scholarly journals Non-Clinic Blood Pressure Measurement – More Light, Less Darkness

2018 ◽  
Vol 10 (1) ◽  
pp. 13-18
Author(s):  
Vinay Kapur
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Measurement ◽  
Target Organ Damage ◽  
Early Morning ◽  
Morbidity And Mortality ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Clinic Blood Pressure ◽  
Night Time ◽  
Nocturnal Hypertension

Non-clinic blood pressure measurements are very important in confirming diagnosis of hypertension and they give us an idea of associated cardiovascular risk more precisely than clinic BP measurements. It can detect masked hypertension and white coat hypertension & ABPM especially can monitor night-time BP diagnosing individuals with nocturnal hypertension.  Masked hypertension and nocturnal hypertension are strongly related with target organ damage along with enhanced morbidity and mortality due to cardiovascular causes. ABPM can also measure early morning rise of BP, mean 24 hour BP, diurnal variation as well as average real variability. Home BP monitoring by patients themselves leads to their greater involvement in maintaining BP records and in achieving treatment goals. The purpose of this review is to preferentially discuss role of non-clinic BP monitoring in making accurate diagnosis and deciding treatment of hypertension that might help a great deal in reducing morbidity and mortality associated with it.        Asian Journal of Medical Sciences Vol.10(1) 2019 13-18 

scholarly journals Office and Ambulatory Arterial Hypertension in Highlanders

Hypertension ◽  
2020 ◽  
Vol 76 (6) ◽  
pp. 1962-1970
Author(s):  
Grzegorz Bilo ◽  
Lorenzo Acone ◽  
Cecilia Anza-Ramírez ◽  
José Luis Macarlupú ◽  
Davide Soranna ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ambulatory Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Blood Pressure Measurement ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Blood Oxygen Saturation ◽  
Chronic Mountain Sickness ◽  
Nocturnal Hypertension ◽  
Mountain Sickness

Millions of people worldwide live at high altitude, being chronically exposed to hypobaric hypoxia. Hypertension is a major cardiovascular risk factor but data on its prevalence and determinants in highlanders are limited, and systematic studies with ambulatory blood pressure monitoring are not available. Aim of this study was to assess the prevalence of clinic and ambulatory hypertension and the associated factors in a sample of Andean highlanders. Hypertension prevalence and phenotypes were assessed with office and ambulatory blood pressure measurement in a sample of adults living in Cerro de Pasco, Peru (altitude 4340 m). Basic clinical data, blood oxygen saturation, hematocrit, and Qinghai Chronic Mountain Sickness score were obtained. Participants were classified according to the presence of excessive erythrocytosis and chronic mountain sickness diagnosis. Data of 289 participants (143 women, 146 men, mean age 38.3 years) were analyzed. Office hypertension was present in 20 (7%) participants, while ambulatory hypertension was found in 58 (20%) participants. Masked hypertension was common (15%), and white coat hypertension was rare (2%). Among participants with ambulatory hypertension, the most prevalent phenotypes included isolated nocturnal hypertension, isolated diastolic hypertension, and systodiastolic hypertension. Ambulatory hypertension was associated with male gender, age, overweight/obesity, 24-hour heart rate, and excessive erythrocytosis. Prevalence of hypertension among Andean highlanders may be significantly underestimated when based on conventional blood pressure measurements, due to the high prevalence of masked hypertension. In highlanders, ambulatory hypertension may be independently associated with excessive erythrocytosis.

MO501INCREASED ALBUMINURIA RISK IN CHRONIC KIDNEY DISEASE PATIENTS WHOSE WHITE COAT-, MASKED-, AND SUSTAINED HYPERTENSION: SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Boby Pratama Putra ◽  
Felix Nugraha Putra
Keyword(s):  
Meta Analysis ◽  
Blood Pressure Measurement ◽  
Target Organ Damage ◽  
Random Effect ◽  
White Coat ◽  
Cochrane Library ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Sustained Hypertension ◽  
Standard Mean Difference

Abstract Background and Aims Latest classification of hypertension based on ambulatory blood pressure measurement was normotension (NT), white coat hypertension (WCHT), masked hypertension (MHT), and sustained hypertension (SHT). Recent studies suggest that WCHT, MHT, and SHT increase risk of target organ damage, particularly albuminuria, although the results were still inconsistent. Albuminuria is not only the sign of early glomerular damage in CKD patients, but also the signs of hypertension progression and predictors for cardiovascular events mortality. This study aims to compare the albuminuria risk among NT and WCHT, MHT, also SHT in CKD patients. Method We searched the literature comprehensively in online databases of Pubmed, EMBASE, ScienceDirect, and Cochrane Library to include all relevant studies using predefined terms until December 2020. We included studies that analyzed the albuminuria risk and compared the log2 urinary albumin-to-creatinine ratio (ACR) among NT and WCHT, MHT, or SHT in CKD patients. We used the Newcastle-Ottawa Scale for Observational Study checklist for evaluating bias risks. Analysis of the studies was conducted to provide pooled Odds Ratio (OR) for albuminuria risk and standard mean difference (SMD) for log2 ACR comparison with 95% Confidence Interval (CI) with random-effect heterogeneity test. Results We included 7 observational studies met our inclusion criteria. WCHT increases albuminuria risk although not statistically significant (pooled OR = 1.72, 95%CI 0.97 to 3.07, p = 0.06, I2 = 75%), while MHT and SHT significantly increase albuminuria risk with pooled OR respectively 1.62 (95%CI 1.03 to 2.53, p = 0.04, I2 = 82%) and 3.17 (95%CI 1.66 to 6.05, p = 0.0005, I2 = 94%). Controlled hypertension significantly protects CKD patients against albuminuria risk based on log2 ACR comparison with WCHT (SMD = 0.52, 95%CI 0.38 to 0.67, p<0.00001, I2 = 0%), MHT (SMD = 0.34, 95%CI 0.19 to 0.49, p<0.0001, I2 = 39%), and SHT (SMD = 0.63, 95%CI 0.31 to 0.95, p=0.0001, I2 = 76%). Conclusion White coat hypertension, masked hypertension, and sustained hypertension increase albuminuria risks in CKD patients. However, further studies are needed to determine the causality.

scholarly journals Long Working Hours and the Prevalence of Masked and Sustained Hypertension

Hypertension ◽  
2020 ◽  
Vol 75 (2) ◽  
pp. 532-538 ◽  
Author(s):  
Xavier Trudel ◽  
Chantal Brisson ◽  
Mahée Gilbert-Ouimet ◽  
Michel Vézina ◽  
Denis Talbot ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ambulatory Blood Pressure ◽  
Blood Pressure Measurement ◽  
Prevalence Ratio ◽  
Working Hours ◽  
Masked Hypertension ◽  
Clinic Blood Pressure ◽  
Long Working Hours ◽  
Sustained Hypertension ◽  
The Mean

Previous studies on the effect of long working hours on blood pressure have shown inconsistent results. Mixed findings could be attributable to limitations related to blood pressure measurement and the lack of consideration of masked hypertension. The objective was to determine whether individuals who work long hours have a higher prevalence of masked and sustained hypertension. Data were collected at 3-time points over 5 years from 3547 white-collar workers. Long working hours were self-reported, and blood pressure was measured using Spacelabs 90207. Workplace clinic blood pressure was defined as the mean of the first 3readings taken at rest at the workplace. Ambulatory blood pressure was defined as the mean of the next readings recorded every 15 minutes during daytime working hours. Masked hypertension was defined as clinic blood pressure < 140/90 mm Hg and ambulatory blood pressure ≥135/85 mm Hg. Sustained hypertension was defined as clinic blood pressure ≥140/90 mm Hg and ambulatory blood pressure ≥135/85 mm Hg or being treated hypertension. Long working hours were associated with the prevalence of masked hypertension (prevalence ratio 49+ =1.70 [95% CI, 1.09–2.64]), after adjustment for sociodemographics, lifestyle-related risk factors, diabetes mellitus, family history of cardiovascular disease, and job strain. The association with sustained hypertension was of a comparable magnitude (prevalence ratio 49+ =1.66 [95% CI, 1.15–2.50]). Results suggest that long working hours are an independent risk factor for masked and sustained hypertension. Workplace strategies targeting long working hours could be effective in reducing the clinical and public health burden of hypertension.

Prevalence and Determinants of Masked Hypertension in Nigeria: The REMAH Study

2020 ◽  
Author(s):  
Augustine N ODILI ◽  
Benjamin DANLADI ◽  
Babangida S CHORI ◽  
Henry OSHAJU ◽  
Peter C NWAKILE ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Blood Glucose ◽  
Confidence Interval ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Clinic Blood Pressure ◽  
Random Blood Glucose ◽  
Oscillometric Device ◽  
Nationally Representative

Abstract Background Estimating the burden of hypertension in Nigeria hitherto relied on clinic blood pressure (BP) measurement alone. This excludes individuals with masked hypertension (MH) i.e. normotensive clinic but hypertensive out-of-clinic BP. Method In a nationally representative sample of adult Nigerians, we obtained clinic BP using auscultatory method and out-of-clinic BP by self-measured home BP with semi-automated oscillometric device. Clinic BP was average of 5 consecutive measurements and home BP was average of 3 days duplicate morning and evening readings. MH was clinic BP &lt; 140 mmHg systolic and 90 mmHg diastolic and home BP ≥ 135 mmHg systolic and/or 85 mmHg diastolic. Result Among 933 participants, the prevalence of sustained, masked and white-coat hypertension was 28.3, 7.9 and 11.9 % respectively. Among subjects whose clinic BP were in the normotensive range (n=558), the prevalence of MH was 13%; 12% among untreated and 27% among treated individuals. The mutually adjusted odds ratios of having MH among all participants with normotensive clinic BP were 1.33 (95% confidence interval, 1.10–1.60) for a 10-year higher age, 1.59 (1.09–2.40) for a 10 mm Hg increment in systolic clinic BP, and 1.16 (1.08–1.28) for a 10mg/dl higher random blood glucose. The corresponding estimates in the untreated population were 1.24 (1.03–1.51), 1.56 (1.04–2.44) and 1.16 (1.08– 1.29), respectively. Conclusion MH is common in Nigeria and increasing age, clinic systolic BP and random blood glucose are the risk factors.

scholarly journals Is there a need to redo many of the diagnoses of hypertension?

2012 ◽  
Vol 130 (3) ◽  
pp. 173-178
Author(s):  
José Marcos Thalenberg ◽  
Bráulio Luna Filho ◽  
Maria Teresa Nogueira Bombig ◽  
Yoná Afonso Francisco ◽  
Rui Manuel dos Santos Póvoa
Keyword(s):  
Blood Pressure ◽  
Drug Withdrawal ◽  
Blood Pressure Monitoring ◽  
Target Organ Damage ◽  
Diagnostic Procedures ◽  
White Coat ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Cross Sectional ◽  
Clinical Measurements

CONTEXT AND OBJECTIVE: Most hypertensive subjects undergoing treatment were diagnosed solely through measurements made in the consultation office. The objective of this study was to redo the diagnosis of treated patients after new clinical measurements and ambulatory blood pressure monitoring (ABPM). DESIGN AND SETTING: Cross-sectional study conducted in an outpatient specialty clinic. METHODS: Patients with mild-to-moderate hypertension or undergoing anti-hypertensive treatment, without target organ damage or diabetes, were included. After drug withdrawal lasting 2-3 weeks, new blood pressure (BP) measurements were made during two separate visits. ABPM was performed blindly, in relation to clinical measurements. The BP thresholds used for diagnosing hypertension, white-coat hypertension, normotension and masked hypertension were: 140 (systolic) and 90 (diastolic) mmHg for office measurements and 135 (systolic) and 85 (diastolic) mmHg for mean awake ABPM (MAA). RESULTS: Evaluations were done on 101 subjects (70% women); mean age 51 ± 10 years. The clinical BP was 155 ± 18/97 ± 10 mmHg (first visit) and 150 ± 16/94 ± 11 mmHg (second visit); MAA was 137 ± 13/ 86 ± 10 mmHg. Sixty-four patients (63%) were confirmed as hypertensive, 28 (28%) as white-coat hypertensive, nine (9%) as normotensive and none as masked hypertensive. After ABPM, 37% of the presumed hypertensive patients did not fit into this category. CONCLUSION: This study showed that hypertension was overdiagnosed among hypertensive subjects undergoing treatment. New diagnostic procedures should be performed after drug withdrawal, with the aid of BP monitoring.

Reliability of single office blood pressure measurements

Heart ◽  
2018 ◽  
Vol 104 (14) ◽  
pp. 1173-1179 ◽  
Author(s):  
Thilo Burkard ◽  
Michael Mayr ◽  
Clemens Winterhalder ◽  
Licia Leonardi ◽  
Jens Eckstein ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Measurement ◽  
Office Blood Pressure ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Short Term ◽  
Cross Sectional ◽  
Registration Number ◽  
The Mean ◽  
The Difference

ObjectivesStandard operating procedures for office blood pressure measurement (OBPM) vary greatly between guidelines and studies. We aimed to compare the difference between a single OBPM and the mean of the three following measurements. Further, we studied how many patients with possible hypertension may be missed due to short-term masked hypertension (STMH) and how many might be overdiagnosed due to short-term white coat hypertension (STWCH).Design and settingIn this cross-sectional, single-centre trial, 1000 adult subjects were enrolled. After 5 min of rest, four sequential standard OBPMs were performed at 2 min intervals in a quiet room in sitting position. We compared the first (fBPM) to the mean of the second to fourth measurement (mBPM). STMH was defined as fBPM <140 mm Hg systolic and <90 mm Hg diastolic and mBPM systolic ≥140 mm Hg or diastolic ≥90 mm Hg. STWCH was defined as fBPM systolic ≥140 mm Hg or diastolic ≥90 mm Hg and mBPM <140 mm Hg systolic and <90 mm Hg diastolic.ResultsComplete measurements were available in 802 subjects. Between fBPM and mBPM, 662 (82.5%), 441 (55%) and 208 (25.9%) subjects showed a difference in systolic and 531 (66.2%), 247 (30.8%) and 51 (6.4%) in diastolic blood pressure (BP) values of >2 mm Hg, >5 mm Hg and >10 mm Hg, respectively. In 3.4% of initially normotensives STMH and in 34.3% of initially hypertensives, STWCH was apparent.ConclusionsThere are significant differences between a single OBPM and the mean of consecutive BP measurements. Our study provides evidence that a single OBPM should not be the preferred method and should be discouraged in future guidelines.Trial registration numberNCT02552030;Results.

scholarly journals Clinical applications for out-of-office blood pressure monitoring

2020 ◽  
Vol 11 ◽  
pp. 204062232090166 ◽  
Author(s):  
Hailan Zhu ◽  
Haoxiao Zheng ◽  
Xinyue Liu ◽  
Weiyi Mai ◽  
Yuli Huang
Keyword(s):  
Blood Pressure ◽  
Clinical Studies ◽  
Blood Pressure Monitoring ◽  
Target Organ Damage ◽  
Epidemiological Data ◽  
Organ Damage ◽  
Home Blood Pressure ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Pressure Monitoring

Hypertension is one of the most common chronic diseases as well as the leading risk factor for cardiovascular disease (CVD). Efficient screening and accurate blood pressure (BP) monitoring are the basic methods of detection and management. However, with developments in electronic technology, BP measurement and monitoring are no longer limited to the physician’s office. Epidemiological and clinical studies have documented strong evidence for the efficacy of out-of-office BP monitoring in multiple fields for managing hypertension and CVD. This review discusses applications for out-of-office BP monitoring, including home blood pressure monitoring (HBPM) and ambulatory blood pressure monitoring (ABPM), based on recent epidemiological data and clinical studies regarding the following factors: the detection of abnormal BP phenotypes, namely, white coat hypertension and masked hypertension; stronger ability to determine the prognosis for target organ damage and mortality; better BP control; screening for hypotension; and unique approaches to identifying circadian BP patterns and BP variability.

scholarly journals Impact of 2018 ESC/ESH and 2017 ACC/AHA Hypertension Guidelines: Difference in Prevalence of White-Coat and Masked Hypertension

Healthcare ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 122
Author(s):  
Byong-Kyu Kim ◽  
Moo-Yong Rhee
Keyword(s):  
Blood Pressure ◽  
White Coat ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Clinic Blood Pressure ◽  
Hypertension Guidelines ◽  
Diagnostic Threshold ◽  
High Prevalence ◽  
Drug History ◽  
Research Grade

Our study evaluated whether there were differences in the prevalence of white-coat hypertension (WH) and masked hypertension (MH) based on the 2018 ESC/ESH and 2017 ACC/AHA hypertension guidelines in Korea. The motivation was the lowering of the diagnostic threshold for hypertension in the 2017 ACC/AHA guidelines. Of 319 participants without antihypertensive drug history and with suspected hypertension based on outpatient clinic blood pressure (BP) measured by physicians, 263 participants (51.6 ± 9.6 years; 125 men) who had valid research-grade office BP and 24-h ambulatory BP measurements were enrolled. WH prevalence based on daytime ambulatory BP among normotensive individuals was lower with the ESC/ESH guidelines than the ACC/AHA guidelines (29.0% vs. 71.4%, p < 0.001). However, MH prevalence based on daytime ambulatory BP among hypertensive individuals was higher based on the ESC/ESH guidelines (21.6% vs. 1.8%, p < 0.001). Seventy percent of WH cases (2017 ACC/AHA guidelines) and 95.2% of MH cases (2018 ESC/ESH guidelines) occurred in individuals with systolic BP of 130–139 mmHg and/or diastolic BP of 80–89 mmHg. The diagnostic threshold of the 2017 ACC/AHA guidelines yielded a higher prevalence of WH compared to that of the 2018 ESC/ESH guidelines. However, the prevalence of MH was higher with the 2018 ESC/ESH guidelines than with the 2017 ACC/AHA guidelines. The high prevalence of WH and MH in people with a systolic BP of 130–139 mmHg or diastolic BP of 80–89 mmHg suggests the need for a more active out-of-office BP measurement in this patient group.

scholarly journals Assessment of the diagnostic accuracy of home blood pressure monitoring by patients

2020 ◽  
Vol 10 (4) ◽  
pp. e31-e31
Author(s):  
Sepideh Hajian ◽  
Nafiseh Rastgoo ◽  
Sanaz Jamshidi
Keyword(s):  
Blood Pressure ◽  
Diagnostic Accuracy ◽  
Blood Pressure Monitoring ◽  
Blood Pressure Measurement ◽  
Home Blood Pressure ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Home Blood Pressure Monitoring ◽  
Pressure Monitoring ◽  
High Level

Introduction: According to available guidelines, home blood pressure monitoring (HBPM) can be used to diagnose hypertension and monitor its treatment; however, its effectiveness has rarely been studied in developing countries, including Iran. Objectives: This study aimed to evaluate the diagnostic accuracy of HBPM, as compared with that of 24-hour ambulatory blood pressure monitoring (ABPM) and office blood pressure measurement (OBPM). Patients and Methods: This study was conducted on 28 patients suspected of having primary hypertension. The blood pressure of the patients was measured by four methods. Initially, blood pressure was measured by a non-physician using a digital sphygmomanometer in a clinic (OBPM-Digital). After about 1 hour, blood pressure was measured by a physician at the clinic using a mercury sphygmomanometer (OBPM-Mercury). In the third stage, the patient’s blood pressure was monitored for 24 hours by the ABPM method. In the fourth stage, each subject used a digital sphygmomanometer to measure HBPM for seven consecutive days. Results: The blood pressure values measured through the ABPM method were significantly lower than those measured by other methods (P<0.05). The prevalence of hypertension diagnosed by OBPM-Mercury, OBPM-Digital, HBPM, and ABPM method was 82%, 54%, 50%, and 21%, respectively. As compared with ABPM as the gold standard, the diagnostic accuracy of HBPM, OBPM-Digital, and OBPM-Mercury was 64%, 61%, and 32%, respectively. The frequency of white coat hypertension (WCH) diagnosed by HBPM and ABPM methods was 39% and 64%, respectively, and the frequency of masked hypertension (MH) diagnosed was 7% and 4%, respectively. The sensitivity, specificity, and diagnostic accuracy of HBPM, as compared with ABPM, in detecting MH were 100%, 96%, and 97%, respectively; in addition, as compared with WCH, they were 56%, 90%, and 68%, respectively. Conclusion: The findings of the present study showed that HBPM had higher diagnostic accuracy than OBPM in diagnosing hypertension. Also, HBPM was able to detect MH with a high level of diagnostic accuracy, and in more than two-thirds of cases, it was also able to detect WCH and diagnose patients with sustained hypertension.

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