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Pihl K, McManus RJ, Stevens R, Tucker KL. Comparison of clinic and home blood pressure readings in higher risk pregnancies - Secondary analysis of the BUMP 1 trial. Pregnancy Hypertens 2024; 36:101114. [PMID: 38394949 DOI: 10.1016/j.preghy.2024.101114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/06/2024] [Accepted: 02/17/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE To compare clinic and home blood pressure readings in higher risk pregnancies in the antenatal period from 20 weeks gestation, and to evaluate differences between the two modalities. STUDY DESIGN A cohort study comprising a secondary analysis of a large randomised controlled trial (BUMP 1). POPULATION Normotensive women at higher risk of pregnancy hypertension randomised to self-monitoring of blood pressure. MAIN OUTCOME MEASURES The primary outcome was the overall mean difference between clinic and home readings for systolic blood pressure (sBP) and diastolic blood pressure (dBP). Blood pressure readings were averaged across each gestational week for each participant and compared within the same gestational week. Calculations of the overall differences were based on the average difference for each week for each participant. RESULTS The cohort comprised 925 participants. In total, 92 (10 %) developed a hypertensive disorder during the pregnancy. A significant difference in the overall mean sBP (clinic - home) of 1.1 mmHg (0.5-1.6 95 %CI) was noted, whereas no significant difference for the overall mean dBP was found (0.0 mmHg (-0.4-0.4 95 %CI)). No tendency of proportional bias was noted based on Bland-Altman plots. Increasing body mass index in general increased the difference (clinic - home) for both sBP and dBP in a multivariate analysis. CONCLUSIONS No clinically significant difference was found between clinic and home blood pressure readings in normotensive higher risk pregnancies from gestational week 20+0 until 40+0. Clinic and home blood pressure readings might be considered equal during pregnancy in women who are normotensive at baseline.
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Affiliation(s)
- Kasper Pihl
- Department for Continuing Education, University of Oxford, Oxford, United Kingdom; Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
| | - Richard Stevens
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Katherine L Tucker
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Mouseli A, Sharafi M, Amiri Z, Dehghan A, Haghjoo E, Mohsenpour MA, Eftekhari MH, Fatemian H, Keshavarzian O. Prevalence and factors associated with inter-arm systolic and diastolic blood pressure differences: results from the baseline Fasa Adult's Cohort Study (FACS). BMC Public Health 2024; 24:345. [PMID: 38302901 PMCID: PMC10835907 DOI: 10.1186/s12889-024-17857-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 01/23/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND One of the modifiable risk factors for cardiovascular diseases is the inter-arm blood pressure difference (IAD), which can be easily measured. This study aimed to determine the prevalence and factors related to the Iranian population's inter-arm differences in systolic and diastolic blood pressure. METHOD This cross-sectional study was conducted on the baseline data of participants who had Iranian nationality, were at least 1 year of residence in the area, aged within the age range of 35-70 years, and willed to participate from the Fasa Persian Adult Cohort Study (FACS). IAD for systolic and diastolic blood pressure was measured and categorized into two groups of difference < 10 and ≥ 10 mmHg. Logistic regression was used to model the association between independent variables and IAD. RESULTS The prevalence of systolic and diastolic IAD ≥ 10 mmHg was 16.34% and 10.2%, respectively, among 10,124 participants. According to the multivariable logistic regression models, age (adjusted odds ratio (aOR): 1.019 [95% CI: 1.013, 1.025]), body mass index (BMI) (aOR: 1.112 [95% CI: 1.016, 1.229]), having type 2 diabetes (aOR Yes/No: 1.172 [95% CI: 1.015, 1.368]), having chronic headaches (aOR Yes/No: 1.182 [95% CI: 1.024, 1.365]), and pulse rate (aOR: 1.019 [95% CI: 1.014, 1.024]) significantly increased the odds of systolic IAD ≥ 10 mmHg. Additionally, high socio-economic status decreased the odds of systolic IAD ≥ 10 mmHg (aOR High/Low: 0.854 [95% CI: 0.744, 0.979]). For diastolic IAD, age (aOR: 1.112 [95% CI: 1.015, 1.210]) and pulse rate (aOR: 1.021 [95% CI: 1.015, 1.027]) significantly increased the odds of diastolic IAD ≥ 10 mmHg. Moreover, high socioeconomic status decreased the odds of diastolic IAD ≥ 10 mmHg (aOR High/Low: 0.820 [95% CI: 0.698, 0.963]). CONCLUSION The noticeable prevalence of systolic and diastolic IAD in general population exhibits health implications due to its' association with the risk of cardiovascular events. Sociodemographic and medical history assessments have potentials to be incorporated in IAD risk stratification and preventing programs.
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Affiliation(s)
- Ali Mouseli
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mehdi Sharafi
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
- Noncommunicable Disease Research Center, Fasa University of Medical Sciences, Fasa, Iran.
| | - Zahra Amiri
- Social Determinants in Health Promotion Research Center, Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Azizallah Dehghan
- Noncommunicable Disease Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Elham Haghjoo
- Department of Persian Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - Mohammad Ali Mohsenpour
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hassan Eftekhari
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Fatemian
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Omid Keshavarzian
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Zhang L, Liang H, Luo H, He W, Cai Y, Liu S, Fan Y, Huang W, Zhao Q, Zhong D, Li J, Lv S, Li C, Xie Y, Zhang N, Xu D(R. Quality in screening and measuring blood pressure in China's primary health care: a national cross-sectional study using unannounced standardized patients. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 43:100973. [PMID: 38076324 PMCID: PMC10701131 DOI: 10.1016/j.lanwpc.2023.100973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/15/2023] [Accepted: 11/06/2023] [Indexed: 02/12/2024]
Abstract
Background This study aims to evaluate primary care providers' adherence to the standard of measuring blood pressure for people aged 35 or above during their initial visit, as per Chinese guidelines, and to identify factors affecting their practices. Methods We developed 11 standardized patients (SP) cases as tracer conditions to evaluate primary care, and deployed trained SPs for unannounced visits to randomly selected providers in seven provinces of China. The SPs used a checklist based on guidelines to record whether and how blood pressure was measured. Data were analyzed descriptively and regression analysis was performed to examine the association between outcomes and factors such as provider, patient, facility, and clinical case characteristics. Findings The SPs conducted 1201 visits and found that less than one-third of USPs ≥35 had their blood pressure measured. Only 26.9% of migraine and 15.4% of diabetes cases received blood pressure measurements. Additionally, these measurements did not follow the proper guidelines and recommended steps. On average, 55.6% of the steps were followed with few providers considering influencing factors before measurement and only 6.0% of patients received both-arm measurements. The use of wrist sphygmomanometers was associated with poor blood pressure measurement. Interpretation In China, primary care hypertension screening practices fall short of guidelines, with infrequent initiation of blood pressure measurements and inadequate adherence to proper measurement steps. To address this, priority should be placed on adopting, implementing, and upholding guidelines for hypertension screening and measurement. Funding National Natural Science Foundation of China, Swiss Agency for Development and Cooperation, Doctoral Fund Project of Inner Mongolia Medical University, China Postdoctoral Science Foundation.
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Affiliation(s)
- Lanping Zhang
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
- The Third Department of Lung Disease, Shenzhen Third People's Hospital, Shenzhen, Guangdong Province 518112, China
| | - Huijuan Liang
- School of Health Management, Inner Mongolia Medical University, Hohhot, China
| | - Huanyuan Luo
- Acacia Lab for Implementation Science, Institute for Global Health, Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Wenjun He
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
- Acacia Lab for Implementation Science, School of Public Health, Southern Medical University, Guangzhou, China
| | - Yiyuan Cai
- Department of Epidemiology and Health Statistics, School of Public Health, Guizhou Medical University, Guizhou Province, China
| | - Siyuan Liu
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Yancun Fan
- School of Health Management, Inner Mongolia Medical University, Hohhot, China
| | - Wenxiu Huang
- Erfenzi Township Health Center of Wuchuan County, Inner Mongolia, China
| | - Qing Zhao
- Center for World Health Organization Studies and Department of Health Management, School of Health Management of Southern Medical University, Guangzhou, China
| | - Dongmei Zhong
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Jiaqi Li
- Acacia Lab for Implementation Science, School of Public Health, Southern Medical University, Guangzhou, China
| | - Sensen Lv
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Chunping Li
- Acacia Lab for Implementation Science, School of Public Health, Southern Medical University, Guangzhou, China
| | - Yunyun Xie
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Nan Zhang
- School of Health Management, Inner Mongolia Medical University, Hohhot, China
| | - Dong (Roman) Xu
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China
- Center for World Health Organization Studies and Department of Health Management, School of Health Management of Southern Medical University, Guangzhou, China
- Southern Medical University Institute for Global Health (SIGHT), Dermatology Hospital of Southern Medical University (SMU), Guangzhou, China
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Wander GS, McDonagh STJ, Rao MS, Alagesan R, Mohan JC, Bhagwat A, Pancholia AK, Viswanathan M, Chopda MB, Purnanand A, Kapardhi PLN, Vadavi AR, Selvaraj R, Aneja P, Hardas S, Bordoloi N, Sivakadaksham N, Goswami N, Clark CE, Verberk WJ. Clinical relevance of double-arm blood pressure measurement and prevalence of clinically important inter-arm blood pressure differences in Indian primary care. J Clin Hypertens (Greenwich) 2022; 24:993-1002. [PMID: 35811439 PMCID: PMC9380175 DOI: 10.1111/jch.14497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 11/29/2022]
Abstract
Hypertension guidelines recommend measuring blood pressure (BP) in both arms at least once. However, this is seldom done due to uncertainties regarding measurement procedure and the implications of finding a clinically important inter‐arm BP difference (IAD). This study aimed to provide insight into the prevalence of clinically important IADs in a large Indian primary care cohort. A number of 134 678 (37% female) unselected Indian primary care participants, mean age 45.2 (SD 11.9) years, had BP measured in both arms using a standardized, triplicate, automated simultaneous measurement method (Microlife WatchBP Office Afib). On average, there were clinically minor differences in right and left arm BP values: systolic BP 134.4 vs 134.2 mmHg (p < .01) and diastolic BP 82.7 vs 82.6 mmHg (p < .01), respectively. Prevalence of significant mean systolic IAD between 10 and 15 mmHg was 7,813 (5.8%). Systolic IAD ≥ 15 mmHg 2,980 (2.2%) and diastolic IAD ≥ 10 mmHg 7,151 (5.3%). In total, there were 7,595 (5.6%) and 8,548 (6.3%) participants with BP above the 140/90 mmHg threshold in only the left or right arm, respectively. Prevalence of participants with elevated BP on one arm only was highest in patients with a systolic IAD ≥ 15 mmHg; 19.1% and 13.7%, for left and right arm, respectively. This study shows that a substantial prevalence of IAD exists in Indian primary care patients. BP is above the diagnostic threshold for hypertension in one arm only for 6% of participants. These findings emphasize the importance of undertaking bilateral BP measurement in routine clinical practice.
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Affiliation(s)
- Gurpreet S Wander
- Department of Cardiology, Hero DMC Heart Institute, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Sinead T J McDonagh
- Primary care research group, College of Medicine and Health, University of Exeter, UK
| | | | - R Alagesan
- G. A. Vasant Compu Cardiac Scan Centre, Chennai, India
| | - J C Mohan
- Jaipur Golden Hospital Rohini, Delhi, India
| | | | | | | | | | | | | | | | - R Selvaraj
- Preetham Cardiac Care, Coimbatore, India
| | | | - Suhas Hardas
- Poona Hospital and Research Center, Pune & Clinic: Hardas Heart Care, Pune, India
| | | | | | | | - Christopher E Clark
- Primary care research group, College of Medicine and Health, University of Exeter, UK
| | - Willem J Verberk
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
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Lee EKP, Choi RCM, Liu L, Gao T, Yip BHK, Wong SYS. Preference of blood pressure measurement methods by primary care doctors in Hong Kong: a cross-sectional survey. BMC FAMILY PRACTICE 2020; 21:95. [PMID: 32456619 PMCID: PMC7251842 DOI: 10.1186/s12875-020-01153-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/26/2020] [Indexed: 11/10/2022]
Abstract
Background Hypertension is the most common chronic disease and is the leading cause of morbidity and mortality. Its screening, diagnosis, and management depend heavily on accurate blood pressure (BP) measurement. It is recommended that the diagnosis of hypertension should be confirmed or corroborated by out-of-office BP values, measured using ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM). When office BP is used, automated office BP (AOBP) measurement method, which automatically provides an average of 3–5 BP readings, should be preferred. This study aimed to describe the BP measurement methods commonly used by doctors in primary care in Hong Kong, to screen, diagnose, and manage hypertensive patients. Methods In this cross-sectional survey, all doctors registered in the Hong Kong “Primary Care Directory” were mailed a questionnaire, asking their preferred BP-measuring methods to screen, diagnose, and manage hypertensive patients. Furthermore, we also elicited information on the usual number of office BP or HBPM readings obtained, to diagnose or manage hypertension. Results Of the 1738 doctors included from the directory, 445 responded. Manual measurement using a mercury or aneroid device was found to be the commonest method to screen (63.1%), diagnose (56.4%), and manage (72.4%) hypertension. There was a significant underutilisation of ABPM, with only 1.6% doctors using this method to diagnose hypertension. HBPM was used by 22.2% and 56.8% of the respondents to diagnose and manage hypertension, respectively. A quarter (26.7%) of the respondents reported using only one in-office BP reading, while around 40% participants reported using ≥12 HBPM readings. Doctors with specialist qualification in family medicine were more likely to use AOBP in clinics and to obtain the recommended number of office BP readings for diagnosis and management of hypertension. Conclusion Primary Care doctors in Hong Kong prefer to use manual office BP values, measured using mercury or aneroid devices, to screen, diagnose, and manage hypertension, highlighting a marked underutilisation of AOBP and out-of-office BP measuring techniques, especially that of ABPM. Further studies are indicated to understand the underlying reasons and to minimise the gap between real-life clinical practice and those recommended, based on scientific advances. Trial registration Clinicaltrial.gov; ref. no.: NCT03926897.
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Affiliation(s)
- Eric Kam Pui Lee
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China. .,Room 402, 4/F, Jockey Club School of Public Health and Primary Care building, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, China.
| | - Ryan Chun Ming Choi
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Licheng Liu
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Tiffany Gao
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Benjamin Hon Kei Yip
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Samuel Yeung Shan Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
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Heintjes EM, Bezemer ID, Prieto-Alhambra D, Smits E, Booth HP, Dedman D, He Y, Hoti F, Vehkala M, de Vogel S, Robinson NJ, Appenteng K, Penning-van Beest FJA. Evaluating the Effectiveness of an Additional Risk Minimization Measure to Reduce the Risk of Prescribing Mirabegron to Patients with Severe Uncontrolled Hypertension in Four European Countries. Clin Epidemiol 2020; 12:423-433. [PMID: 32431551 PMCID: PMC7200224 DOI: 10.2147/clep.s242065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/11/2020] [Indexed: 01/06/2023] Open
Abstract
Background Mirabegron, indicated for the treatment of overactive bladder, is contraindicated in patients with severe uncontrolled hypertension (systolic blood pressure ≥180 mm Hg and/or diastolic blood pressure ≥110 mm Hg). In September 2015, a Direct Healthcare Professional Communication (DHPC) letter was disseminated as an additional risk minimisation measure. Purpose To assess the effectiveness of the DHPC in reducing the proportions of patients with severe or non-severe uncontrolled hypertension at mirabegron initiation. Methods An observational multi-database cohort study was undertaken using routinely collected healthcare data (December 2012–December 2016) from the PHARMO Database Network (Netherlands), SIDIAP database (Spain), CPRD (United Kingdom, UK) and national healthcare registers and electronic medical records from Finland. DHPC effectiveness was evaluated using interrupted time series analyses comparing trends and changes in monthly proportions of severe or non-severe uncontrolled hypertensive mirabegron initiations relative to the timing of the DHPC dissemination. Results The study population comprised 52,078 patients. Prior to DHPC dissemination, across the four databases, 0.3–1.3% had severe uncontrolled hypertension. Estimated absolute changes (EAC) in proportions of severe uncontrolled hypertension post-DHPC indicated a tendency towards a lower proportion in the Netherlands (EAC −0.36%, p=0.053), unchanged proportions in Spain and the UK and a higher proportion in Finland (EAC +0.73%, p=0.016). For non-severe uncontrolled hypertension (13–16% pre-DHPC), post-DHPC proportions tended to be lower in the Netherlands (EAC −2.02%, p=0.038) and Spain (EAC −1.04%, p=0.071), and unchanged in the UK and Finland. Conclusion Severe uncontrolled hypertension prior to mirabegron initiation was uncommon in these four European countries even before DHPC dissemination. This suggests that other risk minimisation communications (prior to the DHPC dissemination) had worked adequately with respect to minimising mirabegron use among patients with severe uncontrolled hypertension. No strong and consistent evidence of further risk minimisation after the DHPC dissemination was observed in this study.
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Affiliation(s)
- Edith M Heintjes
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | - Irene D Bezemer
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | - Daniel Prieto-Alhambra
- Idiap Jordi Gol Primary Care Research Institute and CIBERFes, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Catalonia, Spain.,Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, England, UK
| | - Elisabeth Smits
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | - Helen P Booth
- Clinical Practice Research Datalink (CPRD), London, UK
| | - Daniel Dedman
- Clinical Practice Research Datalink (CPRD), London, UK
| | - Ying He
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, England, UK
| | | | | | | | | | - Kwame Appenteng
- Astellas Pharma Global Development, Inc., Northbrook, IL, USA
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Lay-Flurrie SL, Sheppard JP, Stevens RJ, Mallen C, Heneghan C, Hobbs FDR, Williams B, Mant J, McManus RJ. Impact of Changes to National Hypertension Guidelines on Hypertension Management and Outcomes in the United Kingdom. Hypertension 2019; 75:356-364. [PMID: 31865798 PMCID: PMC7055938 DOI: 10.1161/hypertensionaha.119.13926] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In recent years, national and international guidelines have recommended the use of out-of-office blood pressure monitoring for diagnosing hypertension. Despite evidence of cost-effectiveness, critics expressed concerns this would increase cardiovascular morbidity. We assessed the impact of these changes on the incidence of hypertension, out-of-office monitoring and cardiovascular morbidity using routine clinical data from English general practices, linked to inpatient hospital, mortality, and socio-economic status data. We studied 3 937 191 adults with median follow-up of 4.2 years (49% men, mean age=39.7 years) between April 1, 2006 and March 31, 2017. Interrupted time series analysis was used to examine the impact of changes to English hypertension guidelines in 2011 on incidence of hypertension (primary outcome). Secondary outcomes included rate of out-of-office monitoring and cardiovascular events. Across the study period, incidence of hypertension fell from 2.1 to 1.4 per 100 person-years. The change in guidance in 2011 was not associated with an immediate change in incidence (change in rate=0.01 [95% CI, -0.18-0.20]) but did result in a leveling out of the downward trend (change in yearly trend =0.09 [95% CI, 0.04-0.15]). Ambulatory monitoring increased significantly in 2011/2012 (change in rate =0.52 [95% CI, 0.43-0.60]). The rate of cardiovascular events remained unchanged (change in rate =-0.02 [95% CI, -0.05-0.02]). In summary, changes to hypertension guidelines in 2011 were associated with a stabilisation in incidence and no increase in cardiovascular events. Guidelines should continue to recommend out-of-office monitoring for diagnosis of hypertension.
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Affiliation(s)
- Sarah L Lay-Flurrie
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK (S.L.L.-F., J.P.S., R.J.S., C.H., F.D.R.H., R.J.M.)
| | - James P Sheppard
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK (S.L.L.-F., J.P.S., R.J.S., C.H., F.D.R.H., R.J.M.)
| | - Richard J Stevens
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK (S.L.L.-F., J.P.S., R.J.S., C.H., F.D.R.H., R.J.M.)
| | - Christian Mallen
- School for Primary, Community and Social Care, Keele University, Keele, UK (C.M.)
| | - Carl Heneghan
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK (S.L.L.-F., J.P.S., R.J.S., C.H., F.D.R.H., R.J.M.)
| | - F D Richard Hobbs
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK (S.L.L.-F., J.P.S., R.J.S., C.H., F.D.R.H., R.J.M.)
| | - Bryan Williams
- Institute of Cardiovascular Science, University College London, London, UK (B.W.)
| | - Jonathan Mant
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK (J.M.)
| | - Richard J McManus
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK (S.L.L.-F., J.P.S., R.J.S., C.H., F.D.R.H., R.J.M.)
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Affiliation(s)
| | | | - Christopher N Floyd
- Department of Clinical Pharmacology, King's College London British Heart Foundation Centre, London, UK
- Biomedical Research Centre, Clinical Research Facility, Guy's and St Thomas' NHS Foundation Trust, London, UK
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9
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Using out-of-office blood pressure measurements in established cardiovascular risk scores: a secondary analysis of data from two blood pressure monitoring studies. Br J Gen Pract 2019; 69:e381-e388. [PMID: 31064741 DOI: 10.3399/bjgp19x702737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 09/07/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Blood pressure (BP) measurement is increasingly carried out through home or ambulatory monitoring, yet existing cardiovascular risk scores were developed for use with measurements obtained in clinics. AIM To describe differences in cardiovascular risk estimates obtained using ambulatory or home BP measurements instead of clinic readings. DESIGN AND SETTING Secondary analysis of data from adults aged 25-84 years in the UK and the Netherlands without prior history of cardiovascular disease (CVD) in two BP monitoring studies: the Blood Pressure in different Ethnic groups (BP-Eth) study and the Home versus Office blood pressure MEasurements: Reduction of Unnecessary treatment Study (HOMERUS). METHOD The primary comparison was Framingham risk calculated using BP measured as in the Framingham study or daytime ambulatory BP measurements. Statistical significance was determined using non-parametric tests. RESULTS In 442 BP-Eth patients (mean age = 58 years, 50% female [n = 222]) the median absolute difference in 10-year Framingham cardiovascular risk calculated using BP measured as in the Framingham study or daytime ambulatory BP measurements was 1.84% (interquartile range [IQR] 0.65-3.63, P = 0.67). In 165 HOMERUS patients (mean age = 56 years, 46% female) the median absolute difference in 10-year risk for daytime ambulatory BP was 2.76% (IQR 1.19-6.39, P<0.001) and only 8 out of 165 (4.8%) of patients were reclassified. CONCLUSION Estimates of cardiovascular risk are similar when calculated using BP measurements obtained as in the risk score derivation study or through ambulatory monitoring. Further research is required to determine if differences in estimated risk would meaningfully influence risk score accuracy.
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10
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Bhaswant M, Brown L, Mathai ML. Queen Garnet plum juice and raspberry cordial in mildly hypertensive obese or overweight subjects: A randomized, double-blind study. J Funct Foods 2019. [DOI: 10.1016/j.jff.2019.03.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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