A comparison of home measurement and ambulatory monitoring of blood pressure in the adjustment of antihypertensive treatment (original) (raw)
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Clinical practice of ambulatory versus home blood pressure monitoring in hypertensive patients
Blood Pressure Monitoring, 2015
Objectives This study aimed to analyze whether blood pressure (BP) measurement is concordant between ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM), and determine whether the decision on treatment changes is similar on the basis of information provided by both methods. Methods Treated hypertensive patients were studied with ABPM and HBPM to evaluate therapeutic efficacy and/or diagnose resistant hypertension (HTN). Modification of pharmacological treatment was decided on the basis of preestablished criteria; therefore, the number of therapeutic changes between both techniques was compared. Results A total of 200 patients were included. The average daytime ABPM systolic blood pressure (SBP) was 136 ± 16 compared with 136 ± 15 (P = 1) with HBPM; the average diurnal diastolic blood pressure (DBP) was 83 ± 12 and 81 ± 9, respectively (P = 0.06). The concordance between both methods was very good for SBP [r = 0.85; Bland-Altman 0.2 (95% confidence interval 0.9-1.4 mmHg)], and good for the DBP [r = 0.77; Bland-Altman 1.8 (95% confidence interval 0.8-2.8 mmHg)]. Both methods were in agreement that HTN was controlled in 68 patients and that it was not controlled in 90 patients, that is, they were concordant in 158 patients (79%, κ = 0.6). More patients required changes with ABPM than HBPM (149 vs. 99 patients, P < 0.0001) Conclusion There were no significant differences in the measurement of diurnal SBP and DBP between both methods. The concordance to determine proper control of HTN was 79%. There was a significant difference in the decision to modify the treatment in favor of the ABPM.
Home blood pressure measurements associated with better blood pressure control: the J-HOME study
Journal of Human Hypertension, 2008
The usefulness of self-measurements of blood pressure (BP) at home (home BP measurements) in hypertensive patients has been reported by many studies. Several national guidelines recommend the use of home BP measurements to achieve better hypertension control. The objective of this study was to clarify the association between home BP measurements and hypertension treatment among 2363 essential hypertensive patients taking antihypertensive drugs. Compared to the 543 (23.0%) patients who had not taken home BP measurements, the 1820 (77.0%) patients who had taken home BP measurements were significantly older, included a higher proportion of males, included a higher proportion with a family history of hypertension, took a greater number of antihypertensive drugs and alpha blockers and took antihypertensive drugs more often in the evening. Home BP measurements were associated with significantly better control of home and office BP levels. Compared to patients who had not taken home BP measurements, the adjusted odds ratios for good control of morning home BPs, evening home BPs and office BPs in patients who had taken home BP measurements were 1.46 (95% confidential interval (CI) 1.33-1.57), 1.35 (95% CI 1.21-1.47) and 1.23 (95% CI 1.06-1.37), respectively. Home BP measurements were associated with good hypertensive management. Our findings suggest that it is important that physicians recommend home BP measurements to their patients.
2012
Results: The mean age of the subjects was 50.5 ± 16.1 years and 74.7% were males. Of the 158 subjects, 62 (39.2%) had “controlled office BP” (BP <140/90 mmHg) and the remaining 96 (60.8%) had “uncontrolled office BP” (BP > 140/90 mmHg). Overall, ABP monitoring was performed for an average of 25.7 ± 7.3 h, which included 15.7 ± 4.5 h of day-time recording and 9.9 ± 3.1 h of night-time recording. As compared to the patients with uncontrolled office BP, those with controlled office BP had lower 24-h BP, day-time BP, night-time BP, and the overall BP load. However, despite apparently controlled office BP, a significant proportion of these patients (24.2%) had increased 24-h average ABP and 58.1% patients had at least 40% day-time BP values above the normal range. Similarly, 10.4% patients with uncontrolled office BP actually had normal 24-h average BP and normal BP load (<40% day-time BP values above the normal range). In addition, patients with controlled office BP had less ma...
Hypertension Research, 2012
Hypertension guidelines recommend blood pressure self-measurement at home (HBP), but no previous trial has assessed cardiovascular outcomes in hypertensive patients treated according to HBP. The multicenter Hypertension Objective Treatment Based on Measurement by Electrical Devices of Blood Pressure (HOMED-BP; trial involved 3518 patients (50% women; mean age 59.6 years) with an untreated systolic/diastolic HBP of 135-179/85-119 mm Hg. In a 2 Â 3 design, patients were randomized to usual control (125-134/80-84 mm Hg (UC)) vs. tight control (o125/o80 mm Hg (TC)) of HBP and to initiation of drug treatment with angiotensin converting enzyme inhibitors, angiotensin receptor blockers or calcium channel blockers. During follow-up, a computer algorithm automatically generated treatment recommendations based on HBP. At the last follow-up (median 5.3 years), TC patients used more antihypertensive drugs than UC patients (1.82 vs. 1.74 defined daily doses, P ¼ 0.045) and had a greater HBP reduction (21.3/13.1 mm Hg vs. 22.7/13.9 mm Hg, P ¼ 0.018/0.020), but they less frequently achieved the lower HBP targets (37.4 vs. 63.5%, Po0.0001). The primary end point, cardiovascular death plus stroke and myocardial infarction, occurred in 25 UC and 26 TC patients (hazard ratio, 1.02; 95% confidence interval, 0.59-1.77; P ¼ 0.94). Rates were similar (PX0.13) in the three drug groups. In all patients combined, the risk of the primary end point independently increased by 41% (6-89%; P ¼ 0.019) and 47% (15-87%; P ¼ 0.0020) for a 1-s.d. increase in baseline (12.5 mm Hg) and follow-up (13.2 mm Hg) systolic HBP. The 5-year risk was minimal (p1%) if on-treatment systolic HBP was 131.6 mm Hg or less. HOMED-BP proved the feasibility of adjusting antihypertensive drug treatment based on HBP and suggests that a systolic HBP level of 130 mm Hg should be an achievable and safe target.
Acta Medica Marisiensis, 2016
Background: A number of studies reveal that home blood pressure variability is associated with cardiovascular risk factors. However, we do not have a consensus regarding the variability index and the frequency of measurements. Objective: The aim of the study was to assess home blood pressure variability for a period of 7 consecutive days and 24-hour ambulatory blood pressure variability using the average real variability index and to test whether home blood pressure variability represents a suitable parameter for long-term monitoring of the hypertensive patients. Material and methods: A number of 31 hypertensive patients were included in the study, 8 male, 23 female, mean age 60.19±7.35 years. At the inclusion ambulatory blood pressure monitoring was performed, home blood pressure monitoring was carried out for 7 consecutive days with 2 measurements daily. We compared ambulatory blood pressure values, variability using paired t-test. We were looking for correlations between HBP values and cardiovascular risk factors. Results: Ambulatory versus home blood pressure derived mean blood pressure was 131.38±15.2 versus 131.93±8.25, p=0.81. Ambulatory derived variability was 10.65±2.05 versus home variability 10.56±4.83, p=0.91. Home versus ambulatory pulse pressure was 51.8± 9.06 mmHg vs. 54.9±11.9 mmHg, p=0.046. We found positive correlation between HBPV and home BP values, p=0.027, r2=0.1577, (CI: 0.04967 to 0.6588). Home, as well as ambulatory derived variability were positively correlated to age p=0.043, r2=0.1377 (CI: 0.01234 to 0.6451) versus p<0.0001, CI: 0.3870 to 0.8220, r2=0.4302. Conclusion: Assessment of home blood pressure monitoring and variability could represent a well-tolerated alternative for long-term follow-up of hypertension management.
Comparisons of home and daytime ambulatory blood pressure measurements
BMC cardiovascular disorders, 2014
Home (HBPM) and ambulatory (ABPM) blood pressure measurements have their advantages and disadvantages in diagnosing and managing hypertension. We studied HBPMs and ABPMs in volunteers taking part in a survey. Of 366 respondents, 270 provided a total of 5997 triplicate HBPMs (Part 1); 175 also provided data on ABPMs, of which the measurements obtained between 6 am and 10 pm were used in this study (Part 2). Part 1, When all 5997 triplicate HPPMs were considered, 1st readings tended to be significantly higher than those of the 2nd and 3rd for both, systolic and diastolic pressures, but when the consideration was restricted to the very first triplicate of each of the 270 subjects, this was true only for systolic HBPM. Part 2, The ABPMs tended to have a wider range than the corresponding HBPMs, and to be distributed towards higher values. Of the non-parametric indices of (ABPM - corresponding HBPM), (First Quartile, Median, Third Quartile and Maximim) all but the minima had positive val...
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...
Family Practice, 2010
Background. The measurement of blood pressure (BP) at home by patients with hypertension is increasingly used to assess and monitor BP. Evidence for its effectiveness in improving BP control is mixed. Methods. To determine if home BP monitoring improves BP a pragmatic cluster randomized contolled trial was carried out in family practices in southeastern Ontario, Canada. Family practice patients with uncontrolled hypertension were recruited to the trail. Patients were divided into two groups: one with at least weekly measurements of BP at home, recording those measurements and showing those to the family physician during office visits for hypertension and the control group were given usual care. The primary outcome was mean awake BP on ambulatory monitoring at 6-and 12-month follow-up and the secondary outcomes were mean BP on full 24-hour ambulatory blood pressure monitoring (ABPM), mean sleep BP on ABPM and BP on the BpTRU device, all at 6-and 12-month follow-up. Results. Home BP monitoring did not improve BP compared to usual care at 12-month follow-up: mean awake systolic BP on ABPM [141.1 versus 142.8 mmHg, mean difference 1.7 mmHg; 95% confidence interval (CI)-0.6 to 4.0, P = 0.314] and mean awake diastolic BP on ABPM (78.7 versus 79.4 mmHg, mean difference 0.7 mmHg; 95% CI-7.7 to 9.1, P = 0.398). Similar negative results were obtained for men and women separately. However, outcomes using the full 24-hour ABPM and the BpTRU device showed a significantly lower diastolic BP at 12 months. When analysis was done by sex, this effect was shown to be only in men. Conclusion. Home BP monitoring may improve BP control in men with hypertension.
Ambulatory versus home blood pressure monitoring
Journal of Hypertension, 2019
Out-of-office blood pressure evaluation assessed using ambulatory (ABP) or home (HBP) monitoring is currently recommended for hypertension management. We evaluated the frequency and determinants of diagnostic disagreement between ABP and HBP measurements. Methods: Cross-sectional data from 1971 participants (mean age 53.8 AE 11.4 years, 52.6% men, 32% treated) from Greece, Finland and the United Kingdom were analyzed. The diagnostic disagreement between HBP and daytime ABP was regarded as certain when (i) the two methods diagnosed a different blood pressure phenotype, (ii) the absolute HBP-ABP difference was more than 10/ 5 mmHg (systolic/diastolic) and (iii) ABP and HBP had a more than 5 mmHg difference from the respective hypertension threshold. Results: In 1574 participants (79.9%), there was agreement between HBP and ABP in diagnosing hypertensive phenotypes (kappa 0.70). Of the remaining 397 participants (20.1%) with diagnostic disagreement, 95 had clinically irrelevant HBP-ABP differences, which reduced the disagreement to 15.3%. When cases with ABP and/or HBP differing 5 mmHg from the respective hypertension threshold were excluded, the certain disagreement between the two methods was reduced to 8.2%. Significant determinants of the HBP-ABP difference were age, sex, study center, BMI, cardiovascular disease history, office hypertension and antihypertensive treatment. Antihypertensive drug treatment, alcohol consumption and office normotension independently increased the odds of diagnostic disagreement. Conclusion: These data suggest that there is considerable diagnostic agreement between HBP and ABP, and that these methods are interchangeable for clinical decisions in most patients. However, considerable disagreement between the two methods occurs in an appreciable minority, most likely due to methodological and patientrelated factors.
The Journal of Clinical Hypertension, 2012
The usefulness of the community pharmacy blood pressure (CPBP) method in the diagnosis or treatment of hypertension has not been adequately addressed in controlled studies. The authors' aim was to assess the agreement between awake ambulatory blood pressure (ABP), home blood pressure (HBP), and CPBP in treated hypertensive patients. This was a cross-sectional study carried out in 169 patients in which blood pressure (BP) was measured at the pharmacy (4 visits), at home (4 days), and by 24-hour ABP monitoring. Lin correlation-concordance coefficient (CCC) and Bland-Altman plots were used to evaluate quantitative agreement. The qualitative agreement to establish the degree of BP control was evaluated using j coefficient. The agreement was acceptable between HBP and CPBP (CCC=0.80 for systolic BP [SBP] and 0.80 for diastolic BP [DBP]; j=0.62) and moderate between awake ABP and CPBP (CCC=0.74 ⁄ 0.67, respectively; j=0.56). The Bland-Altman plots also showed lowest mean differences (0.5 ⁄ 0.3 for SBP and DBP, respectively) for the comparison between CPBP and HBP. The CPBP has a better agreement with HBP than with awake ABP. Thus, the CPBP measurement method could be a good alternative to HBP monitoring, whereas it cannot be used as a screening test to assess the degree of BP control by awake ABP.