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Mizuno H, Choi E, Kario K, Muntner P, Fang CL, Liu J, Sangapalaarachchi DN, Lam M, Yano Y, Schwartz JE, Shimbo D. Diagnostic Accuracy of Office Blood Pressure Measurement and Home Blood Pressure Monitoring for Hypertension Screening Among Adults: Results From the IDH Study. J Am Heart Assoc 2023; 12:e030150. [PMID: 38084733 PMCID: PMC10863761 DOI: 10.1161/jaha.123.030150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 11/14/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Using high awake blood pressure (BP; ≥130/80 mm Hg) on ambulatory BP monitoring (ABPM) as a reference, the purpose of this study was to determine the accuracy of high office BP (≥130/80 mm Hg) at an initial visit and high confirmatory office BP (≥130/80 mm Hg), and separately, high home BP (≥130/80 mm Hg) among participants with high office BP (≥130/80 mm Hg) at an initial office visit. METHODS AND RESULTS The accuracy of office BP measurements using the oscillometric method for detecting high BP on ABPM was determined among 379 participants with complete office BP and ABPM data in the IDH (Improving the Detection of Hypertension) study. For detecting high BP on ABPM, the accuracy of high confirmatory office BP using the oscillometric method and, separately, high home BP was also determined among the subgroup of 122 participants with high office BP at an initial visit and complete home BP monitoring data. High office BP had moderate sensitivity (0.61 [95% CI, 0.53-0.68]) and high specificity (0.85 [95% CI, 0.80-0.90]) for high awake BP. High confirmatory office BP and high home BP had moderate sensitivity (0.69 [95% CI, 0.59-0.79] and 0.79 [95% CI, 0.71-0.87], respectively) and low and moderate specificity (0.44 [95% CI, 0.27-0.61] and 0.72 [95% CI, 0.56-0.88], respectively). CONCLUSIONS Many individuals with high BP on ABPM do not have high office BP. Confirmatory office BP and home blood pressure monitoring also had limited ability to identify individuals with high BP on ABPM.
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Affiliation(s)
- Hiroyuki Mizuno
- The Columbia Hypertension Center and LabColumbia University Irving Medical CenterNew YorkNY
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Eunhee Choi
- The Columbia Hypertension Center and LabColumbia University Irving Medical CenterNew YorkNY
| | - Kazuomi Kario
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Paul Muntner
- Department of Epidemiology, School of Public HealthUniversity of Alabama at BirminghamBirminghamAL
| | - Chloe L. Fang
- The Columbia Hypertension Center and LabColumbia University Irving Medical CenterNew YorkNY
| | - Justin Liu
- The Columbia Hypertension Center and LabColumbia University Irving Medical CenterNew YorkNY
| | | | - Michael Lam
- The Columbia Hypertension Center and LabColumbia University Irving Medical CenterNew YorkNY
| | - Yuichiro Yano
- Noncommunicable Disease (NCD) Epidemiology Research CenterShiga University of Medical ScienceShigaJapan
- Department of Family Medicine and Community HealthDuke UniversityDurhamNC
| | - Joseph E. Schwartz
- Center for Behavioral Cardiovascular HealthColumbia University Irving Medical CenterNew YorkNY
- Department of Psychiatry and Behavioral SciencesStony Brook UniversityStony BrookNY
| | - Daichi Shimbo
- The Columbia Hypertension Center and LabColumbia University Irving Medical CenterNew YorkNY
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Çalış Karanfil F, Karanfil M, Toklu Y. Association of nocturnal subconjunctival hemorrhage and non-dipper blood pressure pattern: A benign clue for serious diseases. Eur J Ophthalmol 2021; 32:3043-3049. [PMID: 34964388 DOI: 10.1177/11206721211070939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the association between non-dipper blood pressure pattern and subconjunctival hemorrhage (SCH). METHODS Twenty-seven consecutive patients with nocturnal SCH and 27 age, sex-matched controls were enrolled. Demographic, blood parameters, office blood pressure measurements, 24-h ambulatory blood pressure monitoring (ABPM) were evaluated. RESULTS Mean diastolic blood pressure (DBP) for nighttime (65.03 ± 7.1 vs. 70.78 ± 10.5, p: 0.22), mean heart rate for nighttime (64.54 ± 8.26 vs. 69.93 ± 9.85, p: 0.034), Minimum Systolic Blood pressure(SBP) and DBP values for nighttime (92.44 ± 9.72 vs. 99.44 ± 10.66, p:0.015 and 51.15 ± 8.31 vs. 57.7 ± 11.2, p: 0.018) were higher, nocturnal fall ratio of SBP and DBP were significantly lower in the SCH ( + ) group compared to SCH (-) group (5.38 ± 8.39 vs. 10.34 ± 6.08, p: 0.016 and 4.26 ± 8.92 vs. 13.78 ± 6.97, p < 0001 respectively). Ten patients (37%) in the SCH (-) group and 18 patients (66.7%) in the SCH ( + ) group were non-dippers (p: 0.029). Mean daytime SBP and DBP were higher compared to office measurements of 4 patients (14.8%) in the SCH (-) group and 11 patients (40.7%) in the SCH ( + ) group (p: 0.033). CONCLUSION SCH had a strong association with non-dipper blood pressure pattern, higher nocturnal heart rate and masked hypertension which are precursors of myocardial infarction, stroke and renal failure. So, SCH should be considered as a clue for serious diseases such as coronary artery disease, myocardial infarction, stroke and patients should be evaluated for ABPM.
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Affiliation(s)
| | - Mustafa Karanfil
- Department of Cardiology, 536164Ankara City Hospital, Ankara, Turkey
| | - Yasin Toklu
- Department of Ophthalmology, 442146Ankara Yıldırım Beyazit University, Ankara, Turkey
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Kaul U, Bhagwat A, Omboni S, Pancholia AK, Hardas S, Bardoloi N, Davidson D, Sivakadaksham PR, Mohan JC, Vaidyanathan PR, Natarajan S, Kapardhi LNP, Reddy KS, Solanki D, Makkar JS, Viswanathan M, Arambam P, Suvarna V, Verberk WJ. Blood pressure and heart rate related to sex in untreated subjects: the India ABPM study. J Clin Hypertens (Greenwich) 2020; 22:1154-1162. [PMID: 32558208 DOI: 10.1111/jch.13894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/07/2020] [Accepted: 05/13/2020] [Indexed: 12/24/2022]
Abstract
Women are underrepresented in groups of patients seeking hypertension care in India. The present paper reports trends in office and ambulatory blood pressure measurement (OBPM, ABPM) and 24-h heart rate (HR) with sex in 14,977 subjects untreated for hypertension (aged 47.3 ± 13.9 years, males 69.4%) visiting primary care physicians. Results showed that, for systolic blood pressure (SBP), females had lower daytime ABPM (131 ± 16 vs. 133 ± 14 mm Hg, P < .001) but higher nighttime ABPM (122 ± 18 vs. 121 ± 16 mm Hg, P < .001) than males. Females had higher HR than men at daytime (80 ± 11 vs 79 ± 11.5 bpm) and nighttime (71 ± 11 vs 69 ± 11), respectively (all P < .001). Dipping percentages for SBP (7.4 ± 7.3 vs 9.3 ± 7.4%), DBP (10.1 ± 8.6 vs. 12.3 ± 8.9%), and HR (10.7 ± 7.9 vs. 12.8 ± 9.2%) were lower (P < .001) for females than for males, respectively. Females more often had isolated nighttime hypertension as compared to males (14.9%, n = 684% vs 10.6%, n = 1105; P < .001). BP patterns and HR showed clear differences in sex, particularly at nighttime. As females were more often affected by non-dipping and elevated nighttime SBP and HR than males, they should receive ABPM, at least, as frequently as men to document higher risk necessitating treatment.
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Affiliation(s)
- Upendra Kaul
- Batra Hospital and Medical Research Centre, 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
| | - Arvind K Pancholia
- Clinical and Preventive Cardiology, Arihant Hospital and RC, Indore, India
| | - Suhas Hardas
- Hospital: Poona Hospital and Research Center, Pune & Clinic: Hardas Heart Care, Pune, India
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Willem J Verberk
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Pierin AMG, Ignez EC, Filho WJ, Barbato AJG, Mion D. Blood pressure measurements taken by patients are similar to home and ambulatory blood pressure measurements. Clinics (Sao Paulo) 2008; 63:43-50. [PMID: 18297206 PMCID: PMC2664186 DOI: 10.1590/s1807-59322008000100009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2007] [Accepted: 10/22/2007] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To compare blood pressure measurements taken at home by physicians, nurses, and patients with office blood pressure measurement , ambulatory blood pressure monitoring and home blood pressure measurement. METHODS A total of 44 patients seen by a home care program were studied. Protocol 1 a) blood pressure was measured by the patient, a physician and a nurse during a regular home visit (Home1); b) home blood pressure measurement was measured for 4 days (HBPM1); c) office blood pressure measurement was measured by a physician, a nurse, and the patient; and by 24-hour ambulatory blood pressure monitoring. Protocol 2 blood pressure was measured by the patient, a physician, and a nurse during a special home visit in the presence of a physician and a nurse only (Home2); and b) home blood pressure measurement was taken for the second time (HBPM2). Echocardiography, guided by a two-dimensional echocardiograph, was performed. RESULTS Protocol 1: a) office blood pressure measurement and Home1 were significantly higher than ambulatory blood pressure monitoring, except for systolic and diastolic office blood pressure measurement taken by the patient or a family member, systolic blood pressure taken by a nurse, and diastolic blood pressure taken by a physician. b) ambulatory blood pressure monitoring and HBPM1 were similar. Protocol 2: a) HBPM2 and Home2 were similar. b) Home2 was significantly lower than Home1, except for diastolic blood pressure taken by a nurse or the patient. There were significant relationships between: a) diastolic blood pressure measured by the patient and the thickness of the interventricular septum, posterior wall, and left ventricular mass; and b) ambulatory and HBPM2 diastolic and systolic blood pressure taken by a physician (home2) and left ventricular mass. Therefore, the data indicate that home blood pressure measurement and ambulatory blood pressure monitoring had good prognostic values relative to "office measurement." CONCLUSION This study showed that the measurement most similar to home blood pressure measurement and ambulatory blood pressure monitoring was blood pressure measured by the patient, and that home blood pressure measurement and ambulatory blood pressure monitoring had good prognostic value relative to "office measurements".
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Affiliation(s)
| | - Edna C. Ignez
- School of Nursing, Universidade de São Paulo - São Paulo/SP, Brazil
| | - Wilson Jacob Filho
- Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil.
| | | | - Décio Mion
- Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil.
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