Prevalence of pseudoresistant hypertension due to inaccurate blood pressure measurement

Bhatt, Hemal; Siddiqui, Mohammed; Judd, Eric; Oparil, Suzanne; Calhoun, David A.

doi:10.1016/j.jash.2016.03.186

Cited by 58 publications

(45 citation statements)

References 41 publications

(36 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Patients reported incorrect clinic BP measurement techniques in our postintervention survey, which is consistent with the literature. 2,3 Hypertension guidelines and physician performance measures have not considered the impact of conventional clinic BP measurements on BP thresholds for hypertension treatment. In the present study, 16 patients had systolic clinic BP >170 mm Hg, and 10 of those patients had average home BP <140/90 mm Hg.…”

Section: Discussionmentioning

confidence: 99%

“…onventional clinic blood pressure (BP) measurements are often inaccurate and distinct from time-consuming, research-quality, clinic BP measurements, which are used for clinical practice guideline development. [1][2][3][4][5][6] Blood pressure is a continuous value with natural variations throughout the day, and repeated measurements over time are generally more accurate in establishing a diagnosis of hypertension. 1,7,8 However, conventional clinic BP is routinely used for hypertension diagnosis, management, and physician performance measures.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Home Blood Pressure Monitoring in Cases of Clinical Uncertainty to Differentiate Appropriate Inaction From Therapeutic Inertia

et al. 2020

View full text Add to dashboard Cite

PURPOSE Conventional clinic blood pressure (BP) measurements are routinely used for hypertension management and physician performance measures. We aimed to check home BP measurements after elevated conventional clinic BP measurements for which physicians did not intensify treatment, to differentiate therapeutic inertia from appropriate inaction. METHODS We conducted a pre and post study of home BP monitoring for patients with uncontrolled hypertension as determined by conventional clinic BP measurements for which physicians did not intensify hypertension management. Physicians were notified of average home BP 2-4 weeks after the initial clinic visit. Outcome measures were the proportion of patients with controlled hypertension using average home BP measurements, changes in hypertension management by physicians, changes in physicians' hypertension metrics, and factors associated with home-clinic BP differences. RESULTS Of 90 recruited patients who had elevated conventional clinic BP recordings, 65.6% had average home BP measurements that were <140/90 mm Hg. Physicians changed treatment plans for 61% of patients with average home BP readings of ≥140/90 mm Hg, whereas decisions to not change treatment for the remaining patients were based on contextual factors. Substituting average home BP for conventional clinic BP for 4% of patients from 2 physicians' hypertension registries improved the physicians' hypertension control rates by 3% to 5%. Greater body mass index and increased number of BP medications were associated with home BP measurement ≥140/90 mm Hg. Clinic BP levels did not estimate normal home BP levels. CONCLUSIONS Documented home BP in cases of clinical uncertainty helped differentiate therapeutic inertia from appropriate inaction and improved physicians' hypertension metrics.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Home Blood Pressure Monitoring in Cases of Clinical Uncertainty to Differentiate Appropriate Inaction From Therapeutic Inertia

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Of the patients 16.5% were found to have a normal BP at screening, suggesting an underlying white-coat effect, although we cannot exclude the possibility that 13.1% of these patients who were on antihypertensive treatment improved their adherence prior to the initial assessment. Bhatt et al [13] showed that 43 of 130 patients were incorrectly diagnosed with apparent resistant hypertension when BP measurements obtained by triage staff were compared with those obtained by trained physicians using a validated BP device on the same day. Interestingly, 62.2% of our patients with normal screening BP had evidence of LVH on the ECG, suggesting better adherence prior to assessment or that the white-coat effect may not be completely benign.…”

Section: Discussionmentioning

confidence: 99%

Evaluation and management of patients referred to a tertiary-level hypertension clinic in Cape Town, South Africa

2016

View full text Add to dashboard Cite

Background. Hypertension remains a global health burden, with a high incidence of long-term morbidity and mortality. Objectives. To evaluate blood pressure (BP) control, factors associated with poor BP control, target organ damage (TOD), white-coat hypertension, treatment-resistant hypertension and secondary hypertension in patients referred to a tertiary-level hypertension clinic. Method. This was a prospective case-control study of patients referred for specialist hypertension management. Patient parameters recorded included age, gender, body mass index, uric acid, cholesterol, screening BP, follow-up BP, TOD and medications. We also recorded causes of secondary hypertension. Net BP change and the percentage achieving target BP were calculated in all patients followed up. Results. A total of 175 patients were sampled (72 males and 103 females, mean age 46.5 years). Of the patients 16.6% had a normal screening BP; 62.9% of patients were followed up, and 43.6% of these achieved BP control. After intervention, there was a net drop of 13.2 mmHg (range 7.9 -18.4) in systolic BP and of 3.8 mmHg (4.4 -12.0) in diastolic BP. Of all the patients, 12.6% had resistant hypertension, 49.1% had evidence of left ventricular hypertrophy and 18.3% had microalbuminuria; 13.1% of the patients were diagnosed with secondary hypertension. Conclusion. Specialist intervention was useful in identifying patients with white-coat and secondary hypertension, as well as in improving hypertension control in patients with apparent treatment-resistant hypertension. However, a significant percentage of patients did not reach target BP, and further efforts are required to identify the underlying causes for this.

show abstract

“…The prevalence of RH from secondary causes is approximately 20% of all cases of RH, the most prevalent being primary aldosteronism, renal parenchymal diseases, and the use of certain medications. Therefore, it is important to include the following tools in the diagnosis for the exclusion of false RH: ambulatory blood pressure monitoring, home blood pressure monitoring, detection of nonadherence, reviewing the therapeutic plan following guideline suggestions, and taking care in blood pressure measurement …”

mentioning

confidence: 99%

“…Therefore, it is important to include the following tools in the diagnosis for the exclusion of false RH: ambulatory blood pressure monitoring, 2 home blood pressure monitoring, detection of nonadherence, reviewing the therapeutic plan following guideline suggestions, 3,4 and taking care in blood pressure measurement. 5 Physicians have little awareness about low adherence, especially because there are no gold standard methods for its evaluation, but the biochemical detection of medication in blood or urine seems to be the most accurate and cost-effective method at follow-up. 6,7 This was the algorithm followed by the investigators of the DENERVE HTA (Denervación en Hipertensión Arterial) trial published in 2016.…”

mentioning

confidence: 99%

Resistant hypertension: a therapeutic challenge

Brandani

2018

J of Clinical Hypertension

View full text Add to dashboard Cite

In 2008, the American Heart Association published resistant hypertension (RH) guidelines.1 Since that year, there has been a lot of research regarding the relevance of making a proper diagnosis and choosing the best treatment. In recent years, there has been an increasing interest in RH because uncontrolled RH is a pathological condition with a poor prognosis.In this regard, it is important to follow steps with the purpose of ruling out pseudoresistant hypertension and then excluding secondary causes. Suboptimal drug therapy, poor adherence to medications, white-coat effect, and inaccurate BP measurement are the most prev- It is difficult to establish the actual prevalence of true RH. Some series have reported a variable prevalence from 2% to 40%, depending on the criteria and the accuracy of the diagnostic procedures. 9,10All guidelines advise the use of three kinds of drugs for treatment:antagonists of the renin-angiotensin system (angiotensin-converting enzyme inhibitors or angiotensin II antagonists), calcium channel blockers, and diuretics, preferably long-lasting agents such as chlorthalidone. All agents must be prescribed at the best doses tolerated and at the optimal regimen of administration. Furthermore, if blood pressure is not under control, a fourth drug should be added. There are some controversies about whether the choice of this fourth drug should be empirically guided or guided by renin profile.To answer these questions, we must consider the paradigmatic tri- In addition, the registries of real-world patients treated with RD, which, taken together, support the safety and efficacy of RD.However, this conclusion must be reached through randomized controlled trials. [16][17][18][19] RH is characterized by an overexpression of humoral and hormonal factors that are involved in the development and maintenance of target organ damage (TOD). In this regard, mineralocorticoid receptor blockade has been proven effective and safe in the treatment of hypertension. Renin-angiotensin system blockade alone is not enough

show abstract

Prevalence of pseudoresistant hypertension due to inaccurate blood pressure measurement

Cited by 58 publications

References 41 publications

Home Blood Pressure Monitoring in Cases of Clinical Uncertainty to Differentiate Appropriate Inaction From Therapeutic Inertia

Home Blood Pressure Monitoring in Cases of Clinical Uncertainty to Differentiate Appropriate Inaction From Therapeutic Inertia

Evaluation and management of patients referred to a tertiary-level hypertension clinic in Cape Town, South Africa

Resistant hypertension: a therapeutic challenge

Contact Info

Product

Resources

About