1
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Pan HY, Lee CK, Liu TY, Lee GW, Chen CW, Wang TD. The role of wearable home blood pressure monitoring in detecting out-of-office control status. Hypertens Res 2024; 47:1033-1041. [PMID: 38242946 PMCID: PMC10994837 DOI: 10.1038/s41440-023-01539-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
Ambulatory blood pressure (ABP) and home blood pressure (HBP) monitoring is currently recommended for management of hypertension. Nonetheless, traditional HBP protocols could overlook diurnal fluctuations, which could also be linked with adverse cardiovascular outcomes. In this observational study, we studied among a group of treated hypertensive patients (N = 62, age: 52.4 ± 10.4 years) by using out-of-office ABP and wearable HBP. They received one session of 24-h ABP measurement with an oscillometric upper-arm monitor, and totally three sessions of 7-day/6-time-daily wearable HBP measurement separated in each month with HeartGuide. Controlled hypertension is defined as an average BP <130/80 mmHg for both daytime ABP and HBP. There was substantial reliability (intraclass correlation coefficient, ICC 0.883-0.911) and good reproducibility (Cohen's kappa = 0.600) for wearable HBP measurement, especially before breakfast and after dinner. Among all patients, 27.4% had both uncontrolled HBP and ABP, 30.6% had uncontrolled HBP only, while 6.5% had uncontrolled ABP only. Female gender and increased numbers of anti-hypertensive agents are correlated with controlled hypertension. Patients with uncontrolled hypertension had a significantly higher maximal daytime blood pressure, which was previously signified as an imperial marker for cardiovascular risk. In conclusion, wearable HBP monitoring in accordance with a dedicated daily-living schedule results in good reliability and reproducibility. Patients with an uncontrolled wearable HBP should benefit from repeated HBP or ABP measurement for risk stratification.
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Affiliation(s)
- Heng-Yu Pan
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu City, Taiwan
| | - Chih-Kuo Lee
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu City, Taiwan
| | - Tzu-Yao Liu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu City, Taiwan
| | - Guan-Wei Lee
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu City, Taiwan
| | - Chiao-Wei Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu City, Taiwan
| | - Tzung-Dau Wang
- Cardiovascular Center and Divisions of Cardiology and Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan.
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2
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Jang Y, Seo JM, Ihm SH, Lee HY. Feasibility, credence, and usefulness of out-of-office cuffless blood pressure monitoring using smartwatch: a population survey. Clin Hypertens 2023; 29:15. [PMID: 37259165 DOI: 10.1186/s40885-023-00242-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/25/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Cuffless blood pressure (BP) measurement, enabled by recent advances in wearable devices, allows for BP monitoring in daily life. This study aims to evaluate the feasibility, cresdence, and usefulness of cuffless BP monitoring through a population survey. METHODS During the "Daily BP Measurement with Your Galaxy Watch" campaign held by the Korean Society of Hypertension, participants were asked to share their experiences with cuffless BP measurement using a smartwatch application through an online survey. The questionnaire included questions about age, underlying medical conditions, smartwatch utilization, experience with BP calibration, the reliability of BP values measured by a smartwatch, and willingness to use the BP monitoring function in the future. RESULTS A total of 1071 participants responded to the survey. The largest age group (decile) was 50-59 years old (33.3%), followed by 40-49 years old (29.9%). Although nearly half of the participants (47.5%) had no chronic diseases, 40.1% reported having hypertension. BP monitoring was the most frequently utilized smartwatch function (95.8%), followed by heart rate measurement (87.1%). 31.8% of participants reported that BP values measured by the smartphone application were "very accurate and helpful," while 63.5% rated them as "slightly lower (44.4%)" or "higher (19.1%)" compared to the standard home BP monitoring device. 93% of the participants reported utilizing the BP monitoring function at least once a week. Regarding the BP calibration process, most participants (93.9%) calibrated the BP measurement application themselves, and 50.8% rated the difficulty level as "very easy." CONCLUSION Cuffless BP measurement using a smartwatch application was feasible in the general population, including the self-calibration process. However, the satisfaction level in terms of accuracy is still modest, indicating a need for further development.
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Affiliation(s)
- Yongjun Jang
- Seoul National University College of Medicine, Seoul, South Korea
| | - Jong-Mo Seo
- Department of Electrical and Computer Engineering, College of Engineering, Seoul National University, Seoul, South Korea
| | - Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, South Korea
| | - Hae Young Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
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3
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Avolio A. The reality and serendipity of cuffless blood pressure monitoring. Hypertens Res 2023:10.1038/s41440-023-01269-z. [PMID: 37016027 DOI: 10.1038/s41440-023-01269-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/12/2023] [Indexed: 04/06/2023]
Affiliation(s)
- Alberto Avolio
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia.
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4
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Kim HL, Lee EM, Ahn SY, Kim KI, Kim HC, Kim JH, Lee HY, Lee JH, Park JM, Cho EJ, Park S, Shin J, Kim YK. The 2022 focused update of the 2018 Korean Hypertension Society Guidelines for the management of hypertension. Clin Hypertens 2023; 29:11. [PMID: 36788612 PMCID: PMC9930285 DOI: 10.1186/s40885-023-00234-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/25/2023] [Indexed: 02/16/2023] Open
Abstract
Hypertension is the leading cause of death in human being, which shows high prevalence and associated complications that increase the mortality and morbidity. Controlling blood pressure (BP) is very important because it is well known that lowering high BP effectively improves patients' prognosis. This review aims to provide a focused update of the 2018 Korean Hypertension Society Guidelines for the management of hypertension. The importance of ambulatory BP and home BP monitoring was further emphasized not only for the diagnosis but also for treatment target. By adopting corresponding BPs, the updated guideline recommended out-of-office BP targets for both standard and intensive treatment. Based on the consensus on corresponding BPs and Systolic Blood Pressure Intervention Trial (SPRINT) revisit, the updated guidelines recommended target BP in high-risk patients below 130/80 mmHg and it applies to hypertensive patients with three or more additional cardiovascular risk factors, one or more risk factors with diabetes, or hypertensive patients with subclinical organ damages, coronary or vascular diseases, heart failure, chronic kidney disease with proteinuria, and cerebral lacunar infarction. Cerebral infarction and chronic kidney disease are also high-risk factors for cardiovascular disease. However, due to lack of evidence, the target BP was generally determined at < 140/90 mmHg in patients with those conditions as well as in the elderly. Updated contents regarding the management of hypertension in special situations are also discussed.
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Affiliation(s)
- Hack-Lyoung Kim
- grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun Mi Lee
- grid.410899.d0000 0004 0533 4755Department of Internal Medicine, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Republic of Korea
| | - Shin Young Ahn
- grid.411134.20000 0004 0474 0479Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kwang-il Kim
- grid.412480.b0000 0004 0647 3378Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Hyeon Chang Kim
- grid.15444.300000 0004 0470 5454Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ju Han Kim
- grid.411597.f0000 0004 0647 2471Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hae-Young Lee
- grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jang Hoon Lee
- grid.258803.40000 0001 0661 1556Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Jong-Moo Park
- grid.255588.70000 0004 1798 4296Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, Republic of Korea
| | - Eun Joo Cho
- grid.488414.50000 0004 0621 6849Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sungha Park
- grid.15444.300000 0004 0470 5454Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinho Shin
- grid.49606.3d0000 0001 1364 9317Department of Internal Medicine, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Young-Kwon Kim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, Republic of Korea.
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5
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Han M, Lee YR, Park T, Ihm SH, Pyun WB, Burkard T, Cho MC, Camafort M, Yang E, Stergiou GS, Lee HY, Seo JM. Feasibility and measurement stability of smartwatch-based cuffless blood pressure monitoring: A real-world prospective observational study. Hypertens Res 2023; 46:922-931. [PMID: 36781979 DOI: 10.1038/s41440-023-01215-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 01/04/2023] [Accepted: 01/20/2023] [Indexed: 02/15/2023]
Abstract
Cuffless wearable devices are currently being developed for long-term monitoring of blood pressure (BP) in patients with hypertension and in apparently healthy people. This study evaluated the feasibility and measurement stability of smartwatch-based cuffless BP monitoring in real-world conditions. Users of the first smartwatch-based cuffless BP monitor approved in Korea (Samsung Galaxy Watch) were invited to upload their data from using the device for 4 weeks post calibration. A total of 760 participants (mean age 43.7 ± 11.9, 80.3% men) provided 35,797 BP readings (average monitoring 22 ± 4 days [SD]; average readings 47 ± 42 per participant [median 36]). Each participant obtained 1.5 ± 1.3 readings/day and 19.7% of the participants obtained measurements every day. BP showed considerable variability, mainly depending on the day and time of the measurement. There was a trend towards higher BP levels on Mondays than on other days of the week and on workdays than in weekends. BP readings taken between 00:00 and 04:00 tended to be the lowest, whereas those between 12:00 and 16:00 the highest. The average pre-post calibration error for systolic BP (difference in 7-day BP before and after calibration), was 6.8 ± 5.6 mmHg, and was increased with higher systolic BP levels before calibration. Smartwatch-based cuffless BP monitoring is feasible for out-of-office monitoring in the real-world setting. The stability of BP measurement post calibration and the standardization and optimal time interval for recalibration need further investigation.
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Affiliation(s)
- Minju Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Young-Ro Lee
- Department of Electrical and Computer Engineering, College of Engineering, Seoul National University, Seoul, South Korea
| | - Taeyoung Park
- Department of Applied Statistics and Department of Statistics and Data Science, Yonsei University, Seoul, Korea
| | - Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Wook Bum Pyun
- Division of Cardiology, Department of Internal Medicine, Ewha Woman's University Seoul Hospital, Seoul, South Korea
| | - Thilo Burkard
- Medical Outpatient and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, Basel, Switzerland
| | - Myeong-Chan Cho
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Miguel Camafort
- ESH Excellence Hypertension Center, Department of Internal Medicine, Geriatrics Section, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Eugene Yang
- Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Hae Young Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea. .,Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
| | - Jong-Mo Seo
- Department of Electrical and Computer Engineering, College of Engineering, Seoul National University, Seoul, South Korea
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6
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Kim HM, Shin J. Role of home blood pressure monitoring in resistant hypertension. Clin Hypertens 2023; 29:2. [PMID: 36641498 PMCID: PMC9840827 DOI: 10.1186/s40885-022-00226-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/18/2022] [Indexed: 01/16/2023] Open
Abstract
The definition of resistant hypertension (RHT) has been updated to include failure to achieve target blood pressure (BP) despite treatment with ≥3 antihypertensive drugs, including diuretics, renin-angiotensin system blockers, and calcium channel blockers, prescribed at the maximum or maximally tolerated doses, or as success in achieving the target blood pressure but requiring ≥4 drugs. RHT is a major clinical problem, as it is associated with higher mortality and morbidity than non-RHT. Therefore, it is crucial to accurately identify RHT patients to effectively manage their disease. Out-of-clinic BP measurement, including home BP monitoring and ambulatory BP monitoring is gaining prominence for the diagnosis and management of RHT. Home BP monitoring is advantageous as it is feasibly repetitive, inexpensive, widely available, and because of its reproducibility over long periods. In addition, home BP monitoring has crucial advantage of allowing safe titration for the maximum or maximally tolerable dose, and for self-monitoring, thereby improving clinical inertia and nonadherence, and allowing true RHT to be more accurately identified.
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Affiliation(s)
- Hyue Mee Kim
- grid.411651.60000 0004 0647 4960Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jinho Shin
- grid.49606.3d0000 0001 1364 9317Division of Cardiology, Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, 04763 Seoul, Republic of Korea
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7
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Nessler K, Krztoń-Królewiecka A, Suska A, Mann MR, Nessler MB, Windak A. The reliability of patient blood pressure self-assessments - a cross-sectional study. BMC PRIMARY CARE 2023; 24:2. [PMID: 36597022 PMCID: PMC9811785 DOI: 10.1186/s12875-022-01962-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Home blood pressure monitoring (HBPM) is an increasingly important tool in managing hypertension (HTN); however, its efficacy depends on its accuracy. This study aimed to explore the differences between blood pressure (BP) measurements conducted by patients and medical professionals and the patient demographic factors correlating with inaccurate self-measured BP levels. METHODS One hundred hypertensive patients completed a questionnaire inquiring about their health status and HBPM procedures and were filmed while measuring their BP using their own devices. A researcher then measured the patients' BP using a calibrated sphygmomanometer to assess the accuracy of patient-performed readings. This cross-sectional study was conducted in five primary healthcare centers in Kraków, Poland. RESULTS The mean differences in systolic and diastolic BP readings by patients and researchers were 8.36 mmHg (SD = 10.90 mmHg) and 2.16 mmHg (SD = 9.12 mmHg), respectively. Inaccuracies in patient BP measurements were associated with a less than high school education level, patients' age, and a family history of HTN. CONCLUSION Patient self-measured BP levels were higher than researcher values, likely due to a higher patient error rate. Healthcare providers must increase training regarding correct HBPM techniques offered to patients; such efforts should be directed at all hypertensive patients, emphasizing the most error-prone demographics.
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Affiliation(s)
- Katarzyna Nessler
- grid.5522.00000 0001 2162 9631Department of Family Medicine, Jagiellonian University Medical College, Bocheńska 4, 31-061 Kraków, Poland
| | - Anna Krztoń-Królewiecka
- grid.5522.00000 0001 2162 9631Department of Family Medicine, Jagiellonian University Medical College, Bocheńska 4, 31-061 Kraków, Poland
| | - Anna Suska
- grid.5522.00000 0001 2162 9631Department of Family Medicine, Students’ Family Medicine Interest Group, Jagiellonian University Medical College, Kraków, Poland
| | - Mitchell R. Mann
- grid.5522.00000 0001 2162 9631Department of Family Medicine, Students’ Family Medicine Interest Group, Jagiellonian University Medical College, Kraków, Poland
| | - Michał B. Nessler
- Burns and Plastic Surgery Centre of Malopolska, Rydygier Memorial Hospital, Os. Zlotej Jesieni 1, 31-826 Kraków, PL Poland
| | - Adam Windak
- grid.5522.00000 0001 2162 9631Department of Family Medicine, Jagiellonian University Medical College, Bocheńska 4, 31-061 Kraków, Poland
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8
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Ihm SH, Park JH, Kim JY, Kim JH, Kim KI, Lee EM, Lee HY, Park S, Shin J, Kim CH. Home blood pressure monitoring: a position statement from the Korean Society of Hypertension Home Blood Pressure Forum. Clin Hypertens 2022; 28:38. [PMID: 36180964 PMCID: PMC9526300 DOI: 10.1186/s40885-022-00218-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/24/2022] [Indexed: 12/02/2022] Open
Abstract
Home blood pressure measurement (HBPM) has the advantage of measuring blood pressure (BP) multiple times over a long period. HBPM effectively diagnoses stress-induced transient BP elevations (i.e., white coat hypertension), insufficient BP control throughout the day (i.e., masked hypertension), and even BP variability. In most cases, HBPM may increase self-awareness of BP, increasing the compliance of treatment. Cumulative evidence has reported better improved predictive values of HBPM in cardiovascular morbidity and mortality than office BP monitoring. In this position paper, the Korean Society of Hypertension Home Blood Pressure Forum provides comprehensive information and clinical importance on HBPM.
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Affiliation(s)
- Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine and Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae-Hyeong Park
- Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jang Young Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Ju-Han Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Kwang-Il Kim
- Division of Geriatrics, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Eun Mi Lee
- Division of Cardiology, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University, Seoul, Republic of Korea
| | - Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital and Integrated Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Cheol-Ho Kim
- Division of Geriatrics, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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9
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Groenland EH, Vendeville JPAC, Bemelmans RHH, Monajemi H, Bots ML, Visseren FLJ, Spiering W. Smartphone Application-Assisted Home Blood Pressure Monitoring Compared With Office and Ambulatory Blood Pressure Monitoring in Patients With Hypertension: the AMUSE-BP Study. Hypertension 2022; 79:2373-2382. [PMID: 35959685 PMCID: PMC9444260 DOI: 10.1161/hypertensionaha.122.19685] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The development of automated, smartphone application (app)-assisted home blood pressure monitoring (HBPM) allows for standardized measurement of blood pressure (BP) at home. The aim of this study was to evaluate the (diagnostic) agreement between app-assisted HBPM, automated office BP (OBP), and the reference standard 24-hour ambulatory BP monitoring (ABPM).
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Affiliation(s)
- Eline H Groenland
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, the Netherlands (E.H.G., J.-P.A.C.V., F.L.J.V., W.S.)
| | - Jean-Paul A C Vendeville
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, the Netherlands (E.H.G., J.-P.A.C.V., F.L.J.V., W.S.)
| | - Remy H H Bemelmans
- Department of Internal Medicine, Ziekenhuis Gelderse Vallei, Ede, the Netherlands (R.H.H.B.)
| | - Houshang Monajemi
- Department of Internal Medicine, Rijnstate, Arnhem, the Netherlands (H.M.)
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (M.L.B.)
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, the Netherlands (E.H.G., J.-P.A.C.V., F.L.J.V., W.S.)
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, the Netherlands (E.H.G., J.-P.A.C.V., F.L.J.V., W.S.)
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10
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Kunanon S, Roubsanthisuk W, Chattranukulchai P, Sangwatanaroj S, Ophascharoensuk V, Sitthisook S, Sukonthasarn A. 2022 Thai Hypertension Society guidelines on home blood pressure monitoring. J Clin Hypertens (Greenwich) 2022; 24:1139-1146. [PMID: 36196468 PMCID: PMC9532919 DOI: 10.1111/jch.14569] [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: 06/13/2022] [Revised: 07/24/2022] [Accepted: 08/11/2022] [Indexed: 11/19/2022]
Abstract
In 2021, the Universal Health Coverage Payment Scheme of Thailand approved home blood pressure monitoring (HBPM) devices for reimbursement. National utilization of HBPM devices will begin in 2022. This article provides the recommendations for HBPM from the Thai Hypertension Society. In this report, the authors review the benefits of HBPM and recommend confirming the diagnosis of hypertension by HBPM. Devices for HBPM should be the automated and validated upper arm cuff devices. HBPM should be ideally done for seven consecutive days before each clinic visit and take at least two readings (1 min apart) in the morning and before going to bed. The average blood pressure (BP) of 125-134/75-84 mmHg is classified as high normal BP and hypertension is BP of 135/85 mmHg or more. Target BP levels depend on the age of the patients; that is, < 125/75 mmHg for patients aged 18-65 years old, and <135/85 mmHg for patients over 65 years of age.
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Affiliation(s)
- Sirisawat Kunanon
- Division of HypertensionDepartment of MedicineFaculty of MedicineSiriraj HospitalMahidol UniversityBangkokThailand
| | - Weranuj Roubsanthisuk
- Division of HypertensionDepartment of MedicineFaculty of MedicineSiriraj HospitalMahidol UniversityBangkokThailand
| | - Pairoj Chattranukulchai
- Division of Cardiovascular MedicineDepartment of MedicineFaculty of MedicineChulalongkorn UniversityKing Chulalongkorn Memorial HospitalBangkokThailand
| | - Somkiat Sangwatanaroj
- Division of Cardiovascular MedicineDepartment of MedicineFaculty of MedicineChulalongkorn UniversityKing Chulalongkorn Memorial HospitalBangkokThailand
| | - Vuddhidej Ophascharoensuk
- Division of NephrologyDepartment of Internal MedicineFaculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Surapun Sitthisook
- Division of Cardiovascular MedicineDepartment of MedicineFaculty of MedicineChulalongkorn UniversityKing Chulalongkorn Memorial HospitalBangkokThailand
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11
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Lin H, Pan H, Chen C, Cheng H, Chia Y, Sogunuru GP, Tay JC, Turana Y, Verma N, Kario K, Wang T. Standardized home blood pressure monitoring: Rationale behind the 722 protocol. J Clin Hypertens (Greenwich) 2022; 24:1161-1173. [PMID: 36196472 PMCID: PMC9532917 DOI: 10.1111/jch.14549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/02/2022] [Accepted: 07/05/2022] [Indexed: 11/07/2022]
Abstract
Home blood pressure (HBP) has been recognized as a prognostic predictor for cardiovascular events, and integrated into the diagnosis and management of hypertension. With increasing accessibility of oscillometric blood pressure devices, HBP monitoring is easy to perform, more likely to obtain reliable estimation of blood pressures, and feasible to document long-term blood pressure variations, compared to office and ambulatory blood pressures. To obtain reliable HBP estimates, a standardized HBP monitoring protocol is essential. A consensus regarding the optimal duration and frequency of HBP monitoring is yet to be established. Based on the current evidence, the "722" protocol, which stands for two measurements on one occasion, two occasions a day (morning and evening), and over a consecutive of 7 days, is most commonly used in clinical studies and recommended in relevant guidelines and consensus documents. HBP monitoring based on the "722" protocol fulfills the minimal requirement of blood pressure measurements to achieve agreement of blood pressure classifications defined by office blood pressures and to predict cardiovascular risks. In the Taiwan HBP consensus, the frequency of repeating the "722" protocol of HBP monitoring according to different scenarios of hypertension management, from every 2 weeks to 3 months, is recommended. It is reasonable to conclude that the "722" protocol for HBP monitoring is clinically justified and can serve as a basis for standardized HBP monitoring.
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Affiliation(s)
- Hung‐Ju Lin
- CardiovascularCenter and Division of Cardiology, Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Heng‐Yu Pan
- Department of Internal MedicineNational Taiwan University Hospital Yun‐Lin BranchYun‐Lin CountyTaiwan
| | - Chen‐Huan Chen
- Department of MedicineNational Yang Ming Chiao Tung University College of MedicineTaipeiTaiwan
- Department of Medical EducationTaipei Veterans General HospitalTaipeiTaiwan
| | - Hao‐Min Cheng
- Institute of Public Health and Community Medicine Research CenterNational Yang‐Ming University School of MedicineTaipeiTaiwan
- Department of MedicineDivision of CardiologyTaipei Veterans General HospitalTaipeiTaiwan
- Faculty of MedicineNational Yang‐Ming University School of MedicineTaipeiTaiwan
- Department of Medical EducationCenter for Evidence‐based MedicineTaipei Veterans General HospitalTaipeiTaiwan
| | - Yook‐Chin Chia
- Department of Medical SciencesSchool of Medical and Life SciencesSunway UniversitySelangor Darul EhsanBandar SunwayMalaysia
- Department of Primary Care MedicineFaculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Guru Prasad Sogunuru
- Fortis HospitalsChennaiTamil NaduIndia
- College of Medical SciencesKathmandu UniversityBharatpurNepal
| | - Jam Chin Tay
- Department of General MedicineTan Tock Seng HospitalSingapore CitySingapore
| | - Yuda Turana
- Department of NeurologySchool of Medicine and Health SciencesAtma Jaya Catholic University of IndonesiaJakartaIndonesia
| | - Narsingh Verma
- Asia Pacific Society of HypertensionDepartment of PhysiologyKing George's Medical UniversityLucknowIndia
| | - Kazuomi Kario
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Tzung‐Dau Wang
- Cardiovascular Center and Divisions of Cardiology and Hospital Medicine, Department of Internal MedicineNational Taiwan University Hospital and National Taiwan University College of MedicineTaipeiTaiwan
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12
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Sarker MHR, Moriyama M, Rashid HU, Rahman MM, Chisti MJ, Das SK, Saha SK, Arifeen SE, Ahmed T, Faruque ASG. Chronic Kidney Disease Awareness Campaign and Mobile Health Education to Improve Knowledge, Quality of Life, and Motivation for a Healthy Lifestyle Among Patients With Chronic Kidney Disease in Bangladesh: Randomized Controlled Trial. J Med Internet Res 2022; 24:e37314. [PMID: 35969429 PMCID: PMC9412733 DOI: 10.2196/37314] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/05/2022] [Accepted: 06/13/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is linked to major health consequences and a poor quality of life. Despite the fact that CKD is becoming more prevalent, public knowledge of the disease remains low. OBJECTIVE This study aimed to evaluate the outcome of a health education intervention designed to enhance knowledge, health-related quality of life (QOL), and motivation about healthy lifestyle among adults with CKD. METHODS This study was a parallel-group (1:1), randomized controlled trial in the Mirzapur subdistrict of Bangladesh that compared 2 groups of patients with CKD. Adults with CKD (stages 1-3) were enrolled in November 2020 and randomly assigned the intervention or control group. The intervention group received health education through a CKD awareness campaign and mobile health technologies and was observed for 6 months, whereas the control group received standard treatment. The primary outcome was the evaluation of improved scores on the CKD knowledge questionnaire, and the secondary outcomes were improved QOL and changes in the levels of blood pressure (BP), BMI, serum creatinine, fasting blood sugar (FBS), hemoglobin, cholesterol, high-density lipoprotein cholesterol, triglyceride, serum uric acid, blood urea nitrogen (BUN), and albumin-to-creatinine ratio. RESULTS The study enrolled 126 patients (control: n=63; intervention: n=63) and performed intention-to-treat analysis. The analyses included repeated measures ANOVA, and the results were observed to be significantly different from within groups (P<.001), between groups (P<.001), and the interaction of group × time factor (P<.001) for knowledge score. Diastolic BP and BMI showed significant differences arising from within groups (P<.001 and P=.01, respectively) and the interaction of group × time factor (P=.001 and P=.02, respectively); food salinity and hip circumferences showed significant differences arising from within groups (P=.001 and P=.03, respectively) and between groups (P=.001 and P=.02, respectively). Moreover, systolic BP and waist circumference showed significant differences from within groups (P<.001 and P=.003, respectively). However, no significant differences were found arising from within groups, between groups, and the interactions of group × time for QOL, urine salinity, and mid-upper arm circumference. Regarding the laboratory findings, from baseline to 6 months, the mean (SD) FBS decreased by 0.51 (3.77) mmol/L in the intervention group and 0.10 (1.44) mmol/L in the control group (P=.03); however, blood urea nitrogen increased by 3.64 (7.17) mg/dL in the intervention group and 1.68 (10.10) mg/dL in the control group (P=.01). CONCLUSIONS The health education strategy, which included a campaign and mobile health, showed promise for enhancing CKD knowledge among patients with CKD. This strategy may also aid patients with CKD in controlling their FBS and BP. The combined health education initiatives give evidence for scaling them up in Bangladesh and possibly other low- and middle-income countries, particularly in rural and peri-urban settings. TRIAL REGISTRATION ClinicalTrials.gov NCT04094831; https://clinicaltrials.gov/ct2/show/NCT04094831. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/30191.
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Affiliation(s)
- Mohammad Habibur Rahman Sarker
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Michiko Moriyama
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Harun Ur Rashid
- Kidney Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Md Moshiur Rahman
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mohammod Jobayer Chisti
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Sumon Kumar Das
- Menzies - School of Health Research, Charles Darwin University, Darwin, Australia
| | - Samir Kumar Saha
- Child Health Research Foundation, Dhaka, Bangladesh
- Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - A S G Faruque
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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13
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Verberk WJ. Atrial fibrillation and 24-h ambulatory blood pressure pattern. J Clin Hypertens (Greenwich) 2022; 24:848-850. [PMID: 35702949 PMCID: PMC9278569 DOI: 10.1111/jch.14522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Willem J Verberk
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
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14
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Thijs L, Asayama K, Maestre GE, Hansen TW, Buyse L, Wei DM, Melgarejo JD, Brguljan-Hitij J, Cheng HM, de Souza F, Gilis-Malinowska N, Kawecka-Jaszcz K, Mels C, Mokwatsi G, Muxfeldt ES, Narkiewicz K, Odili AN, Rajzer M, Schutte AE, Stolarz-Skrzypek K, Tsai YW, Vanassche T, Vanholder R, Zhang ZY, Verhamme P, Kruger R, Mischak H, Staessen JA. Urinary proteomics combined with home blood pressure telemonitoring for health care reform trial: rational and protocol. Blood Press 2021; 30:269-281. [PMID: 34461803 PMCID: PMC9412130 DOI: 10.1080/08037051.2021.1952061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Hypertension and diabetes cause chronic kidney disease (CKD) and diastolic left ventricular dysfunction (DVD) as forerunners of disability and death. Home blood pressure telemonitoring (HTM) and urinary peptidomic profiling (UPP) are technologies enabling prevention. METHODS UPRIGHT-HTM (Urinary Proteomics Combined with Home Blood Pressure Telemonitoring for Health Care Reform [NCT04299529]) is an investigator-initiated 5-year clinical trial with patient-centred design, which will randomise 1148 patients to be recruited in Europe, sub-Saharan Africa and South America. During the whole study, HTM data will be collected and freely accessible for patients and caregivers. The UPP, measured at enrolment only, will be communicated early during follow-up to 50% of patients and their caregivers (intervention), but only at trial closure in 50% (control). The hypothesis is that early knowledge of the UPP risk profile will lead to more rigorous risk factor management and result in benefit. Eligible patients, aged 55-75 years old, are asymptomatic, but have ≥5 CKD- or DVD-related risk factors, preferably including hypertension, type-2 diabetes, or both. The primary endpoint is a composite of new-onset intermediate and hard cardiovascular and renal outcomes. Demonstrating that combining UPP with HTM is feasible in a multicultural context and defining the molecular signatures of early CKD and DVD are secondary endpoints. EXPECTED OUTCOMES The expected outcome is that application of UPP on top of HTM will be superior to HTM alone in the prevention of CKD and DVD and associated complications and that UPP allows shifting emphasis from treating to preventing disease, thereby empowering patients.
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Affiliation(s)
- Lutgarde Thijs
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.,Tohoku Institute for Management of Blood Pressure, Sendai, Japan.,Research Institute Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium
| | - Gladys E Maestre
- Research Institute Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium.,Department of Neurosciences and Department of Human Genetics, University of Texas Rio Grande Valley School of Medicine, Brownsville, TX, USA.,Alzheimer's Disease Resource Center for Minority Aging Research, University of Texas Rio Grande Valley, Brownsville, TX, USA
| | - Tine W Hansen
- Research Institute Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium.,Steno Diabetes Center Copenhagen, Gentofte and Research Centre for Prevention and Health, Capital Region of Denmark, Denmark
| | - Luk Buyse
- Sports Medicine, Brussels Health Campus, Vrije Universiteit Brussel, Brussel, Belgium
| | - Dong-Mei Wei
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jesus D Melgarejo
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jana Brguljan-Hitij
- Department of Internal Medicine, Division of Hypertension, University Medical Centre, Ljubljana, Slovenia
| | - Hao-Min Cheng
- Taipei Veterans General Hospital, National Yang-Ming University, Taipei, ROC Taiwan
| | - Fabio de Souza
- Cardiology Section, Department of Specialized Medicine, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | | | - Kalina Kawecka-Jaszcz
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Carina Mels
- Hypertension in Africa Research Team, Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Gontse Mokwatsi
- Hypertension in Africa Research Team, Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Elisabeth S Muxfeldt
- Department of Internal Medicine, Hypertension Program, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | - Augustine N Odili
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Marek Rajzer
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Aletta E Schutte
- Hypertension in Africa Research Team, Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.,School of Population Health, University of New South Wales, The George Institute for Global Health, Sydney, Australia
| | - Katarzyna Stolarz-Skrzypek
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Yi-Wen Tsai
- Taipei Veterans General Hospital, National Yang-Ming University, Taipei, ROC Taiwan
| | - Thomas Vanassche
- Division of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Raymond Vanholder
- European Kidney Health Alliance, Brussels, Belgium.,Department of Nephrology, University Hospital Ghent, Ghent, Belgium
| | - Zhen-Yu Zhang
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Peter Verhamme
- Division of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Ruan Kruger
- Hypertension in Africa Research Team, Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | | | - Jan A Staessen
- Research Institute Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium.,Biomedical Science Group, Faculty of Medicine, University of Leuven, Leuven, Belgium
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15
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Pena-Hernandez C, Nugent K, Tuncel M. Twenty-Four-Hour Ambulatory Blood Pressure Monitoring. J Prim Care Community Health 2021; 11:2150132720940519. [PMID: 32646277 PMCID: PMC7356999 DOI: 10.1177/2150132720940519] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The diagnosis, management, and estimated mortality risk in patients with hypertension have been historically based on clinic or office blood pressure readings. Current evidence indicates that 24-hour ambulatory blood pressure monitoring should be an integral part of hypertension care. The 24-hour ambulatory monitors currently available on the market are small devices connected to the arm cuff with tubing that measure blood pressure every 15 to 30 minutes. After 24 hours, the patient returns, and the data are downloaded, including any information requested by the physician in a diary. The most useful information includes the 24-hour average blood pressure, the average daytime blood pressure, the average nighttime blood pressure, and the calculated percentage drop in blood pressure at night. The most widely used criteria for 24-hour measurements are from the American Heart Association 2017 guidelines and the European Society of Hypertension 2018 guidelines. Two important scenarios described in this document are white coat hypertension, in which patients have normal blood pressures at home but high blood pressures during office visits, and masked hypertension, in which patients are normotensive in the clinic but have high blood pressures outside of the office. The Centers for Medicare and Medicaid Services has made changes in its policy to allow reimbursement for a broader use of 24-hour ambulatory blood pressure monitoring within some specific guidelines. Primary care physicians should make more use of ambulatory blood pressure monitoring, especially in patients with difficult to manage hypertension.
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Affiliation(s)
| | - Kenneth Nugent
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Meryem Tuncel
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
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16
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Hypertension Canada's 2020 Comprehensive Guidelines for the Prevention, Diagnosis, Risk Assessment, and Treatment of Hypertension in Adults and Children. Can J Cardiol 2021; 36:596-624. [PMID: 32389335 DOI: 10.1016/j.cjca.2020.02.086] [Citation(s) in RCA: 250] [Impact Index Per Article: 83.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 02/23/2020] [Accepted: 02/23/2020] [Indexed: 11/21/2022] Open
Abstract
Hypertension Canada's 2020 guidelines for the prevention, diagnosis, risk assessment, and treatment of hypertension in adults and children provide comprehensive, evidence-based guidance for health care professionals and patients. Hypertension Canada develops the guidelines using rigourous methodology, carefully mitigating the risk of bias in our process. All draft recommendations undergo critical review by expert methodologists without conflict to ensure quality. Our guideline panel is diverse, including multiple health professional groups (nurses, pharmacy, academics, and physicians), and worked in concert with experts in primary care and implementation to ensure optimal usability. The 2020 guidelines include new guidance on the management of resistant hypertension and the management of hypertension in women planning pregnancy.
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17
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Smartphone / smartwatch-based cuffless blood pressure measurement : a position paper from the Korean Society of Hypertension. Clin Hypertens 2021; 27:4. [PMID: 33494809 PMCID: PMC7831256 DOI: 10.1186/s40885-020-00158-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/23/2020] [Indexed: 12/13/2022] Open
Abstract
Smartphone technology has spread rapidly around the globe. According to a report released by the Korea Information Society Development Institute, about 95% of Koreans aged more than 30 years old owned smartphones. Recently, blood pressure (BP) measurement using a photoplethysmography-based smartphone algorithm paired with the smartwatch is continuously evolving. In this document, the Korean Society of Hypertension intends to remark the current results of smartphone / smartwatch-based BP measurement and recommend optimal BP measurement methods using a smartphone device. We aim to increase the likelihood of success in implementing these new technologies into improved hypertension awareness, diagnosis, and control.
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18
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Zhang D, Huang QF, Li Y, Wang JG. A randomized controlled trial on home blood pressure monitoring and quality of care in stage 2 and 3 hypertension. Hypertens Res 2021; 44:533-540. [PMID: 33442031 DOI: 10.1038/s41440-020-00602-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/27/2020] [Accepted: 11/22/2020] [Indexed: 12/11/2022]
Abstract
In a 12-week, randomized, controlled trial, we investigated whether home blood pressure monitoring (HBPM) would improve treatment adherence and blood pressure control in stage 2 and 3 hypertension. Eligible patients (18-75 years of age and 160-199/100-119 mmHg of clinic systolic/diastolic blood pressure after a 1-week wash-out) were randomized in a 1:4 ratio to an experimental group (with HBPM) and a control group (without HBPM). All patients started antihypertensive treatment with the irbesartan 150 mg/hydrochlorothiazide 12.5 mg/day combination, with the possible addition of irbesartan 150 mg/day and uptitration to irbesartan 300 mg/hydrochlorothiazide 25 mg/day at 4 and 8 weeks of follow-up, respectively. The primary endpoint was the clinic blood pressure control (systolic/diastolic, nondiabetes <140/90 mmHg and diabetes <130/80 mmHg) rate at 12 weeks of follow-up. The randomized patients in the HBPM (n = 96) and control groups (n = 405) had similar characteristics at baseline and similar use of higher dosages of irbesartan/hydrochlorothiazide (300 mg/12.5-25 mg) at 4 (9.4% vs. 12.2%, P = 0.45) and 8 weeks of follow-up (27.1% vs. 35.5%, P = 0.13). During follow-up, both the cumulative treatment discontinuation rate (1.0% vs. 12.6%, P = 0.0008) and the less optimal treatment adherence rate (<90% of prescribed medication, 1.0% vs. 9.9%, P = 0.005) were significantly lower in the HBPM group than in the control group. The proportion of patients who achieved the goal of clinic blood pressure control at 12 weeks of follow-up was significantly higher in the HBPM group than in the control group (66.7% vs. 55.1%, P = 0.04). In conclusion, HBPM improved treatment adherence and blood pressure control in patients with hypertension, despite similar antihypertensive treatment intensities.
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Affiliation(s)
- Di Zhang
- Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qi-Fang Huang
- Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan Li
- Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ji-Guang Wang
- Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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19
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Kim LG, Wilson ECF, Davison WJ, Clark AB, Myint PK, Potter JF. Self-Monitoring and Management of Blood Pressure in Patients with Stroke or TIA: An Economic Evaluation of TEST-BP, A Randomised Controlled Trial. PHARMACOECONOMICS - OPEN 2020; 4:511-517. [PMID: 32056146 PMCID: PMC7426342 DOI: 10.1007/s41669-020-00196-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Prevention of secondary stroke following initial ictus is an important focus of after-stroke care. Blood pressure (BP) is a key risk factor, so usual care following stroke or transient ischaemic attack includes regular BP checks and monitoring of anti-hypertensive medication. This is traditionally carried out in primary care, but the evidence supporting self-monitoring and self-guided management of BP in the general population with hypertension is growing. OBJECTIVE Our objective was to estimate the cost effectiveness of treatment as usual (TAU) versus (1) self-monitoring of BP (S-MON) and (2) self-monitoring and guided self-management of anti-hypertensive medication (S-MAN). METHODS This was a within-trial economic evaluation of a randomised controlled trial estimating the incremental cost per 1 mmHg BP reduction and per quality-adjusted life-year (QALY) gained over a 6-month time horizon from the perspective of the UK National Health Service (NHS). RESULTS Data were evaluable for 140 participants. Costs per patient were £473, £853 and £1035; mean reduction in systolic BP (SBP) was 3.6, 6.7 and 6.1 mmHg, and QALYs accrued were 0.427, 0.422 and 0.423 for TAU, S-MON and S-MAN, respectively. No statistically significant differences in incremental costs or outcomes were detected. On average, S-MAN was dominated or extended dominated. The incremental cost per 1 mmHg BP reduction from S-MON versus TAU was £137. CONCLUSION On average, S-MAN is an inefficient intervention. S-MON may be cost effective, depending on the willingness to pay for a 1 mmHg BP reduction, although it yielded fewer QALYs over the within-trial time horizon. Decision modelling is required to explore the longer-term costs and outcomes.
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Affiliation(s)
- Lois G Kim
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Forvie Site, Cambridge, UK
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, Strangeways Research Laboratory, Wort's Causeway, Cambridge, UK
| | - Edward C F Wilson
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Forvie Site, Cambridge, UK.
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK.
| | - William J Davison
- Ageing and Stroke Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Allan B Clark
- Medical Statistics Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Phyo K Myint
- Ageing Clinical and Experimental Research (ACER), Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - John F Potter
- Ageing and Stroke Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
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20
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The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019). Hypertens Res 2020; 42:1235-1481. [PMID: 31375757 DOI: 10.1038/s41440-019-0284-9] [Citation(s) in RCA: 976] [Impact Index Per Article: 244.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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21
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Muijsers HEC, van der Heijden OWH, de Boer K, van Bijsterveldt C, Buijs C, Pagels J, Tönnies P, Heiden S, Roeleveld N, Maas AHEM. Blood pressure after PREeclampsia/HELLP by SELF monitoring (BP-PRESELF): rationale and design of a multicenter randomized controlled trial. BMC WOMENS HEALTH 2020; 20:41. [PMID: 32131802 PMCID: PMC7055029 DOI: 10.1186/s12905-020-00910-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/20/2020] [Indexed: 12/16/2022]
Abstract
Background Hypertensive disorders of pregnancy (HDP), such as preeclampsia (PE) or the Hemolysis Elevated Liver enzymes and Low Platelets (HELLP) syndrome are associated with elevated cardiovascular disease (CVD) risks, but standardized prevention guidelines after such pregnancies are lacking. Hypertension is the first emerging risk factor after PE/HELLP pregnancies and is a major risk factor for CVD. Hypertension before the age of 55 years may lead to various manifestations of end-organ damage at relatively young age. Therefore, timely treatment of elevated blood pressure is mandatory, but many of these high-risk women have long-term undetected and untreated hypertension before adequate treatment is initiated. Aim The aim of our study is to assess whether home blood pressure monitoring (HBPM) in women with a previous PE/HELLP pregnancy is a valuable tool for the early detection of hypertension. Methods Women with a history of both early and late PE/HELLP syndrome aged 40–60 years are invited to participate. Patients with a history of CVD, known hypertension and/or use of antihypertensive medication are excluded. Women are randomized between HPBM or ‘usual care’. The primary outcome is feasibility and usability of HBPM after 1 year of follow-up. Secondary outcomes will be the effectiveness of HPBM to detect hypertension, the efficacy of BP treatment, quality of life, health-related symptoms, work ability, and life-style behaviour. The results of this study will provide better strategies for timely detection and prevention of hypertension in women after PE/HELLP. Trial registration ClinicalTrials.gov, NCT03228082. Registered June 15, 2017.
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Affiliation(s)
- Hella E C Muijsers
- Department of Cardiology, Radboud university medical center, Geert-Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands.
| | - Olivier W H van der Heijden
- Department of Obstetrics and Gynecology, Radboud university medical center, Geert-Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
| | - Karin de Boer
- Department of Obstetrics and Gynecology, Rijnstate, Wagnerlaan 55, 6815, AD, Arnhem, The Netherlands
| | - Chantal van Bijsterveldt
- Department of Obstetrics and Gynecology, Canisius-Wilhelmina Hospital, Weg door Jonkerbos 100, 6532, SZ, Nijmegen, The Netherlands
| | - Ciska Buijs
- Department of Obstetrics and Gynecology, Maasziekenhuis Pantein, Dokter Kopstraat 1, 5835 BV, Beugen, The Netherlands
| | - Jens Pagels
- Department of Obstetrics and Gynecology, St. Josef Hospital Moers, Asberger Strasse 4, 47441, Moers, Germany
| | - Peter Tönnies
- Department of Obstetrics and Gynecology, Bethanien Hospital Moers, Bethanienstrasse 21, 47441, Moers, Germany
| | - Susanne Heiden
- Department of Obstetrics and Gynecology, St. Antonius Hospital Kleve, Albersallee 5-7, 47533, Kleve, Germany
| | - Nel Roeleveld
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud university medical center, Geert-Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
| | - Angela H E M Maas
- Department of Cardiology, Radboud university medical center, Geert-Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
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22
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AlHadlaq RK, Swarelzahab MM, AlSaad SZ, AlHadlaq AK, Almasari SM, Alsuwayt SS, Alomari NA. Factors affecting self-management of hypertensive patients attending family medicine clinics in Riyadh, Saudi Arabia. J Family Med Prim Care 2019; 8:4003-4009. [PMID: 31879650 PMCID: PMC6924233 DOI: 10.4103/jfmpc.jfmpc_752_19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 09/16/2019] [Accepted: 10/14/2019] [Indexed: 11/08/2022] Open
Abstract
Background/Aim: Hypertension (HBP) is a chronic disease that has become a public health problem, which has been attributed to numerous risk factors. However, despite numerous HBP management and behavioral treatment guidelines, HBP is poorly controlled among patients due to insufficient care. We conducted this study to identify the prevalence of self-management behaviors and to explore factors affecting self-management behaviors for controlling HBP among hypertensive patients. Methods: We conducted a survey using the Hypertension Self-Care Profile (HBP-SCP) and the Hill-Bone Adherence Scale among diagnosed HBP patients attending the Family Medicine clinics of King Saud Medical City in Riyadh, Saudi Arabia in January 2019. All patients of Saudi nationality aged 18 years and above were included in the study. Results: A total of 187 patients responded to the survey, 95 (50.8%) males and 92 (49.2%) females. Only 93 patients (49.7%) monitor their BP at home, and 68 (36.4%) always measure their BP. Ninety-one patients (48.7%) said that measuring their BP is not important. The most common reason for not taking the anti-HBP medications is they forget to take the medications in 87 (46.5%) of patients. Seventy-two patients (38.5%) did not restrict salt intake, and 51 patients (27.3%) had no time for exercise. More than half of the patients (51.3%) were not motivated to regularly exercise and 56.7% were motivated to limit salt-intake. Confidence to exercise, check BP at home, and eat low-salt foods were also low at 52.4–53.5%. Significant factors including gender, age, BMI, duration of HBP, and presence of cardiac disease were found to be related toward behavior, motivation, and confidence to self-care. Conclusion: Compliance, behavior, motivation, and self-care among hypertensive patients visiting the primary care clinics in our representative population are low. Various factors were found to be related to poor behavior, poor motivation, and less confidence to do home BP monitoring, to exercise more, restrict salt intake, and value the control of HBP. There is a need for health practitioners to assess self-care activities and blood pressure control, and educate patients the importance of HBP monitoring and teaching practical techniques to boost their confidence and motivation to achieve a better behavior, self-care, and compliance to management.
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Affiliation(s)
- Razan K AlHadlaq
- Department of Family Medicine at King Saud Medical City, Riyadh, Saudi Arabia
| | - Mazin M Swarelzahab
- Department of Preventative Medicine at King Saud Medical City, Riyadh, Saudi Arabia
| | - Samaher Z AlSaad
- Department of Family Medicine at King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdulrahman K AlHadlaq
- College of Medicine at King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Saad M Almasari
- Department of Family Medicine at King Saud Medical City, Riyadh, Saudi Arabia
| | - Saleh S Alsuwayt
- Department of Family Medicine at King Saud Medical City, Riyadh, Saudi Arabia
| | - Naif A Alomari
- Department of Family Medicine at King Saud Medical City, Riyadh, Saudi Arabia
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23
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Kaul U, Omboni S, Arambam P, Rao S, Kapoor S, Swahney JPS, Sharma K, Nair T, Chopda M, Hiremath J, Ponde CK, Oomman A, Srinivas BC, Suvarna V, Jasuja S, Borges E, Verberk WJ. Blood pressure related to age: The India ABPM study. J Clin Hypertens (Greenwich) 2019; 21:1784-1794. [PMID: 31769171 DOI: 10.1111/jch.13744] [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: 08/16/2019] [Revised: 10/05/2019] [Accepted: 10/16/2019] [Indexed: 12/11/2022]
Abstract
The present paper reports trends in office blood pressure (BP) measurement (OBPM) and ambulatory blood pressure measurement (ABPM) with age in a large multi-center Indian all comers' population visiting primary care physicians. ABPM and OBPM data from 27 472 subjects (aged 51 ± 14 years, males 68.2%, treated 45.5%) were analyzed and compared. Individual differences between OBPM and ABPM patterns were compared for patients according to 10-year age categories. Results showed that systolic (S) BP values started to increase with age from the age of 40, BP variability (SD) increased from the age of 30 years. Diastolic (D) BP values started to decrease from the age of 50 years. Mean OBPM values were higher than daytime ABPM values (all P < .001) in all age-groups. The prevalence of white coat hypertension (WCH) and masked hypertension (MH) was based on OBPM and daytime, 24-hour, and nighttime average BPs together. WCH decreased with age from 15.1% and 12.4% in treated and untreated subjects at the youngest age to 7.2% and 6.9% in the oldest age, respectively. MH prevalence was higher for untreated than for treated subjects but remained similar for all age-groups (range of 18.6%-21.3%). The prevalence of reverse dippers increased with age from the youngest to oldest group with 7.3%-34.2% (P < .001 for trend). Dippers prevalence decreased from 42.5% to 17.9% from the youngest to oldest age-groups, respectively (P < .001 for trend). These findings confirm that BP patterns show clear differences in trends with age, particularly regarding nighttime BP.
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Affiliation(s)
- Upendra Kaul
- Batra Heart Center and Batra Hospital and Medical Research Center Tughlaqabad institutional Area, New Delhi, India
| | - Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy.,Scientific Research Department of Cardiology, Science and Technology Park for Biomedicine, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Priyadarshini Arambam
- Batra Heart Center and Batra Hospital and Medical Research Center Tughlaqabad institutional Area, New Delhi, India
| | - Srinivas Rao
- Care hospitals Banjara Hills and Nampally, Hyderabad, India
| | - Sunil Kapoor
- Apollo hospitals Jubilee Hills, Hyderabad, India
| | | | - Kamal Sharma
- B.J. Medical College, U.N, Mehta Institute of Cardiology and Research Centre, Civil Hospital, Ahmedabad, India
| | - Tiny Nair
- Department of Cardiology, PRS Hospital, Killipalam, India
| | | | | | | | | | | | | | - Sanjiv Jasuja
- Indraprastha Apollo Hospitals, Institutes of Nephrology, New Delhi, India
| | - Eric Borges
- Bombay Hospital and medical research centre, Mumbai, India
| | - Willem J Verberk
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
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24
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Monahan M, Jowett S, Nickless A, Franssen M, Grant S, Greenfield S, Hobbs FDR, Hodgkinson J, Mant J, McManus RJ. Cost-Effectiveness of Telemonitoring and Self-Monitoring of Blood Pressure for Antihypertensive Titration in Primary Care (TASMINH4). Hypertension 2019; 73:1231-1239. [PMID: 31067190 PMCID: PMC6510405 DOI: 10.1161/hypertensionaha.118.12415] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The use of self-monitoring of blood pressure, with or without telemonitoring, to guide therapy decisions by physicians for patients with hypertension has been recently demonstrated to reduce blood pressure compared with using clinic monitoring (usual care). However, both the cost-effectiveness of these strategies compared with usual care, and whether the additional benefit of telemonitoring compared with self-monitoring alone could be considered value for money, are unknown. This study assessed the cost-effectiveness of physician titration of antihypertensive medication using self-monitored blood pressure, with or without telemonitoring, to make hypertension treatment decisions in primary care compared with usual care. A Markov patient-level simulation model was developed taking a UK Health Service/Personal Social Services perspective. The model adopted a lifetime time horizon with 6-month time cycles. At a willingness to pay of £20 000 per quality-adjusted life year, self-monitoring plus telemonitoring was the most cost-effective strategy (£17 424 per quality-adjusted life year gained) compared with usual care or self-monitoring alone (posting the results to the physician). However, deterministic sensitivity analysis showed that self-monitoring alone became the most cost-effective option when changing key assumptions around long-term effectiveness and time horizon. Overall, probabilistic sensitivity analysis suggested that self-monitoring regardless of transmission modality was likely to be cost-effective compared with usual care (89% probability of cost-effectiveness at £20 000/quality-adjusted life year), with high uncertainty as to whether telemonitoring or self-monitoring alone was the most cost-effective option. Self-monitoring in clinical practice is cost-effective and likely to lead to reduced cardiovascular mortality and morbidity.
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Affiliation(s)
- Mark Monahan
- From the Institute of Applied Health Research, University of Birmingham, United Kingdom (M.M., S.J., S. Greenfield, J.H.)
| | - Sue Jowett
- From the Institute of Applied Health Research, University of Birmingham, United Kingdom (M.M., S.J., S. Greenfield, J.H.)
| | - Alecia Nickless
- Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom (A.N., M.F., F.D.R.H., R.J.M.)
| | - Marloes Franssen
- Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom (A.N., M.F., F.D.R.H., R.J.M.)
| | - Sabrina Grant
- Translational Health Sciences, University of Bristol, United Kingdom (S. Grant)
| | - Sheila Greenfield
- From the Institute of Applied Health Research, University of Birmingham, United Kingdom (M.M., S.J., S. Greenfield, J.H.)
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom (A.N., M.F., F.D.R.H., R.J.M.)
| | - James Hodgkinson
- From the Institute of Applied Health Research, University of Birmingham, United Kingdom (M.M., S.J., S. Greenfield, J.H.)
| | - Jonathan Mant
- Department of Public Health and Primary Care, University of Cambridge, United Kingdom (J.M.)
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom (A.N., M.F., F.D.R.H., R.J.M.)
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25
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Denolle T. [Expert consensus statement on blood pressure measurement from the French Society of Hypertension, an affiliate of the French Society of Cardiology]. Presse Med 2019; 48:1319-1328. [PMID: 31732365 DOI: 10.1016/j.lpm.2019.09.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 09/26/2019] [Indexed: 01/03/2023] Open
Abstract
Since 2016, the French Society of Hypertension has warned about the decline in the management of high blood pressure in France: stagnation, or even decreased number of people who know their blood pressure level, take a treatment and are controlled. These results are lower than those observed in many other countries. Blood pressure is measured with an old method in the doctor's office. Accepted, simple and cost-effective, this method is currently unavoidable for reasons of feasibility and social habit. It has been used in observational and intervention studies that are the basis of the medical reasoning for screening, treatment and drug control of hypertension. In practice, it is too often poorly applied and unpredictable. It is now necessary to measure blood pressure in mmHg using a validated oscillometric automatic device coupled to a specific upper arm cuff adapted to the arm circumferences for the diagnosis and monitoring of high blood pressure in the doctor's office and at home. The auscultatoric measurement is only recommended if any doubt about the reliability of the electronic measurement. Blood pressure measurement is basically performed on both arms to detect asymmetry and then on the arm with the highest blood pressure. It is performed in sitting or lying position after a few minutes of rest without speaking and without having smoked and then in standing position to diagnose orthostatic hypotension, especially in elderly, diabetic and multi-medicated subjects. The blood pressure measurement during the consultation must be repeated and include at least 3 consecutive measurements at one minute intervals. The average of the last 2 measurements determines the blood pressure level. It is recommended to perform BP measurements outside the medical environment for the diagnosis and monitoring of hypertension; Home BP measurement is preferred to ambulatory blood pressure measurement for practical reasons unless otherwise specified. The home blood pressure measurement should include three measurements in the morning at breakfast and three measurements in the evening before bedtime at one minute intervals for at least three days. Prior training must be provided. In treated hypertensive patients, a masked hypertension should be considered as an uncontrolled hypertension and antihypertensive therapy adapted accordingly. The measurement of central BP pressure (aorta) should be limited to clinical research.
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Affiliation(s)
- Thierry Denolle
- Société française d'hypertension artérielle, 5, rue des Colonnes-du-Trône, 75012 Paris, France.
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26
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Bleda AL, Melgarejo-Meseguer FM, Gimeno-Blanes FJ, García-Alberola A, Rojo-Álvarez JL, Corral J, Ruiz R, Maestre-Ferriz R. Enabling Heart Self-Monitoring for All and for AAL-Portable Device within a Complete Telemedicine System. SENSORS (BASEL, SWITZERLAND) 2019; 19:E3969. [PMID: 31540042 PMCID: PMC6767459 DOI: 10.3390/s19183969] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/03/2019] [Accepted: 09/11/2019] [Indexed: 11/16/2022]
Abstract
During the last decades there has been a rapidly growing elderly population and the number of patients with chronic heart-related diseases has exploded. Many of them (such as those with congestive heart failure or some types of arrhythmias) require close medical supervision, thus imposing a big burden on healthcare costs in most western economies. Specifically, continuous or frequent Arterial Blood Pressure (ABP) and electrocardiogram (ECG) monitoring are important tools in the follow-up of many of these patients. In this work, we present a novel remote non-ambulatory and clinically validated heart self-monitoring system, which allows ABP and ECG monitoring to effectively identify clinically relevant arrhythmias. The system integrates digital transmission of the ECG and tensiometer measurements, within a patient-comfortable support, easy to recharge and with a multi-function software, all of them aiming to adapt for elderly people. The main novelty is that both physiological variables (ABP and ECG) are simultaneously measured in an ambulatory environment, which to our best knowledge is not readily available in the clinical market. Different processing techniques were implemented to analyze the heart rhythm, including pause detection, rhythm alterations and atrial fibrillation, hence allowing early detection of these diseases. Our results achieved clinical quality both for in-lab hardware testing and for ambulatory scenario validations. The proposed active assisted living (AAL) Sensor-based system is an end-to-end multidisciplinary system, fully connected to a platform and tested by the clinical team from beginning to end.
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Affiliation(s)
- Andrés-Lorenzo Bleda
- CETEM-Technologic Centre of Furniture and Wood of Region de Murcia, 30510 Yecla, Spain.
| | - Francisco-Manuel Melgarejo-Meseguer
- Departament of Internal Medicine, Murcia University, 30001 Murcia, Spain.
- Arrhythmia Unit, University Hospital Virgen de la Arrixaca, 30120 El Palmar, Spain.
- Murcian Institute of Biosanitary Research Virgen de la Arrixaca, 30120 El Palmar, Spain.
| | | | - Arcadi García-Alberola
- Departament of Internal Medicine, Murcia University, 30001 Murcia, Spain.
- Arrhythmia Unit, University Hospital Virgen de la Arrixaca, 30120 El Palmar, Spain.
- Murcian Institute of Biosanitary Research Virgen de la Arrixaca, 30120 El Palmar, Spain.
| | - José Luis Rojo-Álvarez
- Department of Signal Theory and Communications and Telematic Systemss and Computation, Rey Juan Carlos University, 28943 Fuenlabrada, Spain.
- Center for Computational Simulation, Universidad Politécnica de Madrid, 28223 Pozuelo de Alarcón, Spain.
| | | | | | - Rafael Maestre-Ferriz
- CETEM-Technologic Centre of Furniture and Wood of Region de Murcia, 30510 Yecla, Spain.
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27
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Kaul U, Arambam P, Rao S, Kapoor S, Swahney JPS, Sharma K, Nair T, Chopda M, Hiremath J, Ponde CK, Oomman A, Srinivas BC, Suvarna V, Jasuja S, Borges E, Verberk WJ. Usefulness of ambulatory blood pressure measurement for hypertension management in India: the India ABPM study. J Hum Hypertens 2019; 34:457-467. [PMID: 31484988 PMCID: PMC7299842 DOI: 10.1038/s41371-019-0243-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/23/2019] [Accepted: 08/02/2019] [Indexed: 11/09/2022]
Abstract
The present paper reports differences between office blood pressure (BP) measurement (OBPM) and ambulatory blood pressure measurement (ABPM) in a large multi-centre Indian all comers' population visiting primary care physicians. ABPM and OBPM data from 27,472 subjects (aged 51 ± 14 years, males 68.2%, treated 45.5%) were analysed and compared. Patients were classified based on the following hypertension thresholds: systolic BP (SBP) ≥ 140 and/or diastolic BP (DBP) ≥90 mmHg for OBPM, and SBP ≥ 130 and/or DBP ≥ 80 mmHg for 24-h ABPM, and SBP ≥ 120 and/or DBP ≥ 70 mmHg for night-time ABPM and SBP ≥ 135 and/or DBP ≥ 85 mmHg for daytime ABPM, all together. White coat hypertension (WCH) was seen in 12.0% (n = 3304), masked hypertension (MH) in 19.3% (n = 5293) and 55.5% (n = 15,246) had sustained hypertension. Isolated night-time hypertension (INH) was diagnosed in 11.9% (n = 3256). Untreated subjects had MH relatively more often than treated subjects (23.0% vs. 14.8%, p < 0.0001; respectively). Females had higher relative risk (RR) of having WCH than males (RR 1.16 [CI 95, 1.07-1.25], p < 0.0001). Whereas, males had higher RR of MH than females (RR 1.09 [CI 95, 1.02-1.17] p < 0.01). INH subjects had lower average systolic and diastolic dipping percentages (0.7 ± 6.6/ 2.2 ± 7.9 vs. 9.0 ± 7.3/11.9 ± 8.5, p < 0.001) than those without INH. In conclusion, for diagnosis of hypertension there was a contradiction between OBPM and ABPM in approximately one-third of all patients, and a substantial number of patients had INH. Using ABPM in routine hypertension management can lead to a reduction in burden and associated costs for Indian healthcare.
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Affiliation(s)
- Upendra Kaul
- Batra Heart Centre and Batra Hospital and Medical Research Centre Tughlaqabad institutional Area, New Delhi, India
| | - Priyadarshini Arambam
- Batra Heart Centre and Batra Hospital and Medical Research Centre Tughlaqabad institutional Area, New Delhi, India
| | - Srinivas Rao
- Care hospitals Banjara Hills and Nampally, Hyderabad, India
| | - Sunil Kapoor
- Apollo hospitals Jubilee Hills, Hyderabad, India
| | | | - Kamal Sharma
- B.J. Medical College, U. N. Mehta Institute of Cardiology and Research Centre, Civil Hospital, Ahmedabad, India
| | - Tiny Nair
- PRS Hospital, Department of Cardiology, Killipalam, Trivandrum, India
| | | | | | - C K Ponde
- Hinduja Hospital and medical research centre, Mumbai, India
| | | | - B C Srinivas
- Jayadeva institute of cardiology, Bangalore, India
| | | | - Sanjiv Jasuja
- Indraprastha Apollo Hospitals, Institutes of Nephrology, New Delhi, India
| | - Eric Borges
- Bombay Hospital and medical research centre, Mumbai, India
| | - Willem J Verberk
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.
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28
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Using mHealth for the management of hypertension in UK primary care: an embedded qualitative study of the TASMINH4 randomised controlled trial. Br J Gen Pract 2019; 69:e612-e620. [PMID: 31262847 DOI: 10.3399/bjgp19x704585] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 02/26/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Self-monitoring of blood pressure is common but how telemonitoring with a mobile healthcare (mHealth) solution in the management of hypertension can be implemented by patients and healthcare professionals (HCPs) is currently unclear. AIM Evaluation of facilitators and barriers to self- and telemonitoring interventions for hypertension within the Telemonitoring and Self-monitoring in Hypertension (TASMINH4) trial. DESIGN AND SETTING An embedded process evaluation of the TASMINH4 randomised controlled trial (RCT), in the West Midlands, in UK primary care, conducted between March 2015 and September 2016. METHOD A total of 40 participants comprising 23 patients were randomised to one of two arms: mHealth (self-monitoring by free text/short message service [SMS]) and self-monitoring without mHealth (self-monitoring using paper diaries). There were also15 healthcare professionals (HCPs) and two patient caregivers. RESULTS Four key implementation priority areas concerned: acceptability of self- and telemonitoring to patients and HCPs; managing data; communication; and integrating self-monitoring into hypertension management (structured care). Structured home monitoring engaged and empowered patients to self-monitor regardless of the use of mHealth, whereas telemonitoring potentially facilitated more rapid communication between HCPs and patients. Paper-based recording integrated better into current workflows but required additional staff input. CONCLUSION Although telemonitoring by mHealth facilitates easier communication and convenience, the realities of current UK general practice meant that a paper-based approach to self-monitoring could be integrated into existing workflows with greater ease. Self-monitoring should be offered to all patients with hypertension. Telemonitoring appears to give additional benefits to practices over and above self-monitoring but both need to be offered to ensure generalisability.
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29
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Lee HY, Shin J, Kim GH, Park S, Ihm SH, Kim HC, Kim KI, Kim JH, Lee JH, Park JM, Pyun WB, Chae SC. 2018 Korean Society of Hypertension Guidelines for the management of hypertension: part II-diagnosis and treatment of hypertension. Clin Hypertens 2019; 25:20. [PMID: 31388453 PMCID: PMC6670135 DOI: 10.1186/s40885-019-0124-x] [Citation(s) in RCA: 168] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 06/25/2019] [Indexed: 02/06/2023] Open
Abstract
The standardized techniques of blood pressure (BP) measurement in the clinic are emphasized and it is recommended to replace the mercury sphygmomanometer by a non-mercury sphygmomanometer. Out-of-office BP measurement using home BP monitoring (HBPM) or ambulatory BP monitoring (ABPM) and even automated office BP (AOBP) are recommended to correctly measure the patient’s genuine BP. Hypertension (HTN) treatment should be individualized based on cardiovascular (CV) risk and the level of BP. Based on the recent clinical study data proving benefits of intensive BP lowering in the high risk patients, the revised guideline recommends the more intensive BP lowering in high risk patients including the elderly population. Lifestyle modifications, mostly low salt diet and weight reduction, are strongly recommended in the population with elevated BP and prehypertension and all hypertensive patients. In patients with BP higher than 160/100 mmHg or more than 20/10 mmHg above the target BP, two drugs can be prescribed in combination to maximize the antihypertensive effect and to achieve rapid BP control. Especially, single pill combination drugs have multiple benefits, including maximizing reduction of BP, minimizing adverse effects, increasing adherence, and preventing cardiovascular disease (CVD) and target organ damage.
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Affiliation(s)
- Hae-Young Lee
- 1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jinho Shin
- 2Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Gheun-Ho Kim
- 2Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sungha Park
- 3Department of Internal Medicine, Yonsei University, Seoul, Korea
| | - Sang-Hyun Ihm
- 4Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Chang Kim
- 3Department of Internal Medicine, Yonsei University, Seoul, Korea
| | - Kwang-Il Kim
- 5Department of Internal Medicine, Seoul National University, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ju Han Kim
- Department of Internal Medicine, School of Medicine, Chonnam University, GwangJu, Korea
| | - Jang Hoon Lee
- 7Division of Cardiology, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jong-Moo Park
- 8Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Wook Bum Pyun
- 9Cardiovascular Center, Seoul Hospital, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Shung Chull Chae
- 7Division of Cardiology, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
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30
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Is antihypertensive treatment based on home blood pressure recommended rather than that based on office blood pressure in adults with essential hypertension? (meta-analysis). Hypertens Res 2019; 42:807-816. [DOI: 10.1038/s41440-019-0221-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/13/2018] [Accepted: 11/19/2018] [Indexed: 02/07/2023]
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31
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Fisher NDL, Fera LE, Dunning JR, Desai S, Matta L, Liquori V, Pagliaro J, Pabo E, Merriam M, MacRae CA, Scirica BM. Development of an entirely remote, non-physician led hypertension management program. Clin Cardiol 2019; 42:285-291. [PMID: 30582181 PMCID: PMC6712321 DOI: 10.1002/clc.23141] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Hypertension remains poorly controlled on the population level. National rates of control, even when defined leniently by BP < 140/90 mm Hg, are only ~50%. As growing healthcare costs coincide with tighter blood pressure (BP) targets, innovative management programs are needed to maximize efficiency of care delivery and optimize control. HYPOTHESIS We aimed to develop a remote, navigator-led hypertension innovation program that would leverage algorithmic care pathways, home BP measurements and patient coaching to allow rapid and complete medication titration. METHODS A multidisciplinary group of clinical experts from subspecialties and primary care collaborated to develop an evidence-based clinical algorithm, designed to be automated and administered by non-licensed patient navigators. In the development stage, a prospective pilot cohort of 130 patients was managed by nurse practitioners and pharmacists to ensure efficacy and safety. Patients with clinic BP ≥ 140/90 mm Hg were enrolled and given a Bluetooth-enabled BP device. Home BPs were transmitted automatically into the electronic medical record. Medication titrations were performed by phone at biweekly intervals, based upon weekly average BP, until home BP was controlled at <135/85 mm Hg. RESULTS Eighty-one percent of all enrolled, and 91% of those patients who regularly measured home BP achieved goal, in an average of 7 weeks. Control was reached similarly across races, genders, and ages. CONCLUSIONS A home-based BP control program run by non-physicians can provide efficient, effective and rapid control, suggesting an innovative paradigm for hypertension management. This program is effective, sustainable, adaptable, and scalable to fit current and emerging national systems of healthcare.
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Affiliation(s)
- Naomi D L Fisher
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts
| | - Liliana E Fera
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jacqueline R Dunning
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sonali Desai
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lina Matta
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts
| | - Victoria Liquori
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jaclyn Pagliaro
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts
| | - Erika Pabo
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mary Merriam
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts
| | - Calum A MacRae
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts
| | - Benjamin M Scirica
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts
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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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Reboussin DM, Allen NB, Griswold ME, Guallar E, Hong Y, Lackland DT, Miller E(PR, Polonsky T, Thompson-Paul AM, Vupputuri S. Systematic Review for the 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 2018; 138:e595-e616. [DOI: 10.1161/cir.0000000000000601] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective
To review the literature systematically and perform meta-analyses to address these questions: 1) Is there evidence that self-measured blood pressure (BP) without other augmentation is superior to office-based measurement of BP for achieving better BP control or for preventing adverse clinical outcomes that are related to elevated BP? 2) What is the optimal target for BP lowering during antihypertensive therapy in adults? 3) In adults with hypertension, how do various antihypertensive drug classes differ in their benefits and harms compared with each other as first-line therapy?
Methods
Electronic literature searches were performed by Doctor Evidence, a global medical evidence software and services company, across PubMed and EMBASE from 1966 to 2015 using key words and relevant subject headings for randomized controlled trials that met eligibility criteria defined for each question. We performed analyses using traditional frequentist statistical and Bayesian approaches, including random-effects Bayesian network meta-analyses.
Results
Our results suggest that: 1) There is a modest but significant improvement in systolic BP in randomized controlled trials of self-measured BP versus usual care at 6 but not 12 months, and for selected patients and their providers self-measured BP may be a helpful adjunct to routine office care. 2) systolic BP lowering to a target of <130 mm Hg may reduce the risk of several important outcomes including risk of myocardial infarction, stroke, heart failure, and major cardiovascular events. No class of medications (ie, angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, calcium channel blockers, or beta blockers) was significantly better than thiazides and thiazide-like diuretics as a first-line therapy for any outcome.
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Affiliation(s)
- David M. Reboussin
- These members of the evidence review committee are listed alphabetically, and all participated equally in the process. †The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Norrina B. Allen
- These members of the evidence review committee are listed alphabetically, and all participated equally in the process. †The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Michael E. Griswold
- These members of the evidence review committee are listed alphabetically, and all participated equally in the process. †The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Eliseo Guallar
- These members of the evidence review committee are listed alphabetically, and all participated equally in the process. †The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Yuling Hong
- These members of the evidence review committee are listed alphabetically, and all participated equally in the process. †The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Daniel T. Lackland
- These members of the evidence review committee are listed alphabetically, and all participated equally in the process. †The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Edgar (Pete) R. Miller
- These members of the evidence review committee are listed alphabetically, and all participated equally in the process. †The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Tamar Polonsky
- These members of the evidence review committee are listed alphabetically, and all participated equally in the process. †The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Angela M. Thompson-Paul
- These members of the evidence review committee are listed alphabetically, and all participated equally in the process. †The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Suma Vupputuri
- These members of the evidence review committee are listed alphabetically, and all participated equally in the process. †The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
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There's no place like home: is self-monitoring beneficial in hypertension management? Kidney Int 2018; 94:450-452. [PMID: 30143063 DOI: 10.1016/j.kint.2018.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 06/29/2018] [Indexed: 11/22/2022]
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Klarskov P, Bang LE, Schultz-Larsen P, Gregers Petersen H, Benee Olsen D, Berg RMG, Abrahamsen H, Wiinberg N. Intensive versus conventional blood pressure monitoring in a general practice population. The Blood Pressure Reduction in Danish General Practice trial: a randomized controlled parallel group trial. Fam Pract 2018; 35:433-439. [PMID: 29351658 DOI: 10.1093/fampra/cmx106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To compare the effect of a conventional to an intensive blood pressure monitoring regimen on blood pressure in hypertensive patients in the general practice setting. DESIGN Randomized controlled parallel group trial with 12-month follow-up. SETTING One hundred and ten general practices in all regions of Denmark. PARTICIPANTS One thousand forty-eight patients with essential hypertension. INTERVENTION Conventional blood pressure monitoring ('usual group') continued usual ad hoc blood pressure monitoring by office blood pressure measurements, while intensive blood pressure monitoring ('intensive group') supplemented this with frequent home blood pressure monitoring and 24-hour ambulatory blood pressure monitoring. PRIMARY OUTCOME MEASURES Mean day- and night-time systolic and diastolic 24-hour ambulatory blood pressure. SECONDARY OUTCOME MEASURES Change in systolic and diastolic office blood pressure and change in cardiovascular risk profile. RESULTS Of the patients, 515 (49%) were allocated to the usual group, and 533 (51%) to the intensive group. The reductions in day- and night-time 24-hour ambulatory blood pressure were similar (usual group: 4.6 ± 13.5/2.8 ± 82 mmHg; intensive group: 5.6 ± 13.0/3.5 ± 8.2 mmHg; P = 0.27/P = 0.20). Cardiovascular risk scores were reduced in both groups at follow-up, but more so in the intensive than in the usual group (P = 0.02). CONCLUSION An intensive blood pressure monitoring strategy led to a similar blood pressure reduction to conventional monitoring. However, the intensive strategy appeared to improve patients' cardiovascular risk profile through other effects than a reduction of blood pressure. TRIAL REGISTRATION Clinical Trials NCT00244660.
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Affiliation(s)
- Pia Klarskov
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg and Frederiksberg University Hospitals, Copenhagen, Denmark
| | - Lia E Bang
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | | | - Hans Gregers Petersen
- Informatics and Mathematical Modelling, Technical University of Denmark, Lyngby, Denmark
| | - David Benee Olsen
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg and Frederiksberg University Hospitals, Copenhagen, Denmark.,Centre for Healthy Aging, Department of Biomedical Sciences, Section of Systems Biology Research, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ronan M G Berg
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg and Frederiksberg University Hospitals, Copenhagen, Denmark
| | | | - Niels Wiinberg
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg and Frederiksberg University Hospitals, Copenhagen, Denmark
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Martínez MA, Garcia-Puig J, Loeches MP, Mateo MC, Utiel I, Torres R. Home blood pressure vs. clinic blood pressure measurement-based follow up in type ii diabetics: Effect on 24-h ambulatory BP and albuminuria. Randomised trial. Med Clin (Barc) 2018; 150:413-420. [PMID: 28867335 DOI: 10.1016/j.medcli.2017.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 06/12/2017] [Accepted: 06/15/2017] [Indexed: 11/18/2022]
Abstract
BAKGROUND AND OBJECTIVE To compare the efficacy of two strategies of blood pressure (BP) measurement-based follow-up in hypertension and albuminuria control. PATIENTS AND METHODS Multicentre, prospective, randomised, open trial with a parallel-group design. Nineteen primary care centres and a hospital clinic participated. Adult type 2 diabetics with systolic BP ≥140mmHg without relevant renal disease were randomised to one of two follow-up strategies: 1) standard follow up, with a clinic BP target <140/90mmHg and 2) self-monitoring home BP (SMHBP)-based follow up, with a BP target <135/85mmHg. Biochemical standard blood variables, albuminuria, and 24-h ambulatory BP monitoring were performed at entry, 12 and 24 months. The main outcome measurement was 24-h ambulatory systolic BP variation. Albuminuria change was analysed as a secondary outcome. RESULTS 116 patients were analysed (mean age: 66.8 years). Mean systolic ambulatory 24- h BP change in two years was 3.9mmHg (95% CI 1.8-6.1). We did not find significant differences between both groups (p=0.706). Similarly, no differences were found when we compared other ambulatory BP values. Initial albuminuria was similar in both groups and did not significantly changed throughout the follow-up period. CONCLUSION In type 2 diabetics without relevant nephropathy a SMHBP- based follow up was equivalent to a standard clinic-based BP follow up in BP and albuminuria control.
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Affiliation(s)
- María A Martínez
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Infanta Sofía, S. S. de los Reyes, Universidad Europea, Madrid, España.
| | - Juan Garcia-Puig
- Unidad Metabólico-Vascular, Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, España
| | | | | | - Isaías Utiel
- Centro de Salud General Ricardos, Madrid, España
| | - Rosa Torres
- Unidad Metabólico-Vascular, Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, España
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Reboussin DM, Allen NB, Griswold ME, Guallar E, Hong Y, Lackland DT, Miller EPR, Polonsky T, Thompson-Paul AM, Vupputuri S. Systematic Review for the 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 2018; 71:2176-2198. [PMID: 29146534 PMCID: PMC8654280 DOI: 10.1016/j.jacc.2017.11.004] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To review the literature systematically and perform meta-analyses to address these questions: 1) Is there evidence that self-measured blood pressure (BP) without other augmentation is superior to office-based measurement of BP for achieving better BP control or for preventing adverse clinical outcomes that are related to elevated BP? 2) What is the optimal target for BP lowering during antihypertensive therapy in adults? 3) In adults with hypertension, how do various antihypertensive drug classes differ in their benefits and harms compared with each other as first-line therapy? METHODS Electronic literature searches were performed by Doctor Evidence, a global medical evidence software and services company, across PubMed and EMBASE from 1966 to 2015 using key words and relevant subject headings for randomized controlled trials that met eligibility criteria defined for each question. We performed analyses using traditional frequentist statistical and Bayesian approaches, including random-effects Bayesian network meta-analyses. RESULTS Our results suggest that: 1) There is a modest but significant improvement in systolic BP in randomized controlled trials of self-measured BP versus usual care at 6 but not 12 months, and for selected patients and their providers self-measured BP may be a helpful adjunct to routine office care. 2) systolic BP lowering to a target of <130 mm Hg may reduce the risk of several important outcomes including risk of myocardial infarction, stroke, heart failure, and major cardiovascular events. No class of medications (i.e., angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, calcium channel blockers, or beta blockers) was significantly better than thiazides and thiazide-like diuretics as a first-line therapy for any outcome.
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38
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McManus RJ, Mant J, Franssen M, Nickless A, Schwartz C, Hodgkinson J, Bradburn P, Farmer A, Grant S, Greenfield SM, Heneghan C, Jowett S, Martin U, Milner S, Monahan M, Mort S, Ogburn E, Perera-Salazar R, Shah SA, Yu LM, Tarassenko L, Hobbs FDR. Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): an unmasked randomised controlled trial. Lancet 2018; 391:949-959. [PMID: 29499873 PMCID: PMC5854463 DOI: 10.1016/s0140-6736(18)30309-x] [Citation(s) in RCA: 242] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 01/26/2018] [Accepted: 02/01/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Studies evaluating titration of antihypertensive medication using self-monitoring give contradictory findings and the precise place of telemonitoring over self-monitoring alone is unclear. The TASMINH4 trial aimed to assess the efficacy of self-monitored blood pressure, with or without telemonitoring, for antihypertensive titration in primary care, compared with usual care. METHODS This study was a parallel randomised controlled trial done in 142 general practices in the UK, and included hypertensive patients older than 35 years, with blood pressure higher than 140/90 mm Hg, who were willing to self-monitor their blood pressure. Patients were randomly assigned (1:1:1) to self-monitoring blood pressure (self-montoring group), to self-monitoring blood pressure with telemonitoring (telemonitoring group), or to usual care (clinic blood pressure; usual care group). Randomisation was by a secure web-based system. Neither participants nor investigators were masked to group assignment. The primary outcome was clinic measured systolic blood pressure at 12 months from randomisation. Primary analysis was of available cases. The trial is registered with ISRCTN, number ISRCTN 83571366. FINDINGS 1182 participants were randomly assigned to the self-monitoring group (n=395), the telemonitoring group (n=393), or the usual care group (n=394), of whom 1003 (85%) were included in the primary analysis. After 12 months, systolic blood pressure was lower in both intervention groups compared with usual care (self-monitoring, 137·0 [SD 16·7] mm Hg and telemonitoring, 136·0 [16·1] mm Hg vs usual care, 140·4 [16·5]; adjusted mean differences vs usual care: self-monitoring alone, -3·5 mm Hg [95% CI -5·8 to -1·2]; telemonitoring, -4·7 mm Hg [-7·0 to -2·4]). No difference between the self-monitoring and telemonitoring groups was recorded (adjusted mean difference -1·2 mm Hg [95% CI -3·5 to 1·2]). Results were similar in sensitivity analyses including multiple imputation. Adverse events were similar between all three groups. INTERPRETATION Self-monitoring, with or without telemonitoring, when used by general practitioners to titrate antihypertensive medication in individuals with poorly controlled blood pressure, leads to significantly lower blood pressure than titration guided by clinic readings. With most general practitioners and many patients using self-monitoring, it could become the cornerstone of hypertension management in primary care. FUNDING National Institute for Health Research via Programme Grant for Applied Health Research (RP-PG-1209-10051), Professorship to RJM (NIHR-RP-R2-12-015), Oxford Collaboration for Leadership in Applied Health Research and Care, and Omron Healthcare UK.
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Affiliation(s)
- Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Marloes Franssen
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Alecia Nickless
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Claire Schwartz
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - James Hodgkinson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Peter Bradburn
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sabrina Grant
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Southmead Hospital, Southmead, Bristol, UK
| | - Sheila M Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Carl Heneghan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Susan Jowett
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Una Martin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Siobhan Milner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Mark Monahan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sam Mort
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Emma Ogburn
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rafael Perera-Salazar
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Syed Ahmar Shah
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Ly-Mee Yu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lionel Tarassenko
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Nerenberg KA, Zarnke KB, Leung AA, Dasgupta K, Butalia S, McBrien K, Harris KC, Nakhla M, Cloutier L, Gelfer M, Lamarre-Cliche M, Milot A, Bolli P, Tremblay G, McLean D, Padwal RS, Tran KC, Grover S, Rabkin SW, Moe GW, Howlett JG, Lindsay P, Hill MD, Sharma M, Field T, Wein TH, Shoamanesh A, Dresser GK, Hamet P, Herman RJ, Burgess E, Gryn SE, Grégoire JC, Lewanczuk R, Poirier L, Campbell TS, Feldman RD, Lavoie KL, Tsuyuki RT, Honos G, Prebtani APH, Kline G, Schiffrin EL, Don-Wauchope A, Tobe SW, Gilbert RE, Leiter LA, Jones C, Woo V, Hegele RA, Selby P, Pipe A, McFarlane PA, Oh P, Gupta M, Bacon SL, Kaczorowski J, Trudeau L, Campbell NRC, Hiremath S, Roerecke M, Arcand J, Ruzicka M, Prasad GVR, Vallée M, Edwards C, Sivapalan P, Penner SB, Fournier A, Benoit G, Feber J, Dionne J, Magee LA, Logan AG, Côté AM, Rey E, Firoz T, Kuyper LM, Gabor JY, Townsend RR, Rabi DM, Daskalopoulou SS. Hypertension Canada's 2018 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults and Children. Can J Cardiol 2018; 34:506-525. [PMID: 29731013 DOI: 10.1016/j.cjca.2018.02.022] [Citation(s) in RCA: 418] [Impact Index Per Article: 69.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 02/20/2018] [Accepted: 02/20/2018] [Indexed: 12/13/2022] Open
Abstract
Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension in adults and children. This year, the adult and pediatric guidelines are combined in one document. The new 2018 pregnancy-specific hypertension guidelines are published separately. For 2018, 5 new guidelines are introduced, and 1 existing guideline on the blood pressure thresholds and targets in the setting of thrombolysis for acute ischemic stroke is revised. The use of validated wrist devices for the estimation of blood pressure in individuals with large arm circumference is now included. Guidance is provided for the follow-up measurements of blood pressure, with the use of standardized methods and electronic (oscillometric) upper arm devices in individuals with hypertension, and either ambulatory blood pressure monitoring or home blood pressure monitoring in individuals with white coat effect. We specify that all individuals with hypertension should have an assessment of global cardiovascular risk to promote health behaviours that lower blood pressure. Finally, an angiotensin receptor-neprilysin inhibitor combination should be used in place of either an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in individuals with heart failure (with ejection fraction < 40%) who are symptomatic despite appropriate doses of guideline-directed heart failure therapies. The specific evidence and rationale underlying each of these guidelines are discussed.
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Affiliation(s)
- Kara A Nerenberg
- Division of General Internal Medicine, Departments of Medicine, Obstetrics and Gynecology, Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
| | - Kelly B Zarnke
- O'Brien Institute for Public Health and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alexander A Leung
- Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kaberi Dasgupta
- Department of Medicine and Centre for Outcomes Research and Evaluation, McGill University and Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Sonia Butalia
- Departments of Medicine and Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Kerry McBrien
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kevin C Harris
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Meranda Nakhla
- Department of Medicine and Centre for Outcomes Research and Evaluation, McGill University and Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Lyne Cloutier
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Mark Gelfer
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Alain Milot
- Department of Medicine, Université Laval, Québec, Quebec, Canada
| | - Peter Bolli
- McMaster University, Hamilton, Ontario, Canada
| | - Guy Tremblay
- CHU-Québec-Hopital St. Sacrement, Québec, Quebec, Canada
| | - Donna McLean
- Alberta Health Services and Covenant Health, Edmonton, Alberta, Canada
| | - Raj S Padwal
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Karen C Tran
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Steven Grover
- McGill Comprehensive Health Improvement Program (CHIP), Montreal, Quebec, Canada
| | - Simon W Rabkin
- Vancouver Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gordon W Moe
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan G Howlett
- Departments of Medicine and Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Patrice Lindsay
- Director of Stroke, Heart and Stroke Foundation of Canada, Adjunct Faculty, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mike Sharma
- McMaster University, Hamilton Health Sciences, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Thalia Field
- University of British Columbia, Vancouver Stroke Program, Vancouver, British Columbia, Canada
| | - Theodore H Wein
- McGill University, Stroke Prevention Clinic, Montreal General Hospital, Montreal, Quebec, Canada
| | - Ashkan Shoamanesh
- McMaster University, Hamilton Health Sciences, Population Health Research Institute, Hamilton, Ontario, Canada
| | - George K Dresser
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Pavel Hamet
- Faculté de Médicine, Université de Montréal, Montréal, Quebec, Canada
| | - Robert J Herman
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ellen Burgess
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Steven E Gryn
- Department of Medicine, Western University, London, Ontario, Canada
| | - Jean C Grégoire
- Université de Montréal, Institut de cardiologie de Montréal, Montréal, Quebec, Canada
| | - Richard Lewanczuk
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Luc Poirier
- Institut National d'Excellence en Sante et Services Sociaux, Québec, Quebec, Canada
| | - Tavis S Campbell
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Ross D Feldman
- Winnipeg Regional Health Authority and the University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kim L Lavoie
- University of Quebec at Montreal (UQAM), Montreal Behavioural Medicine Centre, CIUSSS-NIM, Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada
| | - Ross T Tsuyuki
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - George Honos
- CHUM, University of Montreal, Montreal, Quebec, Canada
| | - Ally P H Prebtani
- Internal Medicine, Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada
| | - Gregory Kline
- Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Sheldon W Tobe
- University of Toronto, Toronto, Ontario, and Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Richard E Gilbert
- University of Toronto, Division of Endocrinology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Lawrence A Leiter
- University of Toronto, Division of Endocrinology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Charlotte Jones
- Department of Medicine, UBC Southern Medical Program, Kelowna, British Columbia, Canada
| | - Vincent Woo
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - Robert A Hegele
- Departments of Medicine (Division of Endocrinology) and Biochemistry, Western University, London, Ontario, Canada
| | - Peter Selby
- Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Pipe
- University of Ottawa Heart Institute, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Philip A McFarlane
- Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Paul Oh
- University Health Network, Toronto Rehab and Peter Munk Cardiac Centre, Toronto, Ontario, Canada
| | - Milan Gupta
- Department of Medicine, McMaster University, Hamilton, Ontario, and Canadian Collaborative Research Network, Brampton, Ontario, Canada
| | - Simon L Bacon
- Department of Exercise Science, Concordia University, and Montreal Behavioural Medicine Centre, CIUSSS-NIM, Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada
| | - Janusz Kaczorowski
- Department of Family and Emergency Medicine, Université de Montréal and CRCHUM, Montréal, Quebec, Canada
| | - Luc Trudeau
- Division of Internal Medicine, Department of Medicine, McGill University, Montréal, Quebec, Canada
| | - Norman R C Campbell
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Swapnil Hiremath
- University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Michael Roerecke
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Joanne Arcand
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
| | - Marcel Ruzicka
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Michel Vallée
- Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Quebec, Canada
| | - Cedric Edwards
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Praveena Sivapalan
- Division of General Internal Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Anne Fournier
- Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Geneviève Benoit
- Service de néphrologie, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Janusz Feber
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Janis Dionne
- Department of Pediatrics, Division of Nephrology, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Laura A Magee
- Department of Women and Children's Health, St Thomas' Hospital, London, and Department of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | | | | | - Evelyne Rey
- CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Tabassum Firoz
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Laura M Kuyper
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathan Y Gabor
- Interlake-Eastern Regional Healthy Authority, Concordia Hospital, Winnipeg, Manitoba, Canada
| | - Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Doreen M Rabi
- Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Departments of Medicine and Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Stella S Daskalopoulou
- Division of Internal Medicine, Department of Medicine, McGill University, Montréal, Quebec, Canada
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Boillat T, Rivas H, Wac K. “Healthcare on a Wrist”: Increasing Compliance Through Checklists on Wearables in Obesity (Self-)Management Programs. HEALTH INFORMATICS 2018. [DOI: 10.1007/978-3-319-61446-5_6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Reboussin DM, Allen NB, Griswold ME, Guallar E, Hong Y, Lackland DT, Miller EPR, Polonsky T, Thompson-Paul AM, Vupputuri S. Systematic Review for the 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:e116-e135. [PMID: 29133355 DOI: 10.1161/hyp.0000000000000067] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To review the literature systematically and perform meta-analyses to address these questions: 1) Is there evidence that self-measured blood pressure (BP) without other augmentation is superior to office-based measurement of BP for achieving better BP control or for preventing adverse clinical outcomes that are related to elevated BP? 2) What is the optimal target for BP lowering during antihypertensive therapy in adults? 3) In adults with hypertension, how do various antihypertensive drug classes differ in their benefits and harms compared with each other as first-line therapy? METHODS Electronic literature searches were performed by Doctor Evidence, a global medical evidence software and services company, across PubMed and EMBASE from 1966 to 2015 using key words and relevant subject headings for randomized controlled trials that met eligibility criteria defined for each question. We performed analyses using traditional frequentist statistical and Bayesian approaches, including random-effects Bayesian network meta-analyses. RESULTS Our results suggest that: 1) There is a modest but significant improvement in systolic BP in randomized controlled trials of self-measured BP versus usual care at 6 but not 12 months, and for selected patients and their providers self-measured BP may be a helpful adjunct to routine office care. 2) systolic BP lowering to a target of <130 mm Hg may reduce the risk of several important outcomes including risk of myocardial infarction, stroke, heart failure, and major cardiovascular events. No class of medications (ie, angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, calcium channel blockers, or beta blockers) was significantly better than thiazides and thiazide-like diuretics as a first-line therapy for any outcome.
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Jacob V, Chattopadhyay SK, Proia KK, Hopkins DP, Reynolds J, Thota AB, Jones CD, Lackland DT, Rask KJ, Pronk NP, Clymer JM, Goetzel RZ. Economics of Self-Measured Blood Pressure Monitoring: A Community Guide Systematic Review. Am J Prev Med 2017; 53:e105-e113. [PMID: 28818277 PMCID: PMC5657494 DOI: 10.1016/j.amepre.2017.03.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 02/17/2017] [Accepted: 03/02/2017] [Indexed: 12/17/2022]
Abstract
CONTEXT The health and economic burden of hypertension, a major risk factor for cardiovascular disease, is substantial. This systematic review evaluated the economic evidence of self-measured blood pressure (SMBP) monitoring interventions to control hypertension. EVIDENCE ACQUISITION The literature search from database inception to March 2015 identified 22 studies for inclusion with three types of interventions: SMBP used alone, SMBP with additional support, and SMBP within team-based care (TBC). Two formulae were used to convert reductions in systolic BP (SBP) to quality-adjusted life years (QALYs) to produce cost per QALY saved. All analyses were conducted in 2015, with estimates adjusted to 2014 U.S. dollars. EVIDENCE SYNTHESIS Median costs of intervention were $60 and $174 per person for SMBP alone and SMBP with additional support, respectively, and $732 per person per year for SMBP within TBC. SMBP alone and SMBP with additional support reduced healthcare cost per person per year from outpatient visits and medication (medians $148 and $3, respectively; median follow-up, 12-13 months). SMBP within TBC exhibited an increase in healthcare cost (median, $369 per person per year; median follow-up, 18 months). SMBP alone varied from cost saving to a maximum cost of $144,000 per QALY saved, with two studies reporting an increase in SBP. The two translated median costs per QALY saved were $2,800 and $4,000 for SMBP with additional support and $7,500 and $10,800 for SMBP within TBC. CONCLUSIONS SMBP monitoring interventions with additional support or within TBC are cost effective. Cost effectiveness of SMBP used alone could not be determined.
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Affiliation(s)
- Verughese Jacob
- Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.
| | - Sajal K Chattopadhyay
- Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Krista K Proia
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - David P Hopkins
- Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Jeffrey Reynolds
- Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Anilkrishna B Thota
- Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Christopher D Jones
- Division for Heart Disease and Stroke Prevention, Office of Noncommunicable Diseases, Injury, and Environmental Health, CDC, Atlanta, Georgia
| | | | - Kimberly J Rask
- Emory University, Alliant Health Solutions, Atlanta, Georgia
| | - Nicolaas P Pronk
- HealthPartners Institute, Minneapolis, Minnesota; Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - John M Clymer
- National Forum for Heart Disease and Stroke Prevention, Washington, District of Columbia
| | - Ron Z Goetzel
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Truven Health Analytics, Bethesda, Maryland
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Staessen JA, Li Y, Hara A, Asayama K, Dolan E, O'Brien E. Blood Pressure Measurement Anno 2016. Am J Hypertens 2017; 30:453-463. [PMID: 28052877 DOI: 10.1093/ajh/hpw148] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Indexed: 02/06/2023] Open
Abstract
The rational management of hypertension (HT) inevitably starts with accurate measurement of blood pressure (BP). The recently published Systolic Blood Pressure Intervention Trial implemented automated office BP measurement. However, event-driven studies have overwhelmingly indicated that out-of-the-office BP monitoring is a prerequisite for risk stratification and for identifying the need of initiating or adjusting antihypertensive drug treatment. 24-Hour ambulatory BP monitoring is the preferred method of BP measurement and addresses major issues not covered by conventional or automated office BP measurement or home BP monitoring, such as reliably diagnosing nocturnal HT (the time window of the day during which BP is most predictive of adverse cardiovascular outcome), hypotension, or masked HT, a condition that affects 15% of the general populations and carries a risk equal to that of HT on both office and out-of-the-office BP measurement. Moreover, 24-hour ambulatory BP monitoring is cost-effective. Outcome-driven criteria support single BP thresholds that can be applied in both sexes and across the age range. In conclusion, the overall evidence now overwhelmingly shows that ambulatory BP monitoring is mandatory for the proper management of HT. Health care providers should therefore facilitate access to this technique in both primary and specialized care.
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Affiliation(s)
- Jan A Staessen
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- R&D Group VitaK, Maastricht University, Maastricht, The Netherlands
| | - Yan Li
- Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Azusa Hara
- Department of Social Pharmacy and Public Health, Showa Pharmaceutical University, Tokyo, Japan
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan
| | - Eamon Dolan
- Eamon Dolan, Stroke and Hypertension Unit, Connolly Hospital, Blanchardstown, Co, Dublin, Ireland
| | - Eoin O'Brien
- Conway Institute, University College Dublin, Dublin, Ireland
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Impact of home blood pressure monitoring on blood pressure control in older individuals. J Hypertens 2017; 35:612-620. [DOI: 10.1097/hjh.0000000000001191] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Peixoto AJ. Practical Aspects of Home and Ambulatory Blood Pressure Monitoring. Methodist Debakey Cardiovasc J 2016; 11:214-8. [PMID: 27057289 DOI: 10.14797/mdcj-11-4-214] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Out-of-office blood pressure (BP) monitoring is becoming increasingly important in the diagnosis and management of hypertension. Home BP and ambulatory BP monitoring (ABPM) are the two forms of monitoring BP in the out-of-office environment. Home BP monitoring is easy to perform, inexpensive, and engages patients in the care of their hypertension. Although ABPM is expensive and not widely available, it remains the gold standard for diagnosing hypertension. Observational studies show that both home BP and ABPM are stronger predictors of hypertension-related outcomes than office BP monitoring. There are no clinical trials showing their superiority over office BP monitoring in guiding the treatment of hypertension, but the consistency of observational data make a compelling case for their preferential use in clinical practice.
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Affiliation(s)
- Aldo J Peixoto
- Yale University School of Medicine, New Haven, Connecticut
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Beeftink MMA, Spiering W, Bots ML, Verloop WL, De Jager RL, Sanders MF, Vonken EJ, Blankestijn PJ, Voskuil M. Renal Denervation in a Real Life Setting: A Gradual Decrease in Home Blood Pressure. PLoS One 2016; 11:e0162251. [PMID: 27631608 PMCID: PMC5025101 DOI: 10.1371/journal.pone.0162251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 08/21/2016] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To investigate the blood pressure dynamics after renal denervation through monthly home blood pressure measurements throughout the first 12 months. METHODS A cohort of 70 patients performed highly standardized monthly home blood pressure monitoring during the first year after denervation according to the European Society of Hypertension guidelines. At baseline and 12 months follow-up, office and ambulatory blood pressure as well as routine physical and laboratory assessment was performed. RESULTS Home blood pressure decreased with a rate of 0.53 mmHg/month (95% CI 0.20 to 0.86) systolic and 0.26 mmHg/month (95% CI 0.08 to 0.44) diastolic throughout 12 months of follow-up, while the use of antihypertensive medication remained stable (+0.03 daily defined doses/month, 95% CI -0.01 to 0.08). On average, a 12 month reduction of 8.1 mmHg (95% CI 4.2 to 12.0) was achieved in home systolic blood pressure, 9.3 mmHg (95% CI -14.2 to -4.4) as measured by 24-hour ambulatory blood pressure monitoring and 15.9 mmHg (95% CI -23.8 to -7.9) on office measurements. CONCLUSION Blood pressure reduction after renal denervation occurs as a gradual decrease that extends to at least one-year follow-up. Home monitoring seems a suitable alternative for ambulatory blood pressure monitoring after renal denervation.
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Affiliation(s)
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Michiel L. Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Willemien L. Verloop
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rosa L. De Jager
- Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Margreet F. Sanders
- Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Evert-jan Vonken
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter J. Blankestijn
- Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
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Erden S, Mefkure Ozkaya H, Banu Denizeri S, Karabacak E. The effects of home blood pressure monitoring on blood pressure control and treatment planning. Postgrad Med 2016; 128:584-90. [PMID: 27180599 DOI: 10.1080/00325481.2016.1189303] [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: 01/13/2023]
Abstract
OBJECTIVES Blood pressure monitoring is essential in hypertension, which is an important public health issue. Our objective was to compare the rates of blood pressure control and to investigate factors that affect blood pressure control in patients with hypertension. METHODS The records of 1006 patients with hypertension were examined retrospectively. The blood pressure control rates of the 394 patients who measured their blood pressure at home (group 1) and those who did not (group 2) were compared. RESULTS In group 1, the mean systolic and diastolic blood pressure was 123.91±12.63/78.64±8.92 mmHg measured at home, whereas it was 140.31±20.56/85.76±11.55 mmHg in the office setting (p<0.0001). In the total group (N=1006), the blood pressure control achievement rate was 56.1%. The number of cardiovascular events, hypertension duration, and the rate of being employed was higher in group 1 (p<0.0001, p<0.0001 and p=0.0001, respectively), while heart rate and grade 3-4 retinopathy was lower in group 1 (p<0.0001 for both) . Occupational status, geographical origin, BMI and the use of angiotensin converting enzyme (ACE) inhibitors were found to be the determinants of office BP control (p<0.05, p<0.05, p=0.001 and p<0.05, respectively), and BMI and grade 3-4 retinopathy findings were found to be the determinants of home BP control (p <0.05 for both). CONCLUSION Home blood pressure monitoring is useful in preventing complications and achieving therapy compliance and is essential in diagnosis and treatment planning of hypertension.
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Affiliation(s)
- Sacide Erden
- a Department of Internal Medicine , Istanbul University , Istanbul , Turkey
| | - Hande Mefkure Ozkaya
- b Cerrahpasa Medical School, Department of Endocrinology and Metabolism , Istanbul University , Istanbul , Turkey
| | | | - Emrah Karabacak
- d Emergency Department , Uludere State Government Hospital, Şırnak , Turkey
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Föhr T, Tolvanen A, Myllymäki T, Järvelä-Reijonen E, Peuhkuri K, Rantala S, Kolehmainen M, Korpela R, Lappalainen R, Ermes M, Puttonen S, Rusko H, Kujala U. Physical activity, heart rate variability-based stress and recovery, and subjective stress during a 9-month study period. Scand J Med Sci Sports 2016; 27:612-621. [DOI: 10.1111/sms.12683] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2016] [Indexed: 12/20/2022]
Affiliation(s)
- T. Föhr
- Department of Health Sciences; University of Jyväskylä; Jyväskylä Finland
| | - A. Tolvanen
- Methodology Centre for Human Sciences; University of Jyväskylä; Jyväskylä Finland
| | - T. Myllymäki
- Department of Psychology; University of Jyväskylä; Jyväskylä Finland
| | - E. Järvelä-Reijonen
- Institute of Public Health and Clinical Nutrition; Clinical Nutrition; University of Eastern Finland; Kuopio Finland
| | - K. Peuhkuri
- Medical Faculty, Pharmacology, Medical Nutrition Physiology; University of Helsinki; Helsinki Finland
| | - S. Rantala
- Medical Faculty, Pharmacology, Medical Nutrition Physiology; University of Helsinki; Helsinki Finland
| | - M. Kolehmainen
- Institute of Public Health and Clinical Nutrition; Clinical Nutrition; University of Eastern Finland; Kuopio Finland
| | - R. Korpela
- Medical Faculty, Pharmacology, Medical Nutrition Physiology; University of Helsinki; Helsinki Finland
| | - R. Lappalainen
- Department of Psychology; University of Jyväskylä; Jyväskylä Finland
| | - M. Ermes
- VTT Technical Research Centre of Finland; Tampere Finland
| | - S. Puttonen
- Finnish Institute of Occupational Health; Helsinki Finland
- Institute of Behavioral Sciences; University of Helsinki; Helsinki Finland
| | - H. Rusko
- Department of Biology of Physical Activity; University of Jyväskylä; Jyväskylä Finland
| | - U.M. Kujala
- Department of Health Sciences; University of Jyväskylä; Jyväskylä Finland
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Summertime dosage-dependent hypersensitivity to an angiotensin II receptor blocker. BMC Res Notes 2015; 8:227. [PMID: 26055103 PMCID: PMC4467666 DOI: 10.1186/s13104-015-1215-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 05/29/2015] [Indexed: 01/08/2023] Open
Abstract
Background Summertime dips in blood pressure (BP), both in normotensive and hypertensive subjects, are well known. However, the dips are small and are not related to particular forms or doses of antihypertensive medication. Nevertheless it is the practice in some quarters to decrease antihypertensive medication in summer, and/or to increase in winter. Large scale studies being inconclusive, there are calls for long-term examination of the relationship between environmental temperature and blood pressure in single individuals under medication. Case presentation While analyzing data from a subject whose BP had been controlled for a decade with the angiotensin-II receptor blocker losartan, an extreme, dosage-dependent, summertime dip came to light. Downward dosage adjustment appeared essential and may have prevented hypotension-related pathology. Conclusion The benefits of aggressive medication (the “J curve” phenomenon) being debated, the possibility of seasonal hypersensitivity, perhaps explicable in terms of differential signaling by countervailing receptors, should be taken into account when considering dosage adjustments in hypertensive subjects.
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50
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Randomized clinical trial to assess the effectiveness of remote patient monitoring and physician care in reducing office blood pressure. Hypertens Res 2015; 38:491-7. [DOI: 10.1038/hr.2015.32] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 01/22/2015] [Accepted: 01/26/2015] [Indexed: 01/13/2023]
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