Poor adherence to home blood pressure measurement schedule

Hoeven, Niels V. van der; Born, Bert‐Jan H. van den; Cammenga, Marianne; Montfrans, Gert A. van

doi:10.1097/hjh.0b013e328319917e

Cited by 35 publications

(15 citation statements)

References 15 publications

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“…23 In real-life clinical practice, adherence to measurements may not be as good as observed in our study, as demonstrated previously. 23,24 However, it is also possible that adherence could be even better in the real-life doctor-patient relationship. In any case, we feel that home BP should be measured twice, instead of once, on each occasion because of a lower number of required measurement days, a slightly better predictive ability, and the regression to the mean effect.…”

Section: Discussionmentioning

confidence: 99%

Optimal Schedule for Home Blood Pressure Measurement Based on Prognostic Data

et al. 2011

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Abstract-Current guidelines based on cross-sectional statistical parameters derived from reference populations make equivocal recommendations for the optimal schedule of home blood pressure (BP) measurement. The objective of this study was to determine a schedule for home BP measurements in relation to their predictive value for total cardiovascular risk. Home BP was measured twice every morning and evening for 1 week in an unselected nationwide population of 2081 subjects aged 45 to 74 years. The prognostic significance of BP for fatal and nonfatal cardiovascular events was examined using adjusted Cox proportional hazards regression models. A total of 162 cardiovascular events were recorded during a 6.8-year follow-up. The predictive value of home BP increased progressively with the number of measurements, showing the highest predictive value with the average of all measurements (systolic/diastolic hazard ratio per 1-mm Hg increase in BP: 1.021/1.034; systolic/ diastolic 95% CI: 1.012 to 1.030/1.018 to 1.049). However, most of this increase was achieved during the first 3 days of measurement (hazard ratio: 1.017/1.028; 95% CI: 1.009 to 1.026/1.013 to 1.045), and only minimal increase occurred after day 6. No additional benefit was achieved by discarding the values obtained during the first day of measurement. Morning and evening BPs were equally predictive of future cardiovascular events. Novel prognostic data from this study show that measurement of home BP twice in the morning and evening, preferably for a period of 7 days, or for at least 3 days, provides a thorough image of a patient's BP level. This information should be used to prepare a unified international guideline for home BP measurement. (Hypertension. 2011;57:1081-1086.)Key Words: hypertension Ⅲ blood pressure measurement Ⅲ home blood pressure measurement Ⅲ epidemiology Ⅲ guidelines H ypertension, one of the most important challenges facing public healthcare worldwide, cannot be prevented, detected, treated, or controlled without accurate and practical methods for blood pressure (BP) measurement. 1 During the past decade, the popularity of home BP measurement has exploded as small, easily, and reliably operated automatic devices have been introduced to the market. 2,3 In addition to its ease of use compared with other methods of measurement, home BP measurement also seems to have medical advantages, because it is free from the white-coat effect, and seems to have a stronger predictive power for future cardiovascular events than office BP. 4 Despite the popularity and advantages of home BP measurement, no consensus exists on how many daily measurements and for how many days it should be performed when measuring BP at home to obtain the best assessment of the actual BP levels in a given subject. A great deal of conflict exists in the recommended home BP measurement schedules in various international guidelines, which only demonstrates that no agreement on this matter has yet been reached (Table 1). [5][6][7] Part of the problem arises from the fact t...

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Section: Discussionmentioning

confidence: 99%

Optimal Schedule for Home Blood Pressure Measurement Based on Prognostic Data

et al. 2011

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“…9 With home blood pressure monitoring, patients are reported to be noncompliant with measurements or self-report of blood pressures. 10 There is a small but growing body of evidence to support a new method of offi ce measurements in which a series of automated measurements is taken with the patient sitting alone in a quiet room (serial automated OBPM). The scarce, available research comes predominantly from one research group that used a validated oscillometric offi ce blood pressure device able to be set at measurement intervals of 1 minute or more for a duration of 5 to 10 minutes.…”

Section: Introductionmentioning

confidence: 99%

A Novel Approach to Office Blood Pressure Measurement: 30-Minute Office Blood Pressure vs Daytime Ambulatory Blood Pressure

Wel¹,

Buunk²,

Weel³

et al. 2011

The Annals of Family Medicine

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PURPOSE Current offi ce blood pressure measurement (OBPM) is often not executed according to guidelines and cannot prevent the white-coat effect. Serial, automated, oscillometric OBPM has the potential to overcome both these problems. We therefore developed a 30-minute OBPM method that we compared with daytime ambulatory blood pressure.METHODS Patients referred to a primary care diagnostic center for 24-hour ambulatory blood pressure monitoring (ABPM) had their blood pressure measured using the same validated ABPM device for both ABPM and 30-minute OBPMs. During 30-minute OBPM, blood pressure was measured automatically every 5 minutes with the patient sitting alone in a quiet room. The mean 30-minute OBPM (based on t = 5 to t = 30 minutes) was compared with mean daytime ABPM using paired t tests and the approach described by Bland and Altman on method comparison. RESULTSWe analyzed data from 84 patients (mean age 57 years; 61% female). Systolic and diastolic blood pressures differed from 0 to 2 mm Hg (95% confidence interval, -2 to 2 mm Hg and from 0 to 3 mm Hg) between mean 30-minute OBPM and daytime ABPM, respectively. The limits of agreement were between -19 and 19 mm Hg for systolic and -10 and 13 mm Hg for diastolic blood pressures. Both 30-minute OBPM and daytime ABPM classifi ed normotension, whitecoat hypertension, masked hypertension, and sustained hypertension equally. CONCLUSIONSThe 30-minute OBPM appears to agree well with daytime ABPM and has the potential to detect white-coat and masked hypertension. This fi nding makes 30-minute OBPM a promising new method to determine blood pressure during diagnosis and follow-up of patients with elevated blood pressures. Ann Fam Med 2011;9:128-135. doi:10.1370/afm.1211. INTRODUCTIONT he Framingham and the SCORE (systematic coronary risk evaluation) risk functions, both developed to assess the risk of cardiovascular disease, are based on standardized offi ce blood pressure measurements (OBPMs).1,2 Despite guidelines that advocate the relevance of well-executed, standardized OBPM to prevent several forms of bias, 3,4 it is well known that most caregivers do not execute OBPM strictly according to these guidelines. 5,6 In addition, up to one-quarter of patients is prone to the white-coat effect (in which patients exhibit elevated blood pressure in a clinical setting but not in other settings), which infl uences cardiovascular risk profi ling as well. 7,8 This white-coat effect cannot be overcome by standardized OBPM. As a consequence, the determined cardiovascular risk will be incorrect in an estimated 25% of patients and may lead to under-or overtreatment.To enable a more precise determination of cardiovascular risk, OBPM should be free from (observer) bias and the white-coat effect. The mea- 129BLO OD PR ES SUR E ME A SUR EMENT surement should be uniform, easy to execute correctly for all types of health care personnel (doctors, practice assistants, practice nurses, research assistants, etc), and straightforward to implement in daily practice.Fortunately,...

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“…However, Van der Hoeven et al 18 studied 106 patients undergoing HBPM and concluded that they need proper instruction and a close watch. The authors verified that even using memory-equipped devices to ensure the accuracy of date, time and number of measurements, the participants had difficulties with the method 18 .…”

Section: Discussionmentioning

confidence: 99%