Blood Pressure Measurements Taken by Patients are Similar to Home and Ambulatory Blood Pressure Measurements

Abstract

Pierin AMG, Ignez EC, Jacob Filho W, Barbato AJG, Mion Jr. D. Blood pressure measurements taken by patients are similar to home and ambulatory blood pressure measurements. Clinics. 2008;63(1):43-50. OBJECTIVE:To compare blood pressure measurements taken at home by physicians, nurses, and patients with office blood pressure measurement , ambulatory blood pressure monitoring and home blood pressure measurement. METHODS: A total of 44 patients seen by a home care program were studied. Protocol 1 a) blood pressure was measured by the patient, a physician and a nurse during a regular home visit (Home1); b) home blood pressure measurement was measured for 4 days (HBPM1); c) office blood pressure measurement was measured by a physician, a nurse, and the patient; and by 24-hour ambulatory blood pressure monitoring. Protocol 2 blood pressure was measured by the patient, a physician, and a nurse during a special home visit in the presence of a physician and a nurse only (Home2); and b) home blood pressure measurement was taken for the second time (HBPM2). Echocardiography, guided by a two-dimensional echocardiograph, was performed. RESULTS: Protocol 1: a) office blood pressure measurement and Home1 were significantly higher than ambulatory blood pressure monitoring, except for systolic and diastolic office blood pressure measurement taken by the patient or a family member, systolic blood pressure taken by a nurse, and diastolic blood pressure taken by a physician. b) ambulatory blood pressure monitoring and HBPM1 were similar. Protocol 2: a) HBPM2 and Home2 were similar. b) Home2 was significantly lower than Home1, except for diastolic blood pressure taken by a nurse or the patient. There were significant relationships between: a) diastolic blood pressure measured by the patient and the thickness of the interventricular septum, posterior wall, and left ventricular mass; and b) ambulatory and HBPM2 diastolic and systolic blood pressure taken by a physician (home2) and left ventricular mass. Therefore, the data indicate that home blood pressure measurement and ambulatory blood pressure monitoring had good prognostic values relative to "office measurement." CONCLUSION: This study showed that the measurement most similar to home blood pressure measurement and ambulatory blood pressure monitoring was blood pressure measured by the patient, and that home blood pressure measurement and ambulatory blood pressure monitoring had good prognostic value relative to "office measurements". KEYWORDS:Home blood pressure. Ambulatory blood pressure. Office blood pressure measurement. Hypertension. White coat effect.

Adesão ao tratamento e controle da pressão arterial em idosos com hipertensão

“…Older subjects had a high prevalence of the white coat effect, which can only be detected by methods with no health professional contact 23 . No association between the BP control and good adherence was found.…”

Atuação da enfermeira eleva o controle de hipertensos e diminui o efeito do avental branco

“…The elimination of the observer's action in the blood pressure measurement was also identified in a research in which home visits were made to a group of home care patients. During a special home visit that involved only one physician and one nurse who were members of the patient's treatment team, the pressure levels these professionals measured were similar to the HBPM levels, indicating the absence of the observer's effect in that measure (20) .…”

A monitorização residencial da pressão arterial e o controle de um grupo de hipertensos

“…Reinforcing the importance of the observer's role in blood pressure measurement, another study (15) compared nurses' and patients' measures, evidencing that nurses obtained lower values and that, even when repeated after five minutes, although pressure levels dropped, nurses' measures were lower. Another Brazilian study compared pressure levels among different observers and ascertained that patients' and nurses' measures were close (16) .…”