Is the ‘clinic-home blood pressure difference’ associated with psychological distress? A primary care-based study

Clinic blood pressure (CBP) is generally used for diagnosis and treatment monitoring in hypertension, but target organ damage correlates more closely with home blood pressure (HBP). Eliminating the clinic-home blood pressure difference (CHBPD) would make conventional CBP a more accurate alternative to HBP. This prospective, randomized, open trial compared the effect of a once-daily versus a twice-daily regimen of anti-hypertensive therapy on CHBPD. After a 2-week wash-out period, 85 confirmed stage 1 hypertensive patients were randomized to receive 2 mg tri-chlormethiazide daily in one (40 subjects) or two (45 subjects) daily doses for 3 weeks. CBP and HBP measurements were taken during the third week of treatment and the CHBPD calculated. After treatment, the systolic and diastolic CHBPD values were significantly greater in the once-daily regimen than in the twice-daily regimen. Conventional CBP should not be used as an alternative to HBP for evaluating prognosis and monitoring anti-hypertensive therapy when using a once-daily regimen.

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Inter-arm blood pressure difference and mortality: a cohort study in an asymptomatic primary care population at elevated cardiovascular risk

British Journal of General Practice ◽

10.3399/bjgp16x684949 ◽

2016 ◽

Vol 66 (646) ◽

pp. e297-e308 ◽

Cited By ~ 27

Author(s):

Christopher E Clark ◽

Rod S Taylor ◽

Isabella Butcher ◽

Marlene CW Stewart ◽

Jackie Price ◽

...

Keyword(s):

Blood Pressure ◽

Primary Care ◽

Cohort Study ◽

Cardiovascular Risk ◽

Pressure Difference ◽

Primary Care Population ◽

Blood Pressure Difference

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Inter-Arm Blood Pressure Difference Among Nigerian Primary Care Patients— the Need for Dual Arm Blood Pressure Measurement

Journal of Integrative Cardiology Open Access ◽

10.31487/j.jicoa.2020.04.13 ◽

2020 ◽

pp. 1-7

Author(s):

Oluwaseun Solomon Ojo ◽

Akinfemi Joel Fatusin ◽

Bolatito Betty Fatusin ◽

Ademola Oluwaseun Egunjobi ◽

...

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Primary Care ◽

Pressure Measurement ◽

Pressure Difference ◽

Blood Pressure Measurement ◽

Blood Pressure Difference ◽

Primary Care Patients ◽

The Right ◽

Dual Arm

Background: For many decades, hypertension guidelines have recommended dual-arm blood pressure measurement. However, the practice is poor in Nigerian primary care and its significance largely unidentified. Hence, the need to determine the significance of detecting inter-arm blood pressure difference among primary care patients in our local population. This study was done to determine the point prevalence of inter-arm blood pressure difference and its relationship with hypertension and diabetes mellitus. Methods: A cross-sectional study was conducted among 214 respondents at the general outpatient clinic of a tertiary hospital in Nigeria. Demographic characteristics and anthropometric indices were obtained. Blood pressure readings were obtained through sequentially repeated measurements in respondents’ arms. Results: One hundred and eighty-six respondents had complete data given a completion rate of 86.9%. Systolic blood pressure was higher on the right and left arm in 102 (54.8%) and 56 (30.1%) of the respondents respectively. Diastolic blood pressure was higher on the right and left arm in 73 (39.2%) and 63 (33.9%) of the respondents respectively. The overall prevalence of significant systolic inter-arm difference (≥ 10 mmHg) and diastolic inter-arm difference (≥ 10 mmHg) were 24.2% and 18.8% respectively. Significant systolic inter-arm difference (p=0.033) and diastolic inter-arm difference (p=0.01) were significantly more among respondents with hypertension and/or diabetes mellitus. Conclusion: The blood pressure readings in both arms were different among majority of the respondents, being higher on the right arm in more of them. The prevalence of significant inter-arm difference was high in the unselected primary care patients studied especially among patients with hypertension and/or diabetes mellitus. Blood pressure measurement in both arms should become a routine practice during initial patients’ visits in primary care.

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FREQUENCY AND DETERMINANTS OF AMBULATORY VERSUS HOME BLOOD PRESSURE DIFFERENCE AND THEIR DIAGNOSTIC DISAGREEMENT

Journal of Hypertension ◽

10.1097/01.hjh.0000573696.26240.5f ◽

2019 ◽

Vol 37 ◽

pp. e291

Author(s):

A. Ntineri ◽

T. Niiranen ◽

R. McManus ◽

A. Lindroos ◽

A. Jula ◽

...

Keyword(s):

Blood Pressure ◽

Pressure Difference ◽

Home Blood Pressure ◽

Blood Pressure Difference

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PERSONALITY AFFECTS THE WHITE COAT EFFECT DEFINED AS SCREENING HOME BLOOD PRESSURE DIFFERENCE

Journal of Hypertension ◽

10.1097/00004872-200006001-00616 ◽

2000 ◽

Vol 18 ◽

pp. S178

Author(s):

A. Hozawa ◽

Y. Arai ◽

T. Ohkubo ◽

K. Nagai ◽

I. Tsuji ◽

...

Keyword(s):

Blood Pressure ◽

Pressure Difference ◽

Home Blood Pressure ◽

White Coat ◽

White Coat Effect ◽

Blood Pressure Difference

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Influence of home blood pressure measuring conditions in the evening on the morning–evening home blood pressure difference in treated hypertensive patients: the J-HOME study

Blood Pressure Monitoring ◽

10.1097/mbp.0b013e32832e2a40 ◽

2009 ◽

Vol 14 (4) ◽

pp. 160-165 ◽

Cited By ~ 8

Author(s):

Kie Ito ◽

Taku Obara ◽

Takayoshi Ohkubo ◽

Kenta Gonokami ◽

Takahiro Shinki ◽

...

Keyword(s):

Blood Pressure ◽

Pressure Difference ◽

Home Blood Pressure ◽

Hypertensive Patients ◽

Home Study ◽

Blood Pressure Difference

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Prevalence of Inter Arm Blood Pressure Difference among Type 2 Diabetics in Primary Care

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol03-i09/439 ◽

2018 ◽

Vol 3 (09) ◽

Author(s):

Dr. Amal Al Balushi ◽

Dr Firdous Jahan ◽

Dr. Maiya Al Jahdhami ◽

Dr. Kamlesh Bhargava

Keyword(s):

Blood Pressure ◽

Primary Care ◽

Cardiovascular Risk ◽

Pressure Difference ◽

Diabetic Patients ◽

Duration Of Diabetes ◽

Blood Pressure Difference ◽

Type 2 Diabetics ◽

Patients With Diabetes

Hypertension in patients with diabetes is a common problem; it increases the risk of cardiovascular, renal and ophthalmologic complications. Appropriate measurement of blood pressure is important, as the readings are the target of all pharmacological and non-pharmacological treatment. The aim of the present study was to observe the prev-alence of significant difference in blood pressure in the arms in type 2 Diabetics and to establish if there is association between inter-arm blood pressure difference (IAD) and cardiovascular risk. A cross sectional study conducted in 5 primary care health centers. BP measurements were done by automatic Omron 7 machine; the measure-ments were done two times with interchanging the instruments between two arms. Da-ta collection included demographic data (including, age, sex, body mass index (BMI), waist circumferences, duration of Diabetes, history of HTN, and smoking status).The data collection form also included entry of last biochemical investigations done in-cluding total cholesterol, LDL, HDL, triglyceride, glycosylated hemoglobin (HbA1c) and Cardiovascular risk (CV risk ) calculated by UKPDS engine version 2.0. Data was analyzed with SPSS (version 19). A total of 155 patients were studied. Mean age of patients was 55yrs. 22 participants (14.2, 95% CI=9.1-20.7) had systolic IAD >10 mmHg, 51 (33%, 95% CI=25.6-40.9) had a diastolic IAD >5 mmHg and 9 (5.8 %, 95% CI=2.7-10.7) had a diastolic difference >10 mmHg. In addition, the results showed statistically significant correlation between systolic interarm BP difference and duration of diabetes (P=0.025).There is significant diastolic interarm blood pres-sure difference in diabetic patients. Hence it is important to measure the blood pres-sure in both arms for patients with diabetes to treat hypertension in diabetics appropri-ately.

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