Treatment and follow up using home blood pressure measurement versus clinic and ambulatory blood pressure measurement: a randomized prospective trial

Out-of-office blood pressure measurement using home (HBP) or ambulatory (ABP) monitoring is often necessary for the accurate evaluation of hypertension. These methods have several similarities and major differences. Therefore, they are regarded as complementary, rather than competitive, and there is uncertainty on how they should be applied in clinical practice. This study compared hypertension management based on clinic and ABP measurements, or on HBP measurements alone.Method: Untreated subjects with elevated blood pressure were randomized to treatment initiation and titration based on clinic and ABP measurements, or on HBP measurements alone. Target organ damage was assessed at baseline and after 1 year of treatment with echocardiographic left ventricular mass index (primary endpoint), pulse wave velocity and urinary albumin excretion. Secondary endpoints were the decline in office, home and ambulatory blood pressure and the hypertension control that could be achieved by each one of these methods. Results: A total of 172 subjects were recruited, of which 145 were randomized and 116 completed the study (mean age 50.7±10.5 years, 69 men [59%], mean follow-up 13.4±1.4 months). There was no difference between the two arms in treatment-induced change in left ventricular mass index (mean difference 0.50±1.11 [SD] g/m2, 95% CI -1.70, 2.70). Moreover, there was no difference between the two arms in treatment induced changes in pulse wave velocity (-0.16±0.42 m/s, -0.99, 0.66), urinary albumin excretion (-0.85±4.28 mg/dl, -9.37, 7.66), HBP and ABP levels and hypertension control rates.No difference was found between the two arms in blood pressure decline and hypertension control rate assessed by home or ambulatory blood pressure monitoring.Conclusion: These data suggest that HBP monitoring alone is as reliable as combined clinic and ABP measurements in monitoring the effects of antihypertensive drug treatment on blood pressure and preclinical target organ damage.Σκοπός: Η αξιολόγηση της αρτηριακής πίεσης εκτός ιατρείου, με μετρήσεις στο σπίτι ή με 24ωρηκαταγραφή, είναι συχνά απαραίτητες για την ακριβή αξιολόγηση της υπέρτασης. Οι δύο αυτές τεχνικές έχουν αρκετές ομοιότητες αλλά και σημαντικές διαφορές. Ως εκ τούτου, θεωρούνται συμπληρωματικές παρά ανταγωνιστικές ή εναλλακτικές, όμως δεν είναι ακόμα σαφές το πώς πρέπει να εφαρμόζονται στην κλινική πράξη. Η παρούσα μελέτη είχε ως σκοπό τη σύγκριση της συνολικής αντιμετώπισης της υπέρτασης, με διάγνωση, τιτλοποίηση της αντιυπερτασικής αγωγής και παρακολούθηση, βασισμένη είτε στο συνδυασμό μετρήσεων αρτηριακής πίεσης στο ιατρείο και 24ωρης καταγραφής, είτε αποκλειστικά σε μετρήσεις στο σπίτι.Μέθοδος: Άτομα χωρίς αντιυπερτασική αγωγή που επισκέφθηκαν το Κέντρο Υπέρτασης της Γ΄Παθολογικής Κλινικής του Πανεπιστημίου Αθηνών και είχαν αυξημένη αρτηριακή πίεση,τυχαιοποιήθηκαν για έναρξη θεραπείας, τιτλοποίησή της και παρακολούθηση, είτε με βάση τοσυνδυασμό μετρήσεων στο ιατρείο και 24ωρης καταγραφής, είτε με βάση αποκλειστικά μετρήσεις στο σπίτι. Η βλάβη οργάνων στόχων εκτιμήθηκε κατά την ένταξη στη μελέτη και μετά από ένα χρόνο υπό θεραπεία, με υπερηχογραφικό δείκτη μάζας αριστερής κοιλίας (πρωτεύον καταληκτικό σημείο), ταχύτητα αγωγής σφυγμικού κύματος και απέκκριση λευκωματίνης στα ούρα. Δευτερεύοντα καταληκτικά σημεία ήταν η μείωση της αρτηριακής πίεσης σύμφωνα με την κάθε μέθοδο μέτρησης και η ρύθμιση της υπέρτασης που επιτεύχθηκε αξιολογούμενη με κάθε μέθοδο. Αποτελέσματα: Συνολικά 172 άτομα αξιολογήθηκαν, εκ των οποίων 145 τυχαιοποιήθηκαν και 116 ολοκλήρωσαν τη μελέτη [μέση ηλικία 50.7±10.5 έτη, 69 άντρες (59%), μέση διάρκεια παρακολούθησης 13.4±1.4 μήνες]. Δε διαπιστώθηκε διαφορά ανάμεσα στις δύο τυχαιοποιημένες ομάδες ως προς τη μείωση του δείκτη μάζας αριστερής κοιλίας με τη θεραπεία (μέση διαφορά 0.50±1.11 g/m2, 95% όρια αξιοπιστίας -1.70, 2.70). Επιπλέον, δε διαπιστώθηκε διαφορά ανάμεσα στις δύο ομάδες όσον αφορά τη μείωση της ταχύτητα αγωγής του σφυγμικού κύματος (-0.16±0.42 m/s, -0.99, 0.66), τη μείωση της απέκκρισης λευκωματίνης στα ούρα (-0.85±4.28 mg/dl, -9.37, 7.66), τη μείωση της αρτηριακής πίεσηςσύμφωνα με τις μετρήσεις στο ιατρείο, το σπίτι και την 24ωρη καταγραφή και στο ποσοστό ρύθμισης της υπέρτασης. Συνεπώς οι δύο ομάδες, μετά από 13.4±1.4 μήνες παρακολούθησης υπό θεραπευτική αγωγή δε διέφεραν ως προς την υποστροφή της βλάβης των οργάνων στόχων, τη μείωση της αρτηριακής πίεσης και τη ρύθμιση της υπέρτασης.Συμπέρασμα: Τα αποτελέσματα της μελέτης υποδεικνύουν ότι η μέτρηση της αρτηριακής πίεσης στο σπίτι, είναι εξίσου αποτελεσματική μέθοδος με το συνδυασμό μετρήσεων στο ιατρείο και την 24ωρη καταγραφή για την αξιολόγηση της επίδρασης της φαρμακευτικής αγωγής στην αρτηριακή πίεση και την ασυμπτωματική βλάβη οργάνων στόχων

Automatic Office Blood Pressure Measured without Doctors or Nurses Present

BACKGROUND: We evaluated the agreement between office blood pressure (OBP) measured by a mercury sphygmomanometer (Sphyg) and an automatic (Auto) device without any observers, and compared Auto and Sphyg OBP with ambulatory blood pressure (ABP) and home blood pressure (HBP). METHODS: OBP was measured in 75 hypertensive patients at two sites using an automatic monitor without a doctor or a nurse present and by Sphyg during three clinic visits. Between visits, monitoring of ABP and HBP was also performed. RESULTS: The mean Auto OBP was similar to that of Sphyg OBP and the values were closely correlated (intraclass correlation coefficient=0.84 for systolic OBP and 0.91 for diastolic OBP); however, the difference between Auto and Sphyg systolic OBP (1.6 ± 8.2 mmHg) varied by the first office visit, sex, and the site. Auto systolic OBP was lower than both systolic awake ABP (137.1 ± 14.7 mmHg) and HBP (139.2 ± 15.6 mmHg). Auto systolic OBP and Sphyg OBP were similarly correlated with systolic awake ABP (both r=0.59, P0.68, P CONCLUSION: Auto systolic OBP measured without a doctor or a nurse present was lower than systolic awake ABP and HBP. Auto and rigorously assessed Sphyg OBP had similar means and were similarly related to awake ABP. Auto OBP might be an advantageous alternative to Sphyg measurements in the usual clinic setting

Automatic Office Blood Pressure Measured without Doctors or Nurses Present

BACKGROUND: We evaluated the agreement between office blood pressure (OBP) measured by a mercury sphygmomanometer (Sphyg) and an automatic (Auto) device without any observers, and compared Auto and Sphyg OBP with ambulatory blood pressure (ABP) and home blood pressure (HBP). METHODS: OBP was measured in 75 hypertensive patients at two sites using an automatic monitor without a doctor or a nurse present and by Sphyg during three clinic visits. Between visits, monitoring of ABP and HBP was also performed. RESULTS: The mean Auto OBP was similar to that of Sphyg OBP and the values were closely correlated (intraclass correlation coefficient=0.84 for systolic OBP and 0.91 for diastolic OBP); however, the difference between Auto and Sphyg systolic OBP (1.6 ± 8.2 mmHg) varied by the first office visit, sex, and the site. Auto systolic OBP was lower than both systolic awake ABP (137.1 ± 14.7 mmHg) and HBP (139.2 ± 15.6 mmHg). Auto systolic OBP and Sphyg OBP were similarly correlated with systolic awake ABP (both r=0.59, P0.68, P CONCLUSION: Auto systolic OBP measured without a doctor or a nurse present was lower than systolic awake ABP and HBP. Auto and rigorously assessed Sphyg OBP had similar means and were similarly related to awake ABP. Auto OBP might be an advantageous alternative to Sphyg measurements in the usual clinic setting

The Mystery of High-density Lipoprotein: Quantity or Quality? Update on Therapeutic Strategies

This review summarizes the data challenging the concept that cardiovascular protection through high-density lipoprotein (HDL) is only associated with its serum concentration. This conventional impression about its protective role now appears obsolete. New aspects of its mechanisms are revealed and novel therapeutic strategies are based on them. However, data from long-term cost-effectiveness studies of treating HDL are still needed. There is a need for biomarkers that represent the functional characteristics of HDL in order to better quantify the total cardiovascular risk. (C) 2015 MedReviews (R), LL

STRIDE BP international initiative for accurate blood pressure measurement:Systematic review of published validation studies of blood pressure measuring devices

Blood pressure (BP) is a vital sign, and its measurement is essential for diagnosing and treating hypertension. The accuracy of BP monitors is therefore essential, but unfortunately very few devices available on the market have been validated using an established protocol. STRIDE BP (www.stridebp.org) is an international nonprofit organization with the mission to improve the accuracy of BP measurement and the diagnosis of hypertension. It has a prestigious Scientific Advisory Board and operates in affiliation with the European Society of Hypertension, the International Society of Hypertension, and the World Hypertension League. STRIDE BP provides lists of accurate office, ambulatory, and home BP monitors. STRIDE BP performed a systematic review of 419 published validations (270 articles and 260 devices). In these publications, 50 (12%) of the validations were rejected compared with 129 (31%) rejected by STRIDE BP (P < .001). Of 79 validations approved in publications but rejected by STRIDE BP, 7 (9%) were rejected due to device inaccuracy and 72 (91%) due to inadequate study quality (execution, analysis, and reporting). Errors in conducting and reporting published validations must be avoided. Peer review must ascertain that a comprehensive checklist of all aspects of a validation study have been adhered to. The implementation of a Universal Standard for device validation and the global dissemination of information on accurate devices by STRIDE BP are expected to improve the quality and accuracy of BP measurement, which should have a positive impact on the diagnosis and management of hypertension globally