Usefulness of Home Blood Pressure in the Diagnosis and Control of Hypertension in Primary Care (original) (raw)
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Home Blood Pressure Measurement - Epidemiology and Clinical Application
2008
Hypertension, the leading global risk factor for early mortality, can not be detected or treated without accurate and practical methods of BP measurement. Although home blood pressure (BP) measurement enjoys considerable popularity among patients, the lack of evidence needed to assure its place in modern clinical practice has hindered its widespread acceptance among physicians. The objective of this study was to show that home BP measurement is more accurate than conventional clinic BP measurement and can be used effectively in clinical practice. We assessed the use of home BP for diagnosing hypertension and guiding antihypertensive treatment. The association between home BP and hypertensive end-organ damage was also examined. The first study population consisted of a representative sample of the Finnish adult population (2 120 individuals aged 45-74 years). These subjects underwent a clinical interview, electrocardiography and measurement of clinic and home BP. Carotid intima-media thickness (an indicator of atherosclerosis) and arterial pulse wave velocity (an indicator of arterial stiffness) were also measured in two subsets of 758 and 237 subjects, respectively. In a second study cohort, consisting of 98 hypertensive patients, adjustment of antihypertensive treatment was randomized to either daytime ambulatory BP or home diastolic BP. Clinic BP was significantly higher than home BP (mean systolic/diastolic difference was 8/3 mmHg), and the overall agreement between the two methods in diagnosing hypertension was moderate at best (75%). Of 593 subjects with elevated clinic BP, 38% had normal BP at home; so called white-coat hypertension. Hypertension could therefore be overdiagnosed in every third patient in a clinical screening situation. White-coat hypertension was associated with mildly elevated clinic BP, lower body mass index and non-smoking status, but not with psychiatric disease. However, the cardiovascular risk profile of white-coat hypertensives was between that of the normotensives and sustained hypertensives, indicating that white-coat hypertension is not a completely benign phenomenon, and may be a precursor of true hypertension. Home BP was more closely associated with hypertensive end-organ damage (intima-media thickness, pulse wave velocity, and electrocardiographic evidence of left ventricular hypertrophy) than was clinic BP. The adjustment of antihypertensive treatment based on home BP measurement is effective as it led to equally good BP control as did ambulatory BP monitoring, which has been considered by many as the gold standard. On the basis of these results and data from previous studies, it can be concluded that home BP measurement is an improvement over conventional clinic BP measurement. Home monitoring of BP is as a convenient, accurate, and widely available option and may become the method of choice when diagnosing and treating hypertension. A paradigm shift is needed in BP measurement as evidencebased medicine suggests that clinic BP measurement should only be used for screening purposes.
Home blood pressure self-measurement: ''Current situation and new perspectives''
The method typically used to diagnose and monitor hypertensive patients has been to measure blood pressure in the physician's surgery; however, it is a well-known fact that this approach poses certain drawbacks, such as observer bias, failure to detect an alert reaction in the clinic, etc., difficulties that affect its accuracy as a diagnostic method. In recent years, the varying international scientific societies have persistently recommended the use of blood pressure measurements outside the clinic (at home or in the outpatient setting), using validated automatic devices. Data from some studies suggest that if we rely solely on in-office measurements, approximately 15-20% of the time we may be wrong when making decisions, both in terms of diagnosis and patient follow-up. Home blood pressure measurements are a simple and very affordable method that has a similar reproducibility and prognostic value as ambulatory blood pressure monitoring, the availability of which is currently very limited. Moreover, ambulatory self-measurements have the significant benefit of being able to improve control of hypertensive individuals.
Home Readings of Blood Pressure in Assessment of Hypertensive Subjects
Acta Medica Scandinavica, 2009
Outpatient clinic blood pressure (OPC-BP) was compared to home blood pressure (Home-BP) measured three times daily during a two week period in 122 consecutively referred hypertensive subjects. A semi-automatic device (TM-101) including a microphone for detection of Korotkoff-sounds, selfdeflation of cuff pressure and digital display of blood pressure was used. Mean difference between OPC-BP and Home-BP was systolic + 13 mm Hg (range-21-+ loo mg Hg) and diastolic + 5 mm Hg (Irange-2 7-+ 36 mm Hg). Although a significant correlation could be demonstrated between Home-BP and OPC-BP, the inter-individual scatter was pronounced and unpredictable from the hypertensive organ damages. It is argued, that home readings should be used to greater extent in the evaluation of patients with hypertension.
Integration of Home Blood Pressure Monitoring in Hypertension Management
Background: White coat syndrome, masked hypertension, and poor technique may produce inaccurate offi ce-based blood pressure (BP) readings and lead to over diagnosis and over treatment with antihypertensive agents. National and international hypertension guidelines recommend using home BP monitoring in conjunction with offi ce readings for hypertension diagnostic and/or treatment evaluation.
Hypertension, 2008
Home blood pressure monitoring (HBPM) overcomes many of the limitations of traditional office blood pressure (BP) measurement and is both cheaper and easier to perform than ambulatory BP monitoring. Monitors that use the oscillometric method are currently available that are accurate, reliable, easy to use, and relatively inexpensive. An increasing number of patients are using them regularly to check their BP at home, but although this has been endorsed by national and international guidelines, detailed recommendations for their use have been lacking. There is a rapidly growing literature showing that measurements taken by patients at home are often lower than readings taken in the office and closer to the average BP recorded by 24-hour ambulatory monitors, which is the BP that best predicts cardiovascular risk. Because of the larger numbers of readings that can be taken by HBPM than in the office and the elimination of the white-coat effect (the increase of BP during an office visit), home readings are more reproducible than office readings and show better correlations with measures of target organ damage. In addition, prospective studies that have used multiple home readings to express the true BP have found that home BP predicts risk better than office BP (Class IIa; Level of Evidence A). This call-to-action article makes the following recommendations: (1) It is recommended that HBPM should become a routine component of BP measurement in the majority of patients with known or suspected hypertension; (2) Patients should be advised to purchase oscillometric monitors that measure BP on the upper arm with an appropriate cuff size and that have been shown to be accurate according to standard international protocols. They should be shown how to use them by their healthcare providers; (3) Two to 3 readings should be taken while the subject is resting in the seated position, both in the morning and at night, over a period of 1 week. A total of Ն12 readings are recommended for making clinical decisions; (4) HBPM is indicated in patients with newly diagnosed or suspected hypertension, in whom it may distinguish between white-coat and sustained hypertension. If the results are equivocal, ambulatory BP monitoring may help to establish the diagnosis; (5) In patients with prehypertension, HBPM may be useful for detecting masked hypertension; (6) HBPM is recommended for evaluating the response to any type of antihypertensive treatment and may improve adherence; (7) The target HBPM goal for treatment is Ͻ135/85 mm Hg or Ͻ130/80 mm Hg in high-risk patients; (8) HBPM is useful in the elderly, in whom both BP variability and the white-coat effect are increased; (9) HBPM is of value in patients with diabetes, in whom tight BP control is of paramount importance; (10) Other populations in whom HBPM may be beneficial include pregnant women, children, and patients with kidney disease; and (11) HBPM has the potential to improve the quality of care while reducing costs and should be reimbursed. (Hypertension. 2008;52:000-000.)
Self-measured home blood pressure in predicting ambulatory hypertension
American journal of hypertension, 2004
Physicians are commonly uncertain whether a person with office blood pressure (BP) around 140/90 mm Hg actually has hypertension. This is primarily because of BP variability. One approach is to perform self-measured home BP and determine if home BP is elevated. There is a general agreement that if home BP is >/=135/85 mm Hg, then antihypertensive therapy may be commenced. However, some persons with home BP below this cut-off will have ambulatory hypertension. We therefore prospectively study the role of home BP in predicting ambulatory hypertension in persons with stage 1 and borderline hypertension. We studied in a cross-sectional way home and ambulatory BP in a group of 48 patients with at least two elevated office BP readings. The group was free of antihypertensive drug therapy for at least 4 weeks and performed 7 days of standardized self-BP measurements at home. We examined the relationships of the three BP methods and also defined a threshold (using receiver operating curve...
Home Blood Pressure Measurement
Journal of The American College of Cardiology, 2005
The purpose of this research was to review the literature on home blood pressure measurement (HBPM) and to provide recommendations regarding HBPM assessment. Observational studies on HBPM, published after 1992, as identified by PubMed, EMBASE, and Cochrane literature searches were reviewed. Studies were selected if they met the following criteria: 1) self-measurements had been performed with validated devices; 2) measurement procedures were described in sufficient detail; and 3) papers clearly explained how final HBPM results were calculated upon which conclusions and/or treatment decisions were based. Office blood pressure measurement (OBPM) yields higher blood pressure values than HBPM. For systolic blood pressure, differences between OBPM and HBPM increase with age and the height of office pressure. Differences also tend to be greater in men than in women and greater in patients without than in those with antihypertensive treatment. Furthermore, HBPM can diagnose normotension with almost absolute certainty; it correlates better with target organ damage and cardiovascular mortality than OBPM, it enables prediction of sustained hypertension in patients with borderline hypertension, and it proves to be an appropriate tool for assessing drug efficacy. Despite some limitations and although more data are needed, HBPM is suitable for routine clinical practice. (J Am Coll Cardiol 2005;46:743-51)