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Rajkumar T, Freyne J, Varnfield M, Lawson K, Butten K, Shanmugalingam R, Hennessy A, Makris A. Remote blood pressure monitoring in high risk pregnancy - study protocol for a randomised controlled trial (REMOTE CONTROL trial). Trials 2023; 24:334. [PMID: 37198630 DOI: 10.1186/s13063-023-07321-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 04/20/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Pregnant women at high risk for developing a hypertensive disorder of pregnancy require frequent antenatal assessments, especially of their blood pressure. This expends significant resources for both the patient and healthcare system. An alternative to in-clinic assessments is a remote blood pressure monitoring strategy, in which patients self-record their blood pressure at home using a validated blood pressure machine. This has the potential to be cost-effective, increase patient satisfaction, and reduce outpatient visits, and has had widespread uptake recently given the increased need for remote care during the ongoing COVID-19 pandemic. However robust evidence supporting this approach over a traditional face-to-face approach is lacking, and the impact on maternal and foetal outcomes has not yet been reported. Thus, there is an urgent need to assess the efficacy of remote monitoring in pregnant women at high risk of developing a hypertensive disorder of pregnancy. METHODS The REMOTE CONTROL trial is a pragmatic, unblinded, randomised controlled trial, which aims to compare remote blood pressure monitoring in high-risk pregnant women with conventional face-to-face clinic monitoring, in a 1:1 allocation ratio. The study will recruit patients across 3 metropolitan Australian teaching hospitals and will evaluate the safety, cost-effectiveness, impact on healthcare utilisation and end-user satisfaction of remote blood pressure monitoring. DISCUSSION Remote blood pressure monitoring is garnering interest worldwide and has been increasingly implemented following the COVID-19 pandemic. However, robust data regarding its safety for maternofoetal outcomes is lacking. The REMOTE CONTROL trial is amongst the first randomised controlled trials currently underway, powered to evaluate maternal and foetal outcomes. If proven to be as safe as conventional clinic monitoring, major potential benefits include reducing clinic visits, waiting times, travel costs, and improving delivery of care to vulnerable populations in rural and remote communities. TRIAL REGISTRATION The trial has been prospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12620001049965p, on October 11th, 2020).
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Affiliation(s)
- Theepika Rajkumar
- School of Medicine, Western Sydney University, Penrith, NSW, Australia.
- Department of Medicine, Campbelltown Hospital, South Western Sydney Local Health District, Campbelltown, NSW, Australia.
| | - Jill Freyne
- Australian E-Health Research Centre, Health and Biosecurity, CSIRO, Brisbane, QLD, Australia
| | - Marlien Varnfield
- Australian E-Health Research Centre, Health and Biosecurity, CSIRO, Brisbane, QLD, Australia
| | - Kenny Lawson
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Kaley Butten
- Australian E-Health Research Centre, Health and Biosecurity, CSIRO, Brisbane, QLD, Australia
| | - Renuka Shanmugalingam
- School of Medicine, Western Sydney University, Penrith, NSW, Australia
- Department of Renal Medicine, Liverpool Hospital, Liverpool, NSW, Australia
- University of New South Wales, Kensington, NSW, Australia
| | - Annemarie Hennessy
- School of Medicine, Western Sydney University, Penrith, NSW, Australia
- Department of Medicine, Campbelltown Hospital, South Western Sydney Local Health District, Campbelltown, NSW, Australia
| | - Angela Makris
- Department of Renal Medicine, Liverpool Hospital, Liverpool, NSW, Australia
- University of New South Wales, Kensington, NSW, Australia
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Moon J, Park JH, Cho SE, Ko KP, Shin SH, Kim JE, Ryu JK, Kang SG. Apnea-hypopnea Index is Correlated with Pulse Rate in Patients with Sleep-related Breathing Disorder without Hypertension, Cardiovascular Disease, or Diabetes Mellitus. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2022; 20:440-449. [PMID: 35879028 PMCID: PMC9329115 DOI: 10.9758/cpn.2022.20.3.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/28/2021] [Accepted: 02/23/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Jeonggeun Moon
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jae Hyoung Park
- Department of Cardiology, Korea University Anam Hospital, Seoul, Korea
| | - Seo-Eun Cho
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Kwang-Pil Ko
- Clinical Preventive Medicine Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seung-Heon Shin
- Department of Otorhinolaryngology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Ji-Eun Kim
- Department of Neurology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Jae Kean Ryu
- Department of Division of Cardiology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Seung-Gul Kang
- Department of Psychiatry and Sleep Medicine Center, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
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Moreno JN, Amorim WW, Mistro S, Medeiros DSD, Cortes ML, Soares DA, Louzado JA, Kochergin CN, Silva KO, Bezerra VM, Oliveira MG. Evaluation of blood pressure through home monitoring in brazilian primary care: a feasibility study. CIENCIA & SAUDE COLETIVA 2020; 26:2997-3004. [PMID: 34378692 DOI: 10.1590/1413-81232021268.17012020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/08/2020] [Indexed: 11/22/2022] Open
Abstract
Blood pressure measurements taken in a clinical setting are subject to errors, therefore there are advantages to monitoring blood pressure at home, especially in in patients diagnosed with hypertension. The study describes the feasibility of home monitoring to assess blood pressure in primary care and compares blood pressure measured at home and during a medical consultation. This cross-sectional study was carried out with patients whose used home blood pressure in the morning and evening, thrice for seven consecutive day sat home. Participants included patients older than 18 years with suspected whitecoat hypertension, taking antihypertensives, or those intolerant of ambulatory blood pressure monitoring, and excluded patients who did not follow the protocol, suffered from an irregular heart rate, and pregnant women. Of the 134 patients who participated in the study, 63.3% had altered blood pressure when measured at health facilities and 48% had higher blood pressure at home. The mean difference between the methods was 10.1 mmHg for systolic and 4.3 mmHg for diastolic. The prevalence of whitecoat hypertension was 19.4%. Blood pressure monitoring at home is a practicable strategy in the Brazilian healthcare system.
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Affiliation(s)
- Jéssica Nunes Moreno
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, campus Anísio Teixeira. Rua Hormindo Barros 58, Candeias. 45029-094. Vitória da Conquista BA Brasil.
| | | | - Sóstenes Mistro
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, campus Anísio Teixeira. Rua Hormindo Barros 58, Candeias. 45029-094. Vitória da Conquista BA Brasil.
| | - Danielle Souto de Medeiros
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, campus Anísio Teixeira. Rua Hormindo Barros 58, Candeias. 45029-094. Vitória da Conquista BA Brasil.
| | - Matheus Lopes Cortes
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, campus Anísio Teixeira. Rua Hormindo Barros 58, Candeias. 45029-094. Vitória da Conquista BA Brasil.
| | - Daniela Arruda Soares
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, campus Anísio Teixeira. Rua Hormindo Barros 58, Candeias. 45029-094. Vitória da Conquista BA Brasil.
| | - José Andrade Louzado
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, campus Anísio Teixeira. Rua Hormindo Barros 58, Candeias. 45029-094. Vitória da Conquista BA Brasil.
| | - Clavdia Nicolaevna Kochergin
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, campus Anísio Teixeira. Rua Hormindo Barros 58, Candeias. 45029-094. Vitória da Conquista BA Brasil.
| | - Kelle Oliveira Silva
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, campus Anísio Teixeira. Rua Hormindo Barros 58, Candeias. 45029-094. Vitória da Conquista BA Brasil.
| | - Vanessa Moraes Bezerra
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, campus Anísio Teixeira. Rua Hormindo Barros 58, Candeias. 45029-094. Vitória da Conquista BA Brasil.
| | - Marcio Galvão Oliveira
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, campus Anísio Teixeira. Rua Hormindo Barros 58, Candeias. 45029-094. Vitória da Conquista BA Brasil.
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Dalfó-Pibernat A, Dalfó Baqué A, Pelegrina Rodríguez FJ, Garin O, Duran X, Cladellas Capdevila M, Comin Colet J. Improving ambulatory blood pressure monitoring knowledge in nurses and doctors: impact of a training intervention. Eur J Cardiovasc Nurs 2018; 17:742-750. [DOI: 10.1177/1474515118782100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Ambulatory blood pressure monitoring (ABPM) is fundamental to diagnosing and monitoring arterial hypertension (HTN), yet it is not known how effective training could be in improving knowledge of ABPM. Purpose: The purpose of this study was to evaluate ABPM knowledge before and after a training activity. Methodology: A before-and-after intervention study of 116 professionals. Data was collected on age, sex, occupational category, work setting, and work experience. ABPM knowledge was determined by a questionnaire to evaluate expertise in understanding and interpreting ABPM results. Results: Multivariate regression analysis showed that, pre-intervention, having more than 20 years’ experience (odds ratio (OR): 5.9; 95% confidence interval (CI): 1.3–33.9; p = 0.049) and being a doctor (OR: 5.7; 95% CI: 1.8–18.3; p = 0.004) were associated with greater ABPM knowledge. Training increased the number of professionals with adequate ABPM knowledge: 85.3% after training vs 26.7% before training. Training increased the questionnaire mean (SD) score by almost 3 (1.7) points: 9 (2.2) after training vs 6.3 (2.2) before training ( p < 0.05). Of the 116 professionals, 90.5% achieved a higher overall score after training. The impact of the intervention was greatest on women nurses older than 45 years and with more years of experience, employed in primary care, and with prior experience of ABPM. Conclusions: Knowledge of ABPM is deficient but can be easily improved by training that is most effective in primary care and among nurses.
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Affiliation(s)
- Artur Dalfó-Pibernat
- PhD Programme, Universitat Autònoma de Barcelona, Spain
- Horta Primary Care Center, Catalan Institute of Health, Barcelona, Spain
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Sant Joan de Déu Nursing’s School University, Barcelona, Spain
| | - Antoni Dalfó Baqué
- Gòtic Primary Care Center, Catalan Institute of Health, Barcelona, Spain
| | | | - Olatz Garin
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Department of Experimental and Health Sciences, Center for Research in Occupational Health (CiSAL), Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Xavier Duran
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Mercè Cladellas Capdevila
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Josep Comin Colet
- Community Heart Failure Program, Department of Cardiology, University of Barcelona, Bellvitge University Hospital and IDIBELL, Catalan Institute of Health, Hospitalet de Llobregat, Barcelona, Spain
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Kim S, Park JJ, Lee SA, Cho Y, Yoon YE, Oh IY, Yoon CH, Suh JW, Cho YS, Youn TJ, Cho GY, Chae IH, Lee HY, Shin J, Park S, Choi DJ. Diagnostic accuracy of manual office blood pressure measurement in ambulatory hypertensive patients in Korea. Korean J Intern Med 2018; 33:113-120. [PMID: 28602060 PMCID: PMC5768545 DOI: 10.3904/kjim.2016.161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 09/04/2016] [Accepted: 10/05/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Currently, office blood pressure (OBP) is the most widely used method of measuring blood pressure (BP) in daily clinical practice. However, data on the diagnostic accuracy of OBP in reference to ambulatory blood pressure (ABP) are scarce in Korea. METHODS In retrospective and prospective cohorts, manual OBP and ABP measurements were compared among ambulatory hypertensive patients. Hypertension was defined as systolic OBP ≥ 140 mmHg and/or diastolic OBP ≥ 90 mmHg, and systolic ABP ≥ 130 mmHg and/or diastolic ABP ≥ 80 mmHg. RESULTS In the retrospective cohort (n = 903), the mean OBP1 (before ABP measurement) was higher than ABP in both systolic (138 ± 17 mmHg vs. 123 ± 13 mmHg, p < 0.001) and diastolic (84 ± 12 mmHg vs. 78 ± 11 mmHg, p < 0.001) measurements. Interestingly, there was only a weak correlation between OBP and ABP (r2 = 0.038, p < 0.001). The overall discordance rate of OBP compared to ABP, which is the reference method for measuring BP, was 43.9%. The prospective cohort (n = 57) showed similar results. In a subgroup analysis, male patients had higher false negative results (masked or under-treated hypertension) than did female patients (26.1% vs. 17.8%, p = 0.003), whereas female patients had a higher false positive rate (white-coat or over-treated hypertension) than did male patients (28.7% vs. 15.2%, p < 0.001). CONCLUSIONS The diagnostic accuracy of manual OBP is low in reference to ABP. Men and women have different patterns of discordance. These findings indicate that management of hypertensive patients with manual OBP measurements may be suboptimal and encourages the use of ABP in ambulatory hypertensive patients.
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Affiliation(s)
- Sehun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin Joo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seung-Ah Lee
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Youngjin Cho
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yeonyee E. Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Il-Young Oh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chang-Hwan Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung-Won Suh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-Seok Cho
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae-Jin Youn
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Goo-Yeong Cho
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - In-Ho Chae
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jinho Shin
- Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, Korea
| | - Sungha Park
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Ju Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Correspondence to Dong-Ju Choi, M.D. Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea Tel: +82-31-787-7007 Fax: +82-31-787-7041 E-mail:
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Park JH, Lee HS, Kim JH, Lee JH, Kim J, Choi SW. Reverse Dipper and High Night-time Heart Rate in Acute Stage of Cerebral Infarction Are Associated with Increased Mortality. J Stroke Cerebrovasc Dis 2014; 23:1171-6. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 10/03/2013] [Accepted: 10/09/2013] [Indexed: 11/26/2022] Open
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Sagarra-Tió M, Félez-Carrobé E, Baiget M, Félez J. Assessment of primary healthcare professionals' management of hypertensive patients with riser pattern. Eur J Cardiovasc Nurs 2014; 14:73-8. [PMID: 24396114 DOI: 10.1177/1474515113518856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Ambulatory blood pressure monitoring (ABPM) was implemented in our primary care setting four years ago. Since then, 450 ABPMs have been performed and 69 riser subjects identified. The riser pattern is an independent risk factor for both incidence of cardiovascular events and their associated mortality. OBJECTIVE The purpose of this study was to assess the amount of control of essential hypertension (EH) among riser patients and to evaluate how our health professionals manage therapeutic changes in riser individuals. MATERIALS AND METHODOLOGY This retrospective study involved 34,289 inhabitants served in a centre in the Barcelona metropolitan area. EH individuals (450) were recruited and ABPM was performed following guidelines of the MAPAPRES (www.cardiorisc.com/MP/index_MP.asp). RESULTS Good control of blood pressure was observed in 46% of dipper and non-dipper subjects but only 35% of riser subjects had blood pressures within good control ranges. The measured cardiovascular risk was either high or very high in 35% of riser individuals. Changes in medication were introduced in riser patients with both good and poor blood pressure control. A second follow-up ABPM was done in only 27% of the riser individuals. In these subjects, therapeutic changes successfully modified ABPM patterns in 87% of cases. CONCLUSIONS Therapeutic changes in riser patients were introduced when these subjects were poorly controlled and these changes were highly effective. Additional ABPM to confirm the effectiveness of therapeutic changes was only performed in some individuals. Thus, for management of riser patients, more specific training of health professionals is needed.
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Affiliation(s)
| | - Estel Félez-Carrobé
- ABS Canaletes, Institut Català de la Salut, Spain ABS Guinardó, Institut Català de la Salut, Spain
| | | | - Jordi Félez
- ABS Canaletes, Institut Català de la Salut, Spain
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Kim BK, Kim YM, Lee Y, Lim YH, Shin J. A reverse dipping pattern predicts cardiovascular mortality in a clinical cohort. J Korean Med Sci 2013; 28:1468-73. [PMID: 24133351 PMCID: PMC3792601 DOI: 10.3346/jkms.2013.28.10.1468] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 07/19/2013] [Indexed: 12/31/2022] Open
Abstract
An abnormal dipping pattern in ambulatory blood pressure monitoring (ABPM) is a cardiovascular (CV) risk factor. However, its impact on CV mortality has not been investigated sufficiently in clinical practice to be considered a standard parameter. We assessed the association between abnormal dipping patterns and increased CV mortality in a tertiary hospital in Korea. Our retrospective cohort study included 401 patients who underwent ABPM between 1994 and 1996 in Hanyang University Hospital, Seoul, Korea. The patients were classified as risers (<0% drop in systolic BP; n=107), and others included dippers and non-dippers (≥0% drop, n=294). The follow-up period was 120 months. The frequency of CV mortality was 14.0% in risers and 5.8% in others. A Cox regression analysis found a significant association between dipping pattern and CV mortality, after adjusting for age, gender, body mass index, hypertension, diabetes mellitus, smoking and hypercholesterolemia. Risers were at greater risk of CV death than others (RR, 3.02, P=0.022), but there was no difference in event rates between dippers and non-dippers. The reverse dipping pattern may be more frequent in clinical settings than in the population at large, and it is strongly associated with increased risk of CV mortality in Korea.
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Affiliation(s)
- Bae Keun Kim
- Division of Cardiology, Department of Internal Medicine, Sung Ae Hospital, Seoul, Korea
| | - Yu-Mi Kim
- Department of Preventive Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Youngu Lee
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Young-Hyo Lim
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
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Félez-Carrobé E, Sagarra-Tió M, Romero A, Rubio M, Planas L, Pérez-Lucena MJ, Baiget M, Cabistañ C, Félez J. Nurse-driven training courses: impact on implementation of ambulatory blood pressure monitoring. Open Nurs J 2013; 7:35-40. [PMID: 23750185 PMCID: PMC3636488 DOI: 10.2174/1874434601307010035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Revised: 02/07/2013] [Accepted: 02/07/2013] [Indexed: 11/28/2022] Open
Abstract
Background: Ambulatory blood pressure monitoring (ABPM) predicts cardiovascular risk and identifies white-coat and masked hypertension, efficacy of treatment and the circadian cycle of hypertensive patients. Objective: To analyze the effectiveness of ABPM implementation thoughtout a nurse-driven training program. Materials and Methodology: Twenty eight professionals were involved in the study carried out in the primary care center of the metropolitan area of Barcelona that serves 34,289 inhabitants. The ABPM implementation program was driven by two nurses that held four education sessions. After a 2-year follow-up period, we assessed the outcome of attendance at the educational sessions. First, we evaluated whether the program increased the number of orders of ABPM. Second, we used a survey to evaluate to what extent the input of our educational sessions was understood by attendants. Third, we analyzed the effect ABPM results had on the treatment of patients with a bad control of their hypertension. Results: After the training sessions we found a 6-fold increase in the number of patients undergoing ABPM. We analyzed 204 hypertensive individuals: 41% dippers, 34% were non-dippers, 20% were risers and 5% were extremely dippers. According to our survey, 100% of attendants had a good practice regarding ABPM management. However only 27% of riser patients were studied with a second ABPM. Conclusions: Specific training processes are needed for implementation of ABPM and an even more concentrated effort should be focused on training in the correct interpretation of ABPM results.
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Affiliation(s)
- Estel Félez-Carrobé
- ABS Canaletes, Institut Català de la Salut. Cerdanyola del Vallès and Barcelona ; ABS Guinardó, Institut Català de la Salut. Cerdanyola del Vallès and Barcelona
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Oladipo I, Adedokun A. Comparison of the average of five readings with averages from fewer readings for automated oscillometric blood pressure measurement in an outpatient clinic. Korean Circ J 2013; 43:329-35. [PMID: 23755079 PMCID: PMC3675307 DOI: 10.4070/kcj.2013.43.5.329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 11/05/2012] [Accepted: 12/26/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The optimal number of consecutive measurements for obtaining an average blood pressure (BP) reading in clinical practice is yet undefined by research. This study aimed to compare readings obtained from an average of 5 with averages of 2, 3, and 4, sequential measurements. SUBJECTS AND METHODS Using an automated oscillometric device (BpTRU), BP measurement was conducted on 410 consenting adults attending a general outpatients clinic. Comparison of an average of 5 readings with averages of 2, 3, and 4 readings involved evaluation of correlations, Bland-Altman analysis, comparison of means and distribution of readings, and determination of the proportion of differences between compared readings which were clinically non-significant. RESULTS 397 (96.8%) sets of complete BP readings were suitable for analysis. Clinically non-significant differences (≤5 mm Hg) were found between at least 79.3% (n=315) and 96.5% (n=383) of compared systolic and diastolic readings, respectively. Bland-Altman's analysis revealed that the 95% limits of agreement for the differences between compared readings were approximately 2-4, 3-7, and 4-11 mm Hg for 2, 3 and 4 readings' systolic comparisons while those for diastolic comparisons were 2-3, 3-5, and 4-7 mm Hg, respectively. Statistically non-significant differences were observed in all comparisons of the distributions of readings that were classified as <140 mm Hg or ≥140 mm Hg and <90 mm Hg or ≥90 mm Hg for systolic and diastolic readings, respectively. Strong positive correlations were found between 5 average readings and each of 2, 3, and 4 average readings, respectively. CONCLUSION An average of 5 readings may be excessive for routine BP measurement using this device at outpatient clinics.
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Affiliation(s)
- Idris Oladipo
- Department of Family Medicine, Lagos State University Teaching Hospital (LASUTH), Lagos, Nigeria
| | - Ayoade Adedokun
- Department of Family Medicine, Lagos State University Teaching Hospital (LASUTH), Lagos, Nigeria
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Schmieder RE, Lehmann MV, Schmidt S. Optimizing blood pressure control in hypertension: the need to use ABPM. Blood Press 2012; 22:65-72. [PMID: 23035939 DOI: 10.3109/08037051.2012.727253] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Hypertension is the most prevalent, treatable cause of cardiovascular (CV) disease. Patients with hypertension and one or more comorbidities increasingly form a significant part of the primary care practitioner's caseload. The emphasis on intensive blood pressure (BP) lowering has softened, encouraging any degree of BP lowering, since any fall in BP is beneficial for reducing CV risk. Consistency of BP control during long-term therapy (i.e. low visit-to-visit variability) and decreasing BP variability over 24-h may be as, if not more, important than degree of BP lowering per se. Fluctuations in BP between visits as well as within a 24-h period have been associated with increased CV risk. Ambulatory BP monitoring (ABPM) is a crucial element of the clinician's armamentarium not only for assessing the "true" BP load and fluctuations under real-life conditions but for identification of various abnormal BP patterns that may require attention, including white- coat hypertension, masked hypertension, non-dipping and the morning BP surge. ABPM provides accurate assessment of treatment effectiveness over 24-h and may lead to better tailoring of therapy. This article reviews the benefits of ABPM and discusses the importance of selecting long-acting antihypertensive agents for optimizing BP control.
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Affiliation(s)
- Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany.
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Oladipo I, Ayoade A. The effect of the first office blood pressure reading on hypertension-related clinical decisions. Cardiovasc J Afr 2012; 23:456-62. [PMID: 23044502 PMCID: PMC3721854 DOI: 10.5830/cvja-2012-052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 06/08/2012] [Indexed: 12/03/2022] Open
Abstract
The effect of the first office blood pressure reading (FBPR) on hypertension-related decisions was evaluated using blood pressure (BP) readings taken with the BpTRU BPM-100 device. BP readings were grouped into three pairs: (1) single readings (first and second readings), (2) computed average of three readings (one including and one excluding the first reading), and (3) computed average of five readings (one including and one excluding the first reading). Categorisation of BP readings under JNC-7 classes and distribution into < 140/90 and ≥ 140/90 mmHg groups were selected as parameters guiding hypertension-related decisions. Readings including FBPR had strong positive correlations to those excluding FBPR (Pearson's correlation coefficient ranged from 0.86-1.00). Also, FBPR-included and FBPR-excluded readings did not differ statistically in JNC-7 categorisation or distribution into < 140/90 or ≥ 140/90 mmHg groups. Our findings suggest that exclusion of FBPR may have no significant impact on hypertension-related clinical decisions.
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Affiliation(s)
- Idris Oladipo
- Department of Family Medicine, Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, Nigeria.
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