Methodology and technology for peripheral and central blood pressure and blood pressure variability measurement

Stergiou, George S.; Parati, Gianfranco; Vlachopoulos, Charalambos; Achimastos, Apostolos; Andreadis, E.; Asmar, Roland; Avolio, Alberto; Bénétos, Athanase; Bilo, Grzegorz; Boubouchairopoulou, N.; Boutouyrie, Pierre; Castiglioni, Paolo; Sierra, Alejandro de la; Dolan, Eamon; Head, Geoffrey A.; Imai, Yutaka; Kario, Kazuomi; Κόλλιας, Αναστάσιος; Kotsis, Vasilios; Manios, Efstathios; McManus, Richard J; Mengden, Thomas; Mihailidou, Anastasia S.; Myers, Martin G.; Niiranen, Teemu J.; Ochoa, Juan Eugenio; Ohkubo, Takayoshi; Omboni, Stefano; Padfield, P. L.; Palatini, Paolo; Papaioannou, Theodore G.; Protogerou, Athanase D.; Redón, Josep; Verdecchia, Paolo; Wang, Ji‐Guang; Zanchetti, Alberto; Mancia, Giuseppe; O’Brien, Eoin

doi:10.1097/hjh.0000000000000969

Cited by 126 publications

(50 citation statements)

References 112 publications

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“…The main issues of office measurements regarding the white coat effect, observer error, and bias problems are presented mainly by auscultatory devices; therefore, oscillometric devices are almost exclusively used for OBP measurement. AOBP is recommended as the preferable technique for OBP measurement by the Canadian Hypertension Education Program19 and by the position statement of the European Society of Hypertension working group on BP monitoring and cardiovascular variability, which suggests it as a superior OBP measurement method 20. The main limitation of our study is the unavailability of the replicated measurements made by the devices, as this would allow for more precise characterization of agreement.…”

Section: Discussionmentioning

confidence: 90%

Attended and Unattended Automated Office Blood Pressure Measurements Have Better Agreement With Ambulatory Monitoring Than Conventional Office Readings

Andreadis

Geladari

Angelopoulos

et al. 2018

JAHA

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BackgroundAutomated office blood pressure (AOBP) measurement is superior to conventional office blood pressure (OBP) because it eliminates the “white coat effect” and shows a strong association with ambulatory blood pressure.Methods and ResultsWe conducted a cross‐sectional study in 146 participants with office hypertension, and we compared AOBP readings, taken with or without the presence of study personnel, before and after the conventional office readings to determine whether their variation in blood pressure showed a difference in blood pressure values. We also compared AOBP measurements with daytime ambulatory blood pressure monitoring and conventional office readings. The mean age of the studied population was 56±12 years, and 53.4% of participants were male. Bland–Altman analysis revealed a bias (ie, mean of the differences) of 0.6±6 mm Hg systolic for attended AOBP compared with unattended and 1.4±6 and 0.1±6 mm Hg bias for attended compared with unattended systolic AOBP when measurements were performed before and after conventional readings, respectively. A small bias was observed when unattended and attended systolic AOBP measurements were compared with daytime ambulatory blood pressure monitoring (1.3±13 and 0.6±13 mm Hg, respectively). Biases were higher for conventional OBP readings compared with unattended AOBP (−5.6±15 mm Hg for unattended AOBP and oscillometric OBP measured by a physician, −6.8±14 mm Hg for unattended AOBP and oscillometric OBP measured by a nurse, and −2.1±12 mm Hg for unattended AOBP and auscultatory OBP measured by a second physician).ConclusionsOur findings showed that independent of the presence or absence of medical staff, AOBP readings revealed similar values that were closer to daytime ambulatory blood pressure monitoring than conventional office readings, further supporting the use of AOBP in the clinical setting.

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Section: Discussionmentioning

confidence: 90%

Attended and Unattended Automated Office Blood Pressure Measurements Have Better Agreement With Ambulatory Monitoring Than Conventional Office Readings

Andreadis

Geladari

Angelopoulos

et al. 2018

JAHA

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“…Technological advances have allowed the development of new devices capable of measuring central BP in a noninvasive way [13, 14]. Their development is based on the premise that central or aortic BP reflects the true load on the target organ.…”

Section: Discussionmentioning

confidence: 99%

Cuff-Based Oscillometric Central and Brachial Blood Pressures Obtained Through ABPM are Similarly Associated with Renal Organ Damage in Arterial Hypertension

Fernández-Llama

Pareja

Yun

et al. 2017

Kidney Blood Press Res

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Background/Aims: Central blood pressure (BP) has been suggested to be a better estimator of hypertension-associated risks. We aimed to evaluate the association of 24-hour central BP, in comparison with 24-hour peripheral BP, with the presence of renal organ damage in hypertensive patients. Methods: Brachial and central (calculated by an oscillometric system through brachial pulse wave analysis) office BP and ambulatory BP monitoring (ABPM) data and aortic pulse wave velocity (PWV) were measured in 208 hypertensive patients. Renal organ damage was evaluated by means of the albumin to creatinine ratio and the estimated glomerular filtration rate. Results: Fifty-four patients (25.9%) were affected by renal organ damage, displaying either microalbuminuria (urinary albumin excretion ≥30 mg/g creatinine) or an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m². Compared to those without renal abnormalities, hypertensive patients with kidney damage had higher values of office brachial systolic BP (SBP) and pulse pressure (PP), and 24-h, daytime, and nighttime central and brachial SBP and PP. They also had a blunted nocturnal decrease in both central and brachial BP, and higher values of aortic PWV. After adjustment for age, gender, and antihypertensive treatment, only ABPM-derived BP estimates (both central and brachial) showed significant associations with the presence of renal damage. Odds ratios for central BP estimates were not significantly higher than those obtained for brachial BP. Conclusion: Compared with peripheral ABPM, cuff-based oscillometric central ABPM does not show a closer association with presence of renal organ damage in hypertensive patients. More studies, however, need to be done to better identify the role of central BP in clinical practice.

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“…The magnitude of this variability can be influenced by factors affecting regional and systemic circulations including arterial stiffness, sympathetic tone, release of vasoactive substances, and baroreceptor sensitivity 1, 2 . Visit-to-visit office blood pressure variability (OBPV) can also be affected by medication non-adherence, class of antihypertensive medication, timing of medication administration, intensity of BP treatment and patient age 3–5 .…”

Section: Introductionmentioning

confidence: 99%

Visit-to-Visit Office Blood Pressure Variability and Cardiovascular Outcomes in SPRINT (Systolic Blood Pressure Intervention Trial)

et al. 2017

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Studies of visit-to-visit office blood pressure variability (OBPV) as a predictor of cardiovascular events and death in high-risk patients treated to lower BP targets are lacking. We conducted a post hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT), a well-characterized cohort of participants randomized to intensive (<120 mm Hg) or standard (<140 mm Hg) systolic BP targets. We defined OBPV as the coefficient of variation of the systolic BP, using measurements taken during the 3-,6-, 9- and 12-month study visits. In our cohort of 7879 participants, older age, female sex, black race, current smoking, chronic kidney disease and coronary disease were independent determinants of higher OBPV. Use of thiazide-type diuretics or dihydropyridine calcium channel blockers was associated with lower OBPV, while angiotensin converting enzyme inhibitors or angiotensin receptor blocker use was associated with higher OBPV. There was no difference in OBPV in participants randomized to standard or intensive treatment groups. We found that OBPV had no significant associations with the composite endpoint of fatal and non-fatal cardiovascular events (N=324 primary endpoints; adjusted hazard ratio [HR] 1.20, 95% confidence interval [CI] 0.85–1.69, highest versus lowest quintile), nor with heart failure or stroke. The highest quintile of OBPV (versus lowest) was associated with all-cause mortality (adjusted HR 1.92, CI 1.22–3.03), although the association of OBPV overall with all-cause mortality was marginal (p=0.07). Our results suggest that clinicians should continue to focus on office BP control rather than on OBPV unless definitive benefits of reducing OBPV are shown in prospective trials.

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Methodology and technology for peripheral and central blood pressure and blood pressure variability measurement

Cited by 126 publications

References 112 publications

Attended and Unattended Automated Office Blood Pressure Measurements Have Better Agreement With Ambulatory Monitoring Than Conventional Office Readings

Attended and Unattended Automated Office Blood Pressure Measurements Have Better Agreement With Ambulatory Monitoring Than Conventional Office Readings

Cuff-Based Oscillometric Central and Brachial Blood Pressures Obtained Through ABPM are Similarly Associated with Renal Organ Damage in Arterial Hypertension

Visit-to-Visit Office Blood Pressure Variability and Cardiovascular Outcomes in SPRINT (Systolic Blood Pressure Intervention Trial)

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