Blood pressure measurement protocol determines hypertension phenotypes in a Middle Eastern population

Abstract

Clinic blood pressure (BP) measurement remains a crucial step in managing hypertension. While the number of measures recorded in different settings varies, with typically 1‐3 measures, there has been no prior justification for the actual number of measures required. We investigated the pattern of BP variability over 5 consecutive automated readings (R1‐R5) and the influence of patient characteristics on this pattern to identify the phenotype of hypertension in a Middle Eastern population. There were 1389 outpatients (51% men, 49% women), age range (18‐87 y) who had 5 unattended automated consecutive BP measurements with one‐minute intervals using the validated Datascope Mindray Passport V Monitor with the patient blinded from the results. Mean (±SEM) SBP for R1 (136.0 ± 2 mm Hg) was similar to R2 (136.2 ± 2 mm Hg). Thereafter SBP progressively declined till R5 by total of 5.5 mm Hg. The SBP decline was less (4.2 mm Hg) in older (>50 years) vs younger participants (8.1 mm Hg; P < .001) and was blunted in diabetic and hypertensive participants. Overall, 43% of participants had R2 > R1, and 24% additionally had R5 > R1. Age was a strong independent predictor of having both R2 > R1 and R5 > R1, as well as diabetes. Diastolic blood pressure (DBP) decreased by average 2.8 mm Hg from R1 to R5. Females had a 5‐fold greater total decline in DBP vs males (P < .001). Using the mean of 5 BP measures resulted in fewer participants being classified as hypertensive (36% of the population) compared to using one measurement (46%), or established BP guidelines which use different combinations of R1‐R3 (37%‐42%). Our findings in a Middle Eastern population highlight the importance of the BP measurement protocol in combination with patient characteristics in determining whether a patient is diagnosed with hypertension. Protocols that rely on different combinations of only 3 measures (R1‐3) will classify more participants as hypertensive, compared to using 5 measures or disregarding a high R2.

Association between high-mobility group box 2 and subclinical hypertension-mediated organ damage in young adults

“…The blood pressure (BP) measurement protocol suggested at least 5 min of rest in a seated position followed by two repeated measurements at 5-min intervals. 4 , 24 Clinic BP measurements were consecutively performed 3 times at clinic visits by trained medical staff using an HEM-1000 BP monitor (Omron Healthcare). Ambulatory BP monitoring was measured using the same type of ambulatory BP monitor (ABPM 6100; Welch Allyn) for each participant.…”

“…Blood samples were collected at field sites using standard protocols. 24 , 28 The level of HMGB2 in serum samples was measured by an HMGB2-ELISA kit (CSB-EL010560MO, CUSABIO Life Science) according to the manufacturer’s guidelines. 12 …”

“…Blood samples were collected at field sites using standard protocols. 24,28 The level of HMGB2 in serum samples was measured by an HMGB2-ELISA kit (CSB-EL010560MO, CUSABIO Life Science) according to the manufacturer's guidelines. 12 Evaluation of subclinical organ damage Carotid-femoral pulse wave velocity (cf-PWV) is considered the gold standard for arterial stiffness assessment in clinical practice.…”