhypertensive participants with a WCE were more likely to have a ssIAD on their first measurement (OR 3.82 (1.77 to −8.25) only. CONCLUSIONS ssIAD prevalence does not vary with ethnicity regardless of hypertensive status but is affected by the number of readings, suggesting the influence of WCE. Multiple readings should be used to confirm ssIADs.
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Affiliation(s)
- Claire Lorraine Schwartz
- Nuffield Department of Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| | - Christopher Clark
- Primary Care Research Group, University of Exeter Medical School, Smeall Building, St Luke’s Campus, Exeter, UK
| | - Constantinos Koshiaris
- Nuffield Department of Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| | - Paramjit S Gill
- WMS—Social Science and Systems in Health, University of Warwick, Coventry, Birmingham, UK
| | - Shelia M Greenfield
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Sayeed M Haque
- Institute of Clinical Science, University of Birmingham, Edgbaston, Birmingham, UK
| | - Gurdip Heer
- Institute of Clinical Science, University of Birmingham, Edgbaston, Birmingham, UK
| | - Amanpreet Johal
- NIHR Clinical Research Network: West Midlands, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Ramandeep Kaur
- Institute of Clinical Science, University of Birmingham, Edgbaston, Birmingham, UK
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Wort’s Causeway, Cambridge, Cambridgeshire, UK
| | - Una Martin
- Institute of Clinical Science, University of Birmingham, Edgbaston, Birmingham, UK
| | | | - Sally Wood
- Nuffield Department of Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
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Panwar R, Sullohern B, Shiel E, Alexis Brown C, Quail A. Validity of a protocol to estimate patients' pre-morbid basal blood pressure. Blood Press 2017; 27:10-18. [PMID: 28745077 DOI: 10.1080/08037051.2017.1358055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE The pre-illness basal mean arterial BP (MAP) is an important reference point to gauge the degree of relative hypotension among unwell patients. We aimed to assess mean bias, correlation, and agreement between basal MAP measured during nighttime ambulatory BP monitoring (ABPM) and basal MAP estimated using a standardized protocol. MATERIALS AND METHODS For a cohort of 137 consecutive patients, aged ≥40 years, who recently underwent ABPM, a blinded investigator estimated basal MAP from up to five most recent clinic BP measurements. Both basal MAP values, measured and estimated, were compared pairwise for each participant. RESULTS We traced a median of 4 [interquartile range 3-5] previous BP measurements per patient over a median period of 132 [interquartile range 55-277] days up until the ABPM test. The estimated basal MAP (mean 88 ± 8 mmHg) was linearly related (Pearson's r = 0.41, p = 0.0001) to the measured basal MAP (mean 88 ± 12 mmHg). Bland-Altman plot revealed a mean bias of 0.3 mmHg with agreement limits of ±22 mmHg. CONCLUSIONS The mean bias between estimated and measured values for basal MAP was insignificant and modest. When a recent nighttime ABPM is unavailable, a protocol based on recent clinic BP readings can be used to estimate patient's basal MAP. STUDY REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12613001382763.
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Affiliation(s)
- Rakshit Panwar
- a Intensive Care Unit , John Hunter Hospital , New Lambton , NSW , Australia.,b School of Medicine and Public Health , University of Newcastle , New Lambton , NSW , Australia
| | - Brendan Sullohern
- c Emergency Department, John Hunter Hospital , New Lambton , NSW , Australia
| | - Emily Shiel
- d Division of Medicine , John Hunter Hospital , New Lambton , NSW , Australia
| | | | - Anthony Quail
- b School of Medicine and Public Health , University of Newcastle , New Lambton , NSW , Australia.,e Anaesthesia and Pain Medicine , John Hunter Hospital , New Lambton , NSW , Australia
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Ravenell J, Shimbo D, Booth JN, Sarpong DF, Agyemang C, Beatty Moody DL, Abdalla M, Spruill TM, Shallcross AJ, Bress AP, Muntner P, Ogedegbe G. Thresholds for Ambulatory Blood Pressure Among African Americans in the Jackson Heart Study. Circulation 2017; 135:2470-2480. [PMID: 28428231 PMCID: PMC5711518 DOI: 10.1161/circulationaha.116.027051] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 04/10/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ambulatory blood pressure (BP) monitoring is the reference standard for out-of-clinic BP measurement. Thresholds for identifying ambulatory hypertension (daytime systolic BP [SBP]/diastolic BP [DBP] ≥135/85 mm Hg, 24-hour SBP/DBP ≥130/80 mm Hg, and nighttime SBP/DBP ≥120/70 mm Hg) have been derived from European, Asian, and South American populations. We determined BP thresholds for ambulatory hypertension in a US population-based sample of African American adults. METHODS We analyzed data from the Jackson Heart Study, a population-based cohort study comprised exclusively of African American adults (n=5306). Analyses were restricted to 1016 participants who completed ambulatory BP monitoring at baseline in 2000 to 2004. Mean SBP and DBP levels were calculated for daytime (10:00 am-8:00 pm), 24-hour (all available readings), and nighttime (midnight-6:00 am) periods, separately. Daytime, 24-hour, and nighttime BP thresholds for ambulatory hypertension were identified using regression- and outcome-derived approaches. The composite of a cardiovascular disease or an all-cause mortality event was used in the outcome-derived approach. For this latter approach, BP thresholds were identified only for SBP because clinic DBP was not associated with the outcome. Analyses were stratified by antihypertensive medication use. RESULTS Among participants not taking antihypertensive medication, the regression-derived thresholds for daytime, 24-hour, and nighttime SBP/DBP corresponding to clinic SBP/DBP of 140/90 mm Hg were 134/85 mm Hg, 130/81 mm Hg, and 123/73 mm Hg, respectively. The outcome-derived thresholds for daytime, 24-hour, and nighttime SBP corresponding to a clinic SBP ≥140 mm Hg were 138 mm Hg, 134 mm Hg, and 129 mm Hg, respectively. Among participants taking antihypertensive medication, the regression-derived thresholds for daytime, 24-hour, and nighttime SBP/DBP corresponding to clinic SBP/DBP of 140/90 mm Hg were 135/85 mm Hg, 133/82 mm Hg, and 128/76 mm Hg, respectively. The corresponding outcome-derived thresholds for daytime, 24-hour, and nighttime SBP were 140 mm Hg, 137 mm Hg, and 133 mm Hg, respectively, among those taking antihypertensive medication. CONCLUSIONS On the basis of the outcome-derived approach for SBP and regression-derived approach for DBP, the following definitions for daytime, 24-hour, and nighttime hypertension corresponding to clinic SBP/DBP ≥140/90 mm Hg are proposed for African American adults: daytime SBP/DBP ≥140/85 mm Hg, 24-hour SBP/DBP ≥135/80 mm Hg, and nighttime SBP/DBP ≥130/75 mm Hg, respectively.
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Affiliation(s)
- Joseph Ravenell
- From Department of Population Health, New York University School of Medicine (J.R., T.M.S., A.J.S., G.O.); Department of Medicine, Columbia University, New York (D.S., M.A.); Department of Epidemiology, University of Alabama at Birmingham (J.N.B., P.M.); Center for Minority Health & Health Disparities Research and Education, Xavier University of Louisiana, New Orleans (D.F.S.); Department of Public Health, Amsterdam Medical Centre, University of Amsterdam, The Netherlands (C.A.); Department of Psychology, University of Maryland, Baltimore County (D.L.B.M.); and Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.).
| | - Daichi Shimbo
- From Department of Population Health, New York University School of Medicine (J.R., T.M.S., A.J.S., G.O.); Department of Medicine, Columbia University, New York (D.S., M.A.); Department of Epidemiology, University of Alabama at Birmingham (J.N.B., P.M.); Center for Minority Health & Health Disparities Research and Education, Xavier University of Louisiana, New Orleans (D.F.S.); Department of Public Health, Amsterdam Medical Centre, University of Amsterdam, The Netherlands (C.A.); Department of Psychology, University of Maryland, Baltimore County (D.L.B.M.); and Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
| | - John N Booth
- From Department of Population Health, New York University School of Medicine (J.R., T.M.S., A.J.S., G.O.); Department of Medicine, Columbia University, New York (D.S., M.A.); Department of Epidemiology, University of Alabama at Birmingham (J.N.B., P.M.); Center for Minority Health & Health Disparities Research and Education, Xavier University of Louisiana, New Orleans (D.F.S.); Department of Public Health, Amsterdam Medical Centre, University of Amsterdam, The Netherlands (C.A.); Department of Psychology, University of Maryland, Baltimore County (D.L.B.M.); and Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
| | - Daniel F Sarpong
- From Department of Population Health, New York University School of Medicine (J.R., T.M.S., A.J.S., G.O.); Department of Medicine, Columbia University, New York (D.S., M.A.); Department of Epidemiology, University of Alabama at Birmingham (J.N.B., P.M.); Center for Minority Health & Health Disparities Research and Education, Xavier University of Louisiana, New Orleans (D.F.S.); Department of Public Health, Amsterdam Medical Centre, University of Amsterdam, The Netherlands (C.A.); Department of Psychology, University of Maryland, Baltimore County (D.L.B.M.); and Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
| | - Charles Agyemang
- From Department of Population Health, New York University School of Medicine (J.R., T.M.S., A.J.S., G.O.); Department of Medicine, Columbia University, New York (D.S., M.A.); Department of Epidemiology, University of Alabama at Birmingham (J.N.B., P.M.); Center for Minority Health & Health Disparities Research and Education, Xavier University of Louisiana, New Orleans (D.F.S.); Department of Public Health, Amsterdam Medical Centre, University of Amsterdam, The Netherlands (C.A.); Department of Psychology, University of Maryland, Baltimore County (D.L.B.M.); and Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
| | - Danielle L Beatty Moody
- From Department of Population Health, New York University School of Medicine (J.R., T.M.S., A.J.S., G.O.); Department of Medicine, Columbia University, New York (D.S., M.A.); Department of Epidemiology, University of Alabama at Birmingham (J.N.B., P.M.); Center for Minority Health & Health Disparities Research and Education, Xavier University of Louisiana, New Orleans (D.F.S.); Department of Public Health, Amsterdam Medical Centre, University of Amsterdam, The Netherlands (C.A.); Department of Psychology, University of Maryland, Baltimore County (D.L.B.M.); and Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
| | - Marwah Abdalla
- From Department of Population Health, New York University School of Medicine (J.R., T.M.S., A.J.S., G.O.); Department of Medicine, Columbia University, New York (D.S., M.A.); Department of Epidemiology, University of Alabama at Birmingham (J.N.B., P.M.); Center for Minority Health & Health Disparities Research and Education, Xavier University of Louisiana, New Orleans (D.F.S.); Department of Public Health, Amsterdam Medical Centre, University of Amsterdam, The Netherlands (C.A.); Department of Psychology, University of Maryland, Baltimore County (D.L.B.M.); and Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
| | - Tanya M Spruill
- From Department of Population Health, New York University School of Medicine (J.R., T.M.S., A.J.S., G.O.); Department of Medicine, Columbia University, New York (D.S., M.A.); Department of Epidemiology, University of Alabama at Birmingham (J.N.B., P.M.); Center for Minority Health & Health Disparities Research and Education, Xavier University of Louisiana, New Orleans (D.F.S.); Department of Public Health, Amsterdam Medical Centre, University of Amsterdam, The Netherlands (C.A.); Department of Psychology, University of Maryland, Baltimore County (D.L.B.M.); and Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
| | - Amanda J Shallcross
- From Department of Population Health, New York University School of Medicine (J.R., T.M.S., A.J.S., G.O.); Department of Medicine, Columbia University, New York (D.S., M.A.); Department of Epidemiology, University of Alabama at Birmingham (J.N.B., P.M.); Center for Minority Health & Health Disparities Research and Education, Xavier University of Louisiana, New Orleans (D.F.S.); Department of Public Health, Amsterdam Medical Centre, University of Amsterdam, The Netherlands (C.A.); Department of Psychology, University of Maryland, Baltimore County (D.L.B.M.); and Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
| | - Adam P Bress
- From Department of Population Health, New York University School of Medicine (J.R., T.M.S., A.J.S., G.O.); Department of Medicine, Columbia University, New York (D.S., M.A.); Department of Epidemiology, University of Alabama at Birmingham (J.N.B., P.M.); Center for Minority Health & Health Disparities Research and Education, Xavier University of Louisiana, New Orleans (D.F.S.); Department of Public Health, Amsterdam Medical Centre, University of Amsterdam, The Netherlands (C.A.); Department of Psychology, University of Maryland, Baltimore County (D.L.B.M.); and Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
| | - Paul Muntner
- From Department of Population Health, New York University School of Medicine (J.R., T.M.S., A.J.S., G.O.); Department of Medicine, Columbia University, New York (D.S., M.A.); Department of Epidemiology, University of Alabama at Birmingham (J.N.B., P.M.); Center for Minority Health & Health Disparities Research and Education, Xavier University of Louisiana, New Orleans (D.F.S.); Department of Public Health, Amsterdam Medical Centre, University of Amsterdam, The Netherlands (C.A.); Department of Psychology, University of Maryland, Baltimore County (D.L.B.M.); and Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
| | - Gbenga Ogedegbe
- From Department of Population Health, New York University School of Medicine (J.R., T.M.S., A.J.S., G.O.); Department of Medicine, Columbia University, New York (D.S., M.A.); Department of Epidemiology, University of Alabama at Birmingham (J.N.B., P.M.); Center for Minority Health & Health Disparities Research and Education, Xavier University of Louisiana, New Orleans (D.F.S.); Department of Public Health, Amsterdam Medical Centre, University of Amsterdam, The Netherlands (C.A.); Department of Psychology, University of Maryland, Baltimore County (D.L.B.M.); and Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B.)
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Abdalla M. Ambulatory Blood Pressure Monitoring: A Complementary Strategy for Hypertension Diagnosis and Management in Low-Income and Middle-Income Countries. Cardiol Clin 2017; 35:117-124. [PMID: 27886781 DOI: 10.1016/j.ccl.2016.08.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Ambulatory blood pressure monitoring (ABPM) can assess out-of-clinic blood pressure. ABPM is an underutilized resource in low-income and middle-income countries but should be considered a complementary strategy to clinic blood pressure measurement for the diagnosis and management of hypertension. Potential uses for ABPM in low-income and middle-income countries include screening of high-risk individuals who have concurrent communicable diseases, such as HIV, and in task-shifting health care strategies.
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Affiliation(s)
- Marwah Abdalla
- Center for Behavioral Cardiovascular Health, Division of Cardiology, Department of Medicine, Columbia University Medical Center, 622 West 168th Street, PH 9-321, New York, NY 10032, USA.
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Gill P, Haque MS, Martin U, Mant J, Mohammed MA, Heer G, Johal A, Kaur R, Schwartz C, Wood S, Greenfield SM, McManus RJ. Measurement of blood pressure for the diagnosis and management of hypertension in different ethnic groups: one size fits all. BMC Cardiovasc Disord 2017; 17:55. [PMID: 28178928 PMCID: PMC5299651 DOI: 10.1186/s12872-017-0491-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 02/03/2017] [Indexed: 12/11/2022] Open
Abstract
Background Hypertension is a major risk factor for cardiovascular disease and prevalence varies by ethnic group. The diagnosis and management of blood pressure are informed by guidelines largely based on data from white populations. This study addressed whether accuracy of blood pressure measurement in terms of diagnosis of hypertension varies by ethnicity by comparing two measurement modalities (clinic blood pressure and home monitoring) with a reference standard of ambulatory BP monitoring in three ethnic groups. Methods Cross-sectional population study (June 2010 - December 2012) with patients (40–75 years) of white British, South Asian and African Caribbean background with and without a previous diagnosis of hypertension recruited from 28 primary care practices. The study compared the test performance of clinic BP (using various protocols) and home-monitoring (1 week) with a reference standard of mean daytime ambulatory measurements using a threshold of 140/90 mmHg for clinic and 135/85 mmHg for out of office measurement. Results A total of 551 participants had complete data of whom 246 were white British, 147 South Asian and 158 African Caribbean. No consistent difference in accuracy of methods of blood pressure measurement was observed between ethnic groups with or without a prior diagnosis of hypertension: for people without hypertension, clinic measurement using three different methodologies had high specificity (75–97%) but variable sensitivity (33–65%) whereas home monitoring had sensitivity of 68–88% and specificity of 64–80%. For people with hypertension, detection of a raised blood pressure using clinic measurements had sensitivities of 34–69% with specificity of 73–92% and home monitoring had sensitivity (81–88%) and specificity (55–65%). Conclusions For people without hypertension, ABPM remains the choice for diagnosing hypertension compared to the other modes of BP measurement regardless of ethnicity. Differences in accuracy of home monitoring and clinic monitoring (higher sensitivity of the former; higher specificity of the latter) were also not affected by ethnicity. Electronic supplementary material The online version of this article (doi:10.1186/s12872-017-0491-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Paramjit Gill
- Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - M Sayeed Haque
- Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Una Martin
- Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Jonathan Mant
- Primary Care Unit, University of Cambridge, Cambridge, CB2 0SR, UK
| | | | - Gurdip Heer
- Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Amanpreet Johal
- Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Ramandeep Kaur
- Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Claire Schwartz
- Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX1 2GG, UK
| | - Sally Wood
- Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX1 2GG, UK
| | - Sheila M Greenfield
- Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Richard J McManus
- Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX1 2GG, UK
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Effects of room environment and nursing experience on clinical blood pressure measurement: an observational study. Blood Press Monit 2017; 22:79-85. [PMID: 28134672 DOI: 10.1097/mbp.0000000000000240] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study aimed to examine the effects of measurement room environment and nursing experience on the accuracy of manual auscultatory blood pressure (BP) measurement. MATERIALS AND METHODS A training database with 32 Korotkoff sounds recordings from the British Hypertension Society was played randomly to 20 observers who were divided into four groups according to the years of their nursing experience (i.e. ≥10 years, 1-9 years, nursing students with frequent training, and those without any medical background; five observers in each group). All the observers were asked to determine manual auscultatory systolic blood pressure (SBP) and diastolic blood pressure (DBP) both in a quiet clinical assessment room and in a noisy nurse station area. This procedure was repeated on another day, yielding a total of four measurements from each observer (i.e. two room environments and two repeated determinations on 2 separate days) for each Korotkoff sound. The measurement error was then calculated against the reference answer, with the effects of room environment and nursing experience of the observer investigated. RESULTS Our results showed that there was no statistically significant difference for BPs measured under both quiet and noisy environments (P>0.80 for both SBP and DBP). However, there was a significant effect on the measurement accuracy between the observer groups (P<0.001 for both SBP and DBP). The nursing students performed best with overall SBP and DBP errors of -0.8±2.4 and 0.1±1.8 mmHg, respectively. The SBP measurement error from the nursing students was significantly smaller than that for each of the other three groups (all P<0.001). CONCLUSION Our results indicate that frequent nursing trainings are important for nurses to achieve accurate manual auscultatory BP measurement.
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Mirdamadi A, Etebari M. Comparison of manual versus automated blood pressure measurement in intensive care unit, coronary care unit, and emergency room. ARYA ATHEROSCLEROSIS 2017; 13:29-34. [PMID: 28761452 PMCID: PMC5515188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
BACKGROUND Accuracy of blood pressure (BP) measurement in clinical settings is one of the most concerns despite of promotion in techniques for the measurement of BP. Our aim was to compare automated versus manual BP measurement in intensive care unit (ICU), coronary care unit (CCU), and emergency room patients. METHODS Totally, 117 patients in ICU, CCU, and emergency department were registered in the study. Demographic information was recorded. The cardioset heart monitoring device was used for measuring BP and mercury sphygmomanometer with appropriate cuffs was used for manual method. Then, the mean BP of two methods was compared based on different age, sex, weight, and disease findings. RESULTS The mean systolic blood pressure (SBP) was 124.526 mmHg, with minimum and maximum of 123.111 and 125.940 mmHg, respectively (Cronbach's alpha = 0.893); furthermore, mean diastolic blood pressure (DBP) was 73.496 mmHg, with minimum and maximum of 72.718 and 74.247 mmHg, respectively (Cronbach's alpha = 0.852). SBP was significantly different between the two methods, and especially in patients below 60 years, hospitalized in ICU ward, overweight, mid-upper arm circumference below 27 cm, and with neurosurgery problems, it was higher by manual method (P < 0.050). Moreover, DBP was more in manual method in patients with female sex, below 60 years, hospitalized in ICU ward and with neurosurgery problems (P < 0.050). CONCLUSION The results of this study suggested that manual method in measurement of BP frequently shows higher BP, especially in patients admitted to hospitals-affecting up to 15 mmHg higher, and this discrepancy is more in critical situations.
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Affiliation(s)
- Ahmad Mirdamadi
- Cardiologist, Fellowship of Echocardiography, Associate Professor, Department of Cardiology, Najafabad Branch, Islamic Azad University, Najafabad, Iran
| | - Mostafa Etebari
- General Practitioner, Najafabad Branch, Islamic Azad University, Najafabad, Iran,Correspondence to: Mostafa Etebari,
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