Abstract 072: Paradoxical Blood Pressure Increase After Brief Patient Rest Period

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Abimbola Shofu ◽  
Timothy Kennedy ◽  
Bassam Omar ◽  
Christopher Malozzi ◽  
G. Mustafa Awan
Keyword(s):  
Blood Pressure ◽  
Rest Period ◽  
Public Health Problem ◽  
White Coat ◽  
White Coat Hypertension ◽  
Paradoxical Response ◽  
Minute Period ◽  
Number Of Patients ◽  
The Cost ◽  
Medication Changes

Background: Office-based blood pressure (BP) measurement is subject to variations which may influence management. Objective: To assess the effect of rest period on repeat BP measurement. Methods: Clinic charts were review identified 200 encounters with BP re-measurement due to initial BP of > 130/80 mmHg. BP was measured initially by a nurse, with the patient in a sitting position and the arm resting at the level of the heart. If BP was > 130/80 mmHg, it was repeated by physician after resting the patient for 15 minutes. Mean age was 64 ± 12 years. Results: Among encounters with BP re-measurement, initial systolic BP (SBP) was 154 ± 25 mmHg, and diastolic BP 87 ± 15 mmHg. Upon re-measurement, 135 of 200 patients (68%) had lower SBP of 144 ± 21 mmHg compared with initial SBP of 161 ± 25 mmHg; a 17 mmHg drop (P < 0.01). However, 53 of 200 patients (27%) had higher SBP of 149 ± 17 mmHg compared with initial SBP of 138 ± 14 mmHg; an 11 mmHg increase (P < 0.01). Twelve patients (6%) had no BP change. In 47% (93/200) of encounters, BP re-measurement necessitated medication changes. Compared with the remaining patients, those with paradoxical increase in BP were younger (60 ± 9 years versus 66 ± 12 years; p < 0.01), and with lower initial SBP (138 ± 14 versus 161 ± 25, p < 0.01). Discussion: Hypertension is a major challenging public health problem. JNC 8 guidelines recommend that prior to BP measurement, patients should be seated quietly for at least 5 minutes in a chair, with feet on the floor, and arm supported at heart level; this may decrease initially elevated BP. However, 27% of our patients exhibited a paradoxical response, with elevation of the SBP after a 15 minute period of rest. The cause of this paradox is not clear, but may have resulted from white-coat hypertension during the rest period, which may be more common in younger patients, as noted in our study. This underscores the importance of ambulatory BP monitoring, especially in subsets of patients prone to having labile or white coat hypertension, to avoid the cost and side effects of BP overtreatment. Studying larger number of patients, and including patient with normal initial BP, may help clarify the mechanism and clinical significance of this observation.

Abstract 106: Paradoxical Increase in Office-Based Blood Pressure Measurement After a Brief Patient Rest Period

Hypertension ◽  
2012 ◽  
Vol 60 (suppl_1) ◽  
Author(s):  
Keerthana Karumbaiah ◽  
Nidal Omar ◽  
Bassam A Omar
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Measurement ◽  
Measurement Data ◽  
Rest Period ◽  
Public Health Problem ◽  
White Coat ◽  
White Coat Hypertension ◽  
Paradoxical Response ◽  
Minute Period ◽  
Cardiology Clinic

BACKGROUND: Office-based blood pressure (BP) measurement is a snapshot of a patient’s ambulatory BP, and is subject to variations which may influence management. OBJECTIVE: To assess the effect of a brief rest period on repeat BP measurement. METHODS: Patient charts reviewed in University-based cardiology clinic identified 170 encounters which contained BP re-measurement data due to elevated initial BP of > 130/80 mmHg. BP was measured initially by a nurse, with the patient in a sitting position and the arm resting at the level of the heart. If BP was > 130/80 mmHg, it was repeated by physician after resting the patient for 15 minutes. Mean age was 64 ± 12 years. Results: Among encounters with BP re-measurement, initial systolic BP (SBP) was 153 ± 27 mmHg, and diastolic BP was 87 ± 16 mmHg. Upon re-measurement, 106 of 170 patients (62%) had lower SBP of 143 ± 23 mmHg compared with initial SBP of 162 ± 28 mmHg; a mean drop of 18 mmHg. However, 53 of 170 patients (31%) had higher SBP of 149 ± 17 mmHg compared with initial SBP of 138 ± 14 mmHg; a mean increase of 10 mmHg. Eleven patients (7%) had no BP change. In 50% (85/170) of encounters, BP re-measurement necessitated hypertensive medication changes. Compared with the remaining patients, those with paradoxical increase in BP were younger (60 ± 9 years versus 66 ± 13 years; p < 0.01), more females (57% versus 47%), and with lower initial SBP (134 ± 14 versus 160 ± 28, p < 0.01). DISCUSSION: Hypertension is a challenging public health problem. JNC 7 guidelines recommend that prior to BP measurement, persons should be seated quietly for at least 5 minutes in a chair, with feet on the floor, and arm supported at heart level; this may decrease initially elevated BP. However, 30% of our patients exhibited a paradoxical response, with elevation of the SBP after a 15 minute period of rest. The cause of this paradox is not clear, but may have resulted from white-coat hypertension during the rest period, which may be more common in younger patients, especially females, as noted in our study. This underscores the importance of ambulatory BP monitoring, especially in subsets of patients prone to having labile or white coat hypertension, to avoid the cost and side effects of BP overtreatment.

scholarly journals Diagnosis of white-coat hypertension based solely on systolic blood pressure. The PIUMA study

2005 ◽  
Vol 18 (5) ◽  
pp. A46-A46 ◽  
Author(s):  
P VERDECCHIA ◽  
F ANGELI ◽  
G REBOLDI ◽  
R GATTOBIGIO ◽  
M SARDONE ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
White Coat ◽  
White Coat Hypertension

scholarly journals P115 Does Post-stroke White Coat Hypertension/Effect (WCH/E) Require Intensive Blood Pressure Management?

2020 ◽  
Vol 25 (Supplement 1) ◽  
pp. S155
Author(s):  
Fran Kirkham ◽  
GN Nuredini ◽  
A Saunders ◽  
Erin Drazich ◽  
Eva Bunting ◽  
...  
Keyword(s):  
Blood Pressure ◽  
White Coat ◽  
White Coat Hypertension ◽  
Pressure Management ◽  
Post Stroke ◽  
Blood Pressure Management ◽  
Intensive Blood Pressure

Abstract 11530: Age-Specific Differences Between Conventional and Ambulatory Daytime Blood Pressure Values

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
David Conen ◽  
Stefanie Aeschbacher ◽  
Lutgarde Thijs ◽  
Yan Li ◽  
José Boggia ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Population Based ◽  
White Coat ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Daytime Blood Pressure ◽  
Collaborative Analysis ◽  
The Individual ◽  
Age Range ◽  
Diagnosis Of Hypertension

Introduction: Mean daytime ambulatory blood pressure (ABP) values are considered to be lower than conventional BP (CBP) values, but data on this relation among younger individuals <50 years are scarce. To address this issue, we performed a collaborative analysis in a large group of participants representing a wide age range. Methods: CBP and 24-hour ABP were measured in 9550 individuals not taking BP lowering treatment from 13 population based cohorts. We compared the individual differences between daytime ABP and CBP according to 10-year age categories. Age-specific prevalences of white-coat hypertension and masked hypertension were calculated based on guideline-recommended thresholds. Results: Among individuals aged 18-30, 30-40 and 40-50 years, mean daytime systolic and diastolic ABP were significantly higher than the corresponding CBP (6.0, 5.2 and 4.7 mmHg for systolic BP; 2.5, 2.7 and 1.7 mmHg for diastolic BP, all p<0.0001) (Figure). Systolic and diastolic BP indices were similar in participants aged 50-60 years (p=0.20 and 0.11, respectively). In individuals aged 60-70 and ≥70 years, CBP was significantly higher than daytime ABP (5.0 and 13.0 mmHg for systolic BP; 2.0 and 4.2 mmHg for diastolic BP, all p<0.0001) (Figure). Accordingly, the prevalence of white coat hypertension exponentially increased from 2.2% to 19.5% from those aged 18-30 years to those aged ≥70 years, with some variation between men and women (prevalence 8.0% versus 6.1%, p=0.0003). Masked hypertension was more prevalent among men (21.1% versus 11.4%, p<0.0001). The age-specific prevalence of masked hypertension was 18.2%, 27.3%, 27.8%, 20.1% 13.6% and 10.2% in men, and 9.0%, 9.9%, 12.2%, 11.9%, 14.7% and 12.1% in women. Conclusions: In this large collaborative analysis we found that the relation between daytime ABP and CBP strongly varies by age. These findings may have important implications for the diagnosis of hypertension and its subtypes in clinical practice.

Abstract 2745: Diagnostic Algorithm Using Office and Home Blood Pressures to Exclude White Coat Hypertension

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Sujith Kuruvilla ◽  
Kiran Nallella ◽  
Anne Mani ◽  
Geetha Pinto ◽  
Daichi Shimbo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Sensitivity And Specificity ◽  
Diagnostic Algorithm ◽  
White Coat ◽  
White Coat Hypertension ◽  
Clinic Blood Pressure ◽  
Cutoff Value ◽  
Sustained Hypertension ◽  
Traditional Algorithm ◽  
Blood Pressures

Background: It has been suggested that the diagnosis of sustained hypertension (SHTN), defined as clinic blood pressure (CBP) ≥140 or ≥90 mmHg plus a daytime ambulatory BP (ABP) ≥135 or ≥85 mmHg can be optimized by taking home BP (HBP) in those with high CBP, and obtaining ABP only if HBP is normal (<135/85). This study tested whether a higher cutoff value for CBP using Receiver Operator Curves (ROC) based on systolic and diastolic CBP for the diagnosis of SHT (95% specificity) would improve the efficiency of the algorithm for diagnosing SHT and reduce the number of subjects requiring HBP and ABP to establish the diagnosis. Methods and Results: We assessed CBP, ABP and HBP in 229 normotensive and untreated hypertensive subjects. CBP was high in 84 subjects. Of these, 74 (88%) had SHTN, and 10 (12%) white coat HTN (WCH- high CBP but normal ABP). With HBP, 69 (82%) had high HBP, and of these 63 (91%) had SHT. Based on traditional algorithm, 15 subjects require ABP monitoring to diagnose SHT, which would be confirmed in 11. Using the ROC algorithm, 55 of 84 subjects (50 SHT; 5 WCH) would be classified as ``hypertensive” (at or above the CBP cut-off); 29 subjects would fall below the cut-off and require HBP (with 24 having SHT); 5 subjects would require ABP. The sensitivity and specificity for diagnosing SHT were 100% and 40% for the traditional algorithm, and 100% and 20% for the ROC algorithm. Conclusions: The ROC algorithm is as effective as the traditional algorithm for diagnosing SHT, and requires fewer HBPs (29 vs. 84) and ABPs (5 vs. 15). Therefore, this algorithm may have widespread indications for the screening of ambulatory hypertension.

scholarly journals Hypertension Subtypes among Thai Hypertensives: An Analysis of Telehealth-Assisted Instrument in Home Blood Pressure Monitoring Nationwide Pilot Project

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Sakolwat Montrivade ◽  
Pairoj Chattranukulchai ◽  
Sarawut Siwamogsatham ◽  
Yongkasem Vorasettakarnkij ◽  
Witthawat Naeowong ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Demographic Data ◽  
Real Life ◽  
Antihypertensive Agents ◽  
Home Blood Pressure ◽  
White Coat ◽  
White Coat Hypertension ◽  
Routine Practice ◽  
White Coat Effect

Background. White-coat hypertension (HT), masked HT, HT with white-coat effect, and masked uncontrolled HT are well-recognized problems of over- and undertreatment of high blood pressure in real-life practice. However, little is known about the true prevalence in Thailand. Objectives. To examine the prevalence and characteristics of each HT subtype defined by mean home blood pressure (HBP) and clinic blood pressure (CBP) using telemonitoring technology in Thai hypertensives. Methods. A multicenter, observational study included adult hypertensives who had been diagnosed for at least 3 months based on CBP without the adoption of HBP monitoring. All patients were instructed to manually measure their HBP twice a day for the duration of at least one week using the same validated automated, oscillometric telemonitoring devices (Uright model TD-3128, TaiDoc Corporation, Taiwan). The HBP, CBP, and baseline demographic data were recorded on the web-based system. HT subtypes were classified according to the treatment status, CBP (≥or <140/90 mmHg), and mean HBP (≥or <135/85 mmHg) into the following eight subtypes: in nonmedicated hypertensives, there are four subtypes that are normotension, white-coat HT, masked HT, and sustained HT; in treated hypertensives, there are four subtypes that are well-controlled HT, HT with white-coat effect, masked uncontrolled HT, and sustained HT. Results. Of the 1,184 patients (mean age 58 ± 12.7 years, 59% women) from 46 hospitals, 1,040 (87.8%) were taking antihypertensive agents. The majority of them were enrolled from primary care hospitals (81%). In the nonmedicated group, the prevalence of white-coat and masked HT was 25.7% and 7.0%, respectively. Among the treated patients, the HT with white-coat effect was found in 23.3% while 46.7% had uncontrolled HBP (a combination of the masked uncontrolled HT (9.6%) and sustained HT (37.1%)). In the medicated older subgroup (n = 487), uncontrolled HBP was more prevalent in male than in female (53.6% vs. 42.4%, p=0.013). Conclusions. This is the first nationwide study in Thailand to examine the prevalence of HT subtypes. Almost one-fourth had white-coat HT or HT with white-coat effect. Approximately half of the treated patients especially in the older males had uncontrolled HBP requiring more intensive interventions. These results emphasize the role of HBP monitoring for appropriate HT diagnosis and management. The cost-effectiveness of utilizing THAI HBPM in routine practice needs to be examined in the future study.

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