scholarly journals Direct Comparison of Home Versus Ambulatory Defined Nocturnal Hypertension for Predicting Cardiovascular Events

Hypertension ◽  
2020 ◽  
Vol 76 (2) ◽  
pp. 554-561 ◽  
Author(s):  
Gontse Gratitude Mokwatsi ◽  
Satoshi Hoshide ◽  
Hiroshi Kanegae ◽  
Takeshi Fujiwara ◽  
Keita Negishi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Events ◽  
Blood Pressure Monitoring ◽  
Home Blood Pressure ◽  
Pressure Monitoring ◽  
Nocturnal Hypertension ◽  
Increased Risk ◽  
Nighttime Blood Pressure ◽  
Study Population ◽  
Artery Disease

The home blood pressure monitoring (HBPM) method that measures blood pressure during sleep hours was reported to be comparable to ambulatory blood pressure monitoring (ABPM) in measuring nighttime blood pressure and detecting nocturnal hypertension. The aim of this study was to directly compare the prognostic power of nocturnal hypertension detected by HBPM versus ABPM for predicting future cardiovascular events. We analyzed nighttime blood pressure (measured by HBPM and ABPM) data of 1005 participants who were included in the J-HOP study (Japan Morning Surge-Home Blood Pressure). During a follow-up period of 7.6±3.4 years, 80 cardiovascular disease events occurred. The majority (91.8%) of our study population were hypertensive, and 80.7% of participants were using antihypertensive medication. Nighttime home systolic blood pressure (SBP) was higher compared to nighttime ambulatory SBP (123.0±14.6 versus 120.3±14.4 mm Hg, P <0.001). Nocturnal hypertension was defined as nighttime home or ambulatory SBP of ≥120 mm Hg. The number of participants with nocturnal hypertension defined by HBPM and ABPM was 564 (56.1%) and 469 (46.7%), respectively. Nocturnal hypertension defined by HBPM was associated with increased risk of future cardiovascular events: total cardiovascular events (coronary artery disease and stroke events; 1.78 [1.00–3.15]) and stroke (2.65 [1.14–6.20]), independent of office SBP. These results were absent with nocturnal hypertension defined by ABPM. This is the first comparison prospective study illustrating that uncontrolled nocturnal hypertension defined by HBPM (independent of office SBP) is a predictor of future cardiovascular events.

Abstract P204: Home Blood Pressure Monitoring: A Missed Opportunity?

Hypertension ◽  
2020 ◽  
Vol 76 (Suppl_1) ◽  
Author(s):  
Gin Den William Chang ◽  
Berta Shamuilova ◽  
Rebecca Mazurkiewicz ◽  
Arber Kodra
Keyword(s):  
Internal Medicine ◽  
Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Internal Medicine Resident ◽  
Home Blood Pressure ◽  
Home Blood Pressure Monitoring ◽  
Pressure Monitoring ◽  
Medicine Resident ◽  
Progress Notes ◽  
Artery Disease

Introduction: The 2017 American College of Cardiology and American Heart Association hypertension guidelines recommend self-measured and home blood pressure (BP) monitoring to confirm the diagnosis of hypertension, to titrate anti-hypertensives and to assess adherence to treatment. However, it is unclear to what extent is home blood pressure monitoring being optimally utilized in everyday clinical practice. Hypothesis: We hypothesized that our Internal Medicine resident clinic underutilizes home BP monitoring as part of the diagnosis and continued management of hypertension. Methods: We performed a retrospective chart review of patients with a history of hypertension patients seen for at our Internal Medicine resident clinic in New York City between July 2019 and September 2019. We examined all progress notes in this time frame for documentation of home BP cuff measurements or prescriptions for home BP monitors as well as patient comorbidities such as tobacco use, coronary artery disease, diabetes and hyperlipidemia. The chi-square test was performed to evaluate and compare guideline adherence between groups. Statistical significance was considered at p < 0.05. Results: A total of 282 patients (mean age: 59) met inclusion criteria, of which, 114 (40.1%) had progress notes discussing home BP monitoring. Of those currently monitoring BP at home, 75/175 female patients (42%) and 68/107 male patients (63%) were not prescribed either a BP cuff or mention of a plan for home BP monitoring (p=0.0007). There was no significant correlation for BP cuff prescriptions or implementation of a BP diary in terms of resident year level, ethnicity, diabetes, coronary artery disease, hyperlipidemia, smoking history. Conclusion: There is a discrepancy in our current practice to incorporate home BP monitoring as part of the comprehensive care of hypertension particularly among males and females. There is a possibility that females are being targeted more for home blood pressure due to the preventive emphasis of cardiovascular morbidity in females. Current interventions including physician and patient clinic education as well as utilization of pamphlets to targeted patients are underway to improve this often overlooked component of hypertension management.

scholarly journals State-of-the-Art review: Home blood pressure monitoring: current status and new developments

2021 ◽  
Author(s):  
Kazuomi Kario
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Blood Pressure Monitoring ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Home Blood Pressure ◽  
Target Organ ◽  
Home Blood Pressure Monitoring ◽  
Pressure Monitoring ◽  
Increased Risk

Abstract Home blood pressure monitoring (HBPM) is a reliable, convenient and less costly alternative to ambulatory blood pressure monitoring (ABPM) for the diagnosis and management of hypertension. Recognition and use of HBPM has dramatically increased over the last 20 years and current guidelines make strong recommendations for the use of both HBPM and ABPM in patients with hypertension. The accuracy and reliability of home BP measurements requires use of a validated device and standardized procedures, and good patient information and training. Key HBPM parameters include morning BP, evening BP and the morning-evening difference. In addition, newer semi-automatic HBPM devices can also measure nighttime BP at fixed intervals during sleep. Advances in technology mean that HBPM devices could provide additional relevant data (e.g. environmental conditions) or determine BP in response to a specific trigger (e.g. hypoxia, increased heart rate). The value of HBPM is highlighted by a growing body of evidence showing that home BP is an important predictor of target organ damage, and cardiovascular disease- and stroke-related morbidity and mortality, and provides better prognostic information than office BP. In addition, use of HBPM to monitor antihypertensive therapy can help to optimize reductions in BP, improve BP control, and reduce target organ damage and cardiovascular risk. Overall, HBPM should play a central role in the management of patients with hypertension, with the goal of identifying increased risk and predicting the onset of cardiovascular disease events, allowing proactive interventions to reduce risk and eliminate adverse outcomes.

scholarly journals Cardiovascular Event Risks Associated With Masked Nocturnal Hypertension Defined by Home Blood Pressure Monitoring in the J-HOP Nocturnal Blood Pressure Study

Hypertension ◽  
2020 ◽  
Vol 76 (1) ◽  
pp. 259-266 ◽  
Author(s):  
Takeshi Fujiwara ◽  
Satoshi Hoshide ◽  
Hiroshi Kanegae ◽  
Kazuomi Kario
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Home Blood Pressure ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Antihypertensive Medications ◽  
Cox Models ◽  
Nocturnal Hypertension ◽  
Sustained Hypertension ◽  
Increased Risk

There is no information regarding the potential association between cardiovascular disease (CVD) event risks and masked nocturnal hypertension defined by home blood pressure (BP) monitoring. We sought to examine this association in a general practice population. For this purpose, we used data from the J-HOP (Japan Morning Surge-Home Blood Pressure) Nocturnal BP Study, which recruited 2745 high-cardiovascular-risk participants (mean [SD] age, 63.6 [10.4] years; 48.7% men; 82.7% on antihypertensive medications). Nocturnal home BPs (HBPs) were measured at 2:00, 3:00, and 4:00 AM using a validated, automated HBP device for 14 consecutive days. The average (SD) of nocturnal HBP measures was 17.1 (13.5). The percentages of participants with controlled BP (nocturnal HBP <120/70 mm Hg and average morning and evening BP <135/85 mm Hg), daytime hypertension (nocturnal HBP <120/70 mm Hg and average morning and evening BP ≥135/85 mm Hg), masked nocturnal hypertension (nocturnal HBP ≥120/70 mm Hg and average morning and evening BP <135/85 mm Hg), and sustained hypertension (nocturnal HBP ≥120/70 mm Hg and average morning and evening BP ≥135/85 mm Hg) were 31.7%, 7.9%, 26.7%, and 33.7%, respectively. During a median 7.6-year follow-up (19 519 person-years), 162 CVD events occurred. The cumulative incidence of CVD events was higher in those with masked nocturnal hypertension and sustained hypertension than in the controlled BP group. Results from Cox models suggested that masked nocturnal hypertension (adjusted hazard ratio, 1.57 [95% CI, 1.00–2.46]) and sustained hypertension (adjusted hazard ratio, 1.97 [95% CI, 1.26–3.06]) were associated with increased risk of CVD events. Participants with masked nocturnal hypertension defined by HBP monitoring are at high risk of future CVD events.

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