Efficacy of isolated home blood pressure monitoring for blood pressure control

Fuchs, Sandra Cristina Pereira Costa; Ferreira-Da-Silva, Andre L; Moreira, Leila Beltrami; Neyeloff, Jeruza Lavanholi; Fuchs, Felipe Costa; Gus, Miguel; Wiehe, Mário; Fuchs, Flávio Danni

doi:10.1097/hjh.0b013e32834e5a4f

Cited by 33 publications

(20 citation statements)

References 19 publications

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“…The remaining ten studies contained all three types of BP measurement (OBPM, HBPM, and ABPM) and BP control data. Two were cross-sectional observational analyses, 30 , 31 five were randomized controlled trials, 32 – 36 and three were quasi-experimental studies without an active intervention 37 , 38 or a control group. 39 The majority of study populations consisted of individuals with mild-to-moderate hypertension, either treated or untreated.…”

Section: Resultsmentioning

confidence: 99%

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Does home blood pressure monitoring improve patient outcomes? A systematic review comparing home and ambulatory blood pressure monitoring on blood pressure control and patient outcomes

Breaux-Shropshire¹,

Judd²,

Vucovich³

et al. 2015

IBPC

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ObjectiveOur objective was to compare the clinical effectiveness of home blood pressure monitoring (HBPM) and 24-hour ambulatory blood pressure monitoring (ABPM) on blood pressure (BP) control and patient outcomes.DesignA systematic review was conducted. We also appraised the methodological quality of studies.Data sourcesPubMed, Scopus, CINAHL, and the Cochrane Central Register of Control Trials (CENTRAL).Inclusion criteriaRandomized control trials, prospective and retrospective cohort studies, observational studies, and case-control studies published in English from any year to present that describe HBPM and 24-hour ABPM and report on systolic and/or diastolic BP and/or heart attack, stroke, kidney failure and/or all-cause mortality for adult patients. Due to the nature of the question, studies with only untreated patients were not considered.ResultsOf 1,742 titles and abstractions independently reviewed by two reviewers, 137 studies met predetermined criteria for evaluation. Nineteen studies were identified as relevant and included in the paper. The common themes were that HBPM and ABPM correlated with cardiovascular events and mortality, and targeting HBPM or ABPM resulted in similar outcomes. Associations between BP measurement type and mortality differed by study population. Both the low sensitivity of office blood pressure monitoring (OBPM) to detect optimal BP control by ABPM and the added association of HBPM with cardiovascular mortality supported the routine use of HBPM in clinical practice. There was insufficient data to determine the benefit of using HBPM as a measurement standard for BP control.ConclusionHBPM encourages patient-centered care and improves BP control and patient outcomes. Given the limited number of studies with both HBPM and ABPM, these measurement types should be incorporated into the design of randomized clinical trials within hypertensive populations.

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Section: Resultsmentioning

confidence: 99%

“… 33 Fuchs et al showed that merely randomizing an individual to HBPM and not making any antihypertensive medication adjustments improves BP control. 38 Using HBPM to titrate antihypertensive medication produces the same level of control as using ABPM. 36 …”

Section: Resultsmentioning

confidence: 99%

Does home blood pressure monitoring improve patient outcomes? A systematic review comparing home and ambulatory blood pressure monitoring on blood pressure control and patient outcomes

Breaux-Shropshire¹,

Judd²,

Vucovich³

et al. 2015

IBPC

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“…This cross-sectional study was done with patients screened to participate in the MONITOR study (Randomized clinical trial of efficacy of home blood pressure monitoring and target organ damage; ClinicalTrials.gov NCT00921791) [ 15 ]. This study was conducted in the Hypertension Clinic of the Division of Cardiology of Hospital de Clínicas de Porto Alegre (Porto Alegre, Brazil).…”

Section: Methodsmentioning

confidence: 99%

“…The exclusion criteria included severe hypertension (office BP ≥ 180/110 mmHg), secondary hypertension, disabling chronic disease (cancer, liver cirrhosis, heart failure, unstable angina pectoris, mental disorders), and myocardial infarction or stroke within six months of enrollment. The results of the main study were published elsewhere [ 15 ].…”

Section: Methodsmentioning

confidence: 99%

Are Retinal Vessels Calibers Influenced by Blood Pressure Measured at the Time of Retinography Acquisition?

Fuchs¹,

Pakter

Maestri

et al. 2015

PLoS ONE

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BackgroundRetinal arterial narrowing is associated with higher office blood pressure (BP) and ambulatory blood pressure monitoring, and increased incidence of cardiovascular disease, but it is still unknown if the vessel caliber is associated with BP measured at the time of retinography acquisition.MethodsRetinal arteriolar and venular calibers were measured by the microdensitometric method in 448 patients with hypertension. Participants underwent 24-hours ambulatory blood pressure (24-h ABP) monitoring simultaneously with the retinography acquisition. Association between arteriolar and venular calibers with increase of 10 mmHg in the mean 24-hours, daily, and nightly BP, and with BP measured at the time of retinography, was evaluated by ANOVA and multivariate analyses.ResultsMean 24-hours, daytime and nighttime systolic and diastolic BP were inversely associated with the arteriolar caliber, but not with the venular caliber. Arteriolar caliber decreased -0.8 (95% CI -1.4 to -0.2) μm per 10-mmHg increase in 24-hours mean systolic BP, adjusted for age, gender, fellow vessel, and duration of hypertension (P = 0.01). The corresponding decreasing in arteriolar caliber by 10 mmHg of increasing in mean diastolic BP was -1.1 μm (-2.0 to -0.2, P = 0.02). The decrease of arteriolar caliber by the same increasing of BP measured at the time of retinography was lower and not statistically significant, particularly for mean diastolic BP and outer arterioles calibers: -1.0 (-1.8 to -0.2) μm in the daytime BP average versus -0.3 (-0.9 to 0.3) at the moment of retinography acquisition.ConclusionsThese findings suggest that the caliber of arteriolar retinal vessels in patients with uncontrolled hypertension are not significantly influenced by blood pressure measured at the time of retinography acquisition.

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“…Low- and middle-income countries may even be facing a persistent increase of individuals with high BP in the next decade [ 1 , 4 ]. Successful attempts have been shown to increase BP control [ 5 , 6 ] but have not been implemented in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Technologies for Innovative Monitoring to Reduce Blood Pressure and Change Lifestyle Using Mobile Phones in Adult and Elderly Populations (TIM Study): Protocol for a Randomized Controlled Trial

et al. 2018

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BackgroundHypertension is a growing problem worldwide, markedly in low- and middle-income countries, where the rate of control slightly decreased. The overall prevalence of hypertension in Brazil is 28.7% among adult individuals and 68.9% in the population aged 60 years and older, and less than a third of patients have controlled blood pressure (BP). The use of technologies—mobile phones and the internet—to implement interventions to reduce blood pressure can minimize costs and diminish cardiovascular risk. Interventions through text messaging and electronic BP monitoring present divergent results.ObjectiveThis trial evaluates the effectiveness of interventions—personalized messages and telemonitoring of BP—to reduce systolic BP and improve lifestyle compared to the usual care of patients with hypertension (control group).MethodsThis factorial randomized controlled trial enrolls individuals aged 30 to 75 years who have a mobile phone and internet access with the diagnosis of hypertension under drug treatment with up to 2 medications and uncontrolled BP. Eligible participants should have both increased office BP and 24-hour BP with ambulatory BP monitoring. Participants with severe hypertension (systolic BP ≥180 or diastolic BP ≥110 mm Hg), life threatening conditions, low life expectancy, recent major cardiovascular event (last 6 months), other indications for the use of antihypertensive medication, diagnosis of secondary hypertension, pregnant or lactating women, or those unable to understand the interventions are excluded. Participants are randomly allocate to 1 of 4 experimental arms: (1) Telemonitoring of blood pressure (TELEM) group: receives an automatic oscillometric device to measure BP, (2) telemonitoring by text message (TELEMEV) group: receives personalized, standardized text messages to stimulate lifestyle changes and adhere with BP-lowering medication, (3) TELEM-TELEMEV group: receives both interventions, and (4) control group: receives usual clinical treatment (UCT). Data collection is performed in a clinical research center located in a referent hospital. The primary outcomes are reduction of systolic BP assessed by 24-hour ambulatory BP monitoring (primary outcome) and change of lifestyle (based on dietary approaches to stop hypertension (DASH)-type diet, sodium restriction, weight loss or control, increase of physical activity).ResultsThis study was funded by two Brazilian agencies: the National Council for Scientific and Technological Development and Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul. Enrollment was completed at the end of 2017 (N=231), the follow-up is ongoing, and data analysis is expected to begin in early 2019. A reduction of 24-hour systolic BP of approximately 8.8 [SD 13.1] mm Hg for participants in the BP monitoring group versus 3.4 [SD 11.6] mm Hg in the UCT group is expected. A similar reduction in the text messaging group is expected.ConclusionsThe use of mobile technologies connected to the internet through mobile phones promotes time optimization, cost redu...

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Efficacy of isolated home blood pressure monitoring for blood pressure control

Abstract: A protocol of HBPM without medication titration enhances the control of BP assessed by ABPM.

Cited by 33 publications

References 19 publications

Does home blood pressure monitoring improve patient outcomes? A systematic review comparing home and ambulatory blood pressure monitoring on blood pressure control and patient outcomes

Does home blood pressure monitoring improve patient outcomes? A systematic review comparing home and ambulatory blood pressure monitoring on blood pressure control and patient outcomes

Are Retinal Vessels Calibers Influenced by Blood Pressure Measured at the Time of Retinography Acquisition?

Technologies for Innovative Monitoring to Reduce Blood Pressure and Change Lifestyle Using Mobile Phones in Adult and Elderly Populations (TIM Study): Protocol for a Randomized Controlled Trial

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