057 Regression to the Mean in Home Blood Pressure: Analyses of the BP GUIDE Study

We assessed the relationship between maximum mean home blood pressure (HBP) and incident cardiovascular disease risks in the general practice population of the J-HOP study (Japan Morning Surge-Home Blood Pressure), which recruited 4231 patients with cardiovascular risk factors (mean [SD] age: 65 [11] years; 53% women; 79% on antihypertensive medications) who measured their HBP in the morning and evening for 14 days. The first day’s HBPs were excluded. The average of morning and evening (the average of morning and evening value [MEave]) BP was defined as the average of all HBP values. The maximum mean HBP was defined as the highest value of mean HBP on one occasion. The variability independent of the mean of MEave BP was assessed. The MEave BP was 134/76 mm Hg; the maximum mean HBP was 156/88 mm Hg. Over a median 3.9-year follow-up (16 762 person-years), 72 stroke, and 76 coronary heart disease events occurred. A Cox regression analysis showed that the hazard ratios of a 1-SD increase in maximum mean home systolic BP (SBP; 95% CI) for incident stroke events were (1) 1.89 (1.23–2.89) including MEave SBP and (2) 1.68 (1.33–2.14) including the variability independent of the mean of MEave SBP. These significant associations were not observed for coronary heart disease events. Adding the maximum mean home SBP to the stroke prediction model significantly improved the discrimination: (1) MEave SBP: C statistics difference (95% CI), 0.019 (0.002–0.038); and (2) variability independent of the mean of MEave SBP: 0.031 (0.008–0.056). The maximum mean HBP could be a useful marker for evaluating the stroke risk of patients. REGISTRATION: URL: https://upload.umin.ac.jp ; Unique identifier: UMIN000000894

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Home Blood Pressure Control and Drug Prescription Patterns among Thai Hypertensives: A 1-Year Analysis of Telehealth Assisted Instrument in Home Blood Pressure Monitoring Nationwide Pilot Project

International Journal of Hypertension ◽

10.1155/2021/8844727 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Anut Sakulsupsiri ◽

Pairoj Chattranukulchai ◽

Sarawut Siwamogsatham ◽

Patchaya Boonchayaanant ◽

Witthawat Naeowong ◽

...

Keyword(s):

Blood Pressure ◽

Channel Blocker ◽

Blood Pressure Monitoring ◽

Drug Prescription ◽

Pilot Project ◽

Home Blood Pressure ◽

Pressure Monitoring ◽

The Mean ◽

One Year

Background. Several interventions have been proposed to improve hypertension control with various outcomes. The home blood pressure (HBP) measurement is widely accepted for assessing the response to medications. However, the enhancement of blood pressure (BP) control with HBP telemonitoring technology has yet to be studied in Thailand. Objective. To evaluate the attainment of HBP control and drug prescription patterns in Thai hypertensives at one year after initiating the TeleHealth Assisted Instrument in Home Blood Pressure Monitoring (THAI HBPM) nationwide pilot project. Methods. A multicenter, prospective study enrolled treated hypertensive adults without prior regular HBPM to obtain monthly self-measured HBP using the same validated, oscillometric telemonitoring devices. The HBP reading was transferred to the clinic via a cloud-based system, so the physicians can adjust the medications at each follow-up visit on a real-life basis. Controlled HBP is defined as having HBP data at one year of follow-up within the defined target range (<135/85 mmHg). Results. A total of 1,177 patients (mean age 58 ± 12.3 years, 59.4% women, 13.1% with diabetes) from 46 hospitals (81.5% primary care centers) were enrolled in the study. The mean clinic BP was 143.9 ± 18.1/84.3 ± 11.9 mmHg while the mean HBP was 134.4 ± 15.3/80.1 ± 9.4 mmHg with 609 (51.8%) patients having HBP reading <135/85 mmHg at enrollment. At one year of follow-up after implementing the HBP telemonitoring, 671 patients (57.0%) achieved HBP control. Patients with uncontrolled HBP had a higher prevalence of dyslipidemia and greater waist circumference than the controlled group. The majority of uncontrolled patients were still prescribed only one (36.0%) or two drugs (34.4%) at the end of the study. The antihypertensive drugs were not uptitrated in 136 (24%) patients with uncontrolled HBP at baseline. Calcium channel blocker was the most prescribed drug class (63.0%) followed by angiotensin-converting enzyme inhibitor (44.8%) while the thiazide-type diuretic was used in 18.9% of patients with controlled HBP and 16.4% in uncontrolled patients. Conclusion. With the implementation of HBP telemonitoring, the BP control rate based on HBP analysis was still low. This is possibly attributed to the therapeutic inertia of healthcare physicians. Calcium channel blocker was the most frequently used agent while the diuretic was underutilized. The long-term clinical benefit of overcoming therapeutic inertia alongside HBP telemonitoring needs to be validated in a future study.

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Feasibility of a New Cuffless Device for Ambulatory Blood Pressure Measurement in Patients With Hypertension: Mixed Methods Study (Preprint)

10.2196/preprints.11164 ◽

2018 ◽

Author(s):

Paula AM Ogink ◽

Jelske M de Jong ◽

Mats Koeneman ◽

Mariska Weenk ◽

Lucien JLPG Engelen ◽

...

Keyword(s):

Blood Pressure ◽

Qualitative Interviews ◽

Blood Pressure Measurement ◽

Home Blood Pressure ◽

Strongly Correlated ◽

User Friendliness ◽

Validated Questionnaire ◽

System Usability Scale ◽

The Mean

BACKGROUND Frequent home blood pressure (BP) measurements result in a better estimation of the true BP. However, traditional cuff-based BP measurements are troublesome for patients. OBJECTIVE This study aimed to evaluate the feasibility of a cuffless device for ambulatory systolic blood pressure (SBP) measurement. METHODS This was a mixed method feasibility study in patients with hypertension. Performance of ambulatory SBPs with the device was analyzed quantitatively by intrauser reproducibility and comparability to a classic home BP monitor. Correct use by the patients was checked with video, and user-friendliness was assessed using a validated questionnaire, the System Usability Scale (SUS). Patient experiences were assessed using qualitative interviews. RESULTS A total of 1020 SBP measurements were performed using the Checkme monitor in 11 patients with hypertension. Duplicate SBPs showed a high intrauser correlation (R=0.86, P<.001). SBPs measured by the Checkme monitor did not correlate well with those of the different home monitors (R=0.47, P=.007). However, the mean SBPs measured by the Checkme and home monitors over the 3-week follow-up were strongly correlated (R=0.75, P=.008). In addition, 36.4% (n=4) of the participants performed the Checkme measurements without any mistakes. The mean SUS score was 86.4 (SD 8.3). The most important facilitator was the ease of using the Checkme monitor. Most important barriers included the absence of diastolic BP and the incidental difficulties in obtaining an SBP result. CONCLUSIONS Given the good intrauser reproducibility, user-friendliness, and patient experience, all of which facilitate patients to perform frequent measurements, cuffless BP monitoring may change the way patients measure their BP at home in the context of ambulant hypertension management.

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Abstract P184: Is Home Blood Pressure More Strongly Associated with Coronary Artery Calcification Than Clinic Blood Pressure Measured Under an Appropriate Condition?

Circulation ◽

10.1161/circ.133.suppl_1.p184 ◽

2016 ◽

Vol 133 (suppl_1) ◽

Author(s):

Atsushi Satoh ◽

Hisatomi Arima ◽

Atsushi Hozawa ◽

Takashi Hisamatsu ◽

Sayaka Kadowaki ◽

...

Keyword(s):

Blood Pressure ◽

Coronary Artery ◽

Coronary Artery Calcification ◽

Home Blood Pressure ◽

Agatston Score ◽

Ideal Condition ◽

Clinic Blood Pressure ◽

Cross Sectional ◽

Electrical Device ◽

The Mean

Background / Objective: A number of studies have shown that home blood pressure (HBP) is more strongly associated with atherosclerotic diseases than clinic blood pressure (CBP). In previous studies, however, measurement of CBP under suboptimal conditions might have undermined the usefulness of CBP for prediction of atherosclerotic diseases. Therefore, we conducted a cross-sectional analysis to clarify whether HBP is more strongly associated with coronary artery calcification (CAC) than strictly measured CBP among a general population of Japanese men. Methods: From 2006 to 2008, we recruited 1094 male participants randomly selected from the residents in Kusatsu City, Shiga, Japan. CBP was measured twice consecutively by a trained physician using electrical device after 5 minutes of complete rest in a sitting position in a silent room. The participants were asked to measure HBP with an electrical device once in the morning during the consecutive 7 days. HBP was measured in seated position after 2 minutes of rest, within an hour after waking up, after urination and before breakfast. The mean of 2 measurements of CBP and the mean of 7 days of HBP were used in the analysis. CAC was assessed using computed tomography. Presence of CAC was defined as Agatston score >10. After exclusion of 175 participants with missing data on HBP, CBP, or CAC, a total of 919 people were included into the present analysis. We calculated multivariable-adjusted odds ratios (ORs) for presence of CAC per one standard deviation (SD) increase of CBP and HBP, then compared by adding interaction terms to the statistical model. ORs were adjusted for age, body mass index, history of cardiovascular diseases, smoking, ethanol consumption, blood sugar, serum total cholesterol, high density lipoprotein cholesterol, and use of medication (hypertension, dyslipidemia, and diabetes mellitus). Results: The mean systolic CBP (SD) and HBP (SD) were 136.8 (19.0) mmHg and 137.2 (18.5) mmHg, respectively. CBP and HBP were highly correlated (r = 0.74 P <0.001). The difference between CBP and HBP was not significant (P = 0.595). CAC was found in 454 (49.4%) participants. Multivariable-adjusted ORs (95% confidence interval) for presence of CAC were comparable between CBP (1.34 (1.14 - 1.58) per 1SD increase) and HBP (1.37 (1.16 - 1.62) per 1SD increase) (P heterogeneity = 0.819). When mean value of the first 2 days of HBP was used as a sensitivity analysis, we found almost the same results (P heterogeneity = 0.992). Similar results were also obtained for diastolic CBP and HBP (P heterogeneity = 0.968 for 7 days of HBP, 0.566 for 2 days of HBP). Conclusion: In conclusion, the association of CBP measured in an ideal condition with CAC was comparable with that of HBP.

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