Reference Values for Self-recorded Blood Pressure

Thijs, Lutgarde; Staessen, Jan A.; Celis, Hilde; Gaudemaris, R. De; Imai, Y.; Julius, Stevo; Fagard, Robert

doi:10.1001/archinte.158.5.481

Cited by 119 publications

(72 citation statements)

References 44 publications

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“…Outcomes of home blood pressure-guided therapy K Asayama et al proposed in current guidelines 1,2 and 5-7 mm Hg lower than the thresholds derived in meta-analyses of aggregate 37 or individualsubject 38 HBP data. Our current findings based on cardiovascular outcome also support the recommendations of the Japanese Society of Hypertension, 2 who proposed that treatment should target systolic levels of 135 mm Hg in patients of older age or with history of stroke, and 125 mm Hg in patients of young-to middle-aged or with diabetes mellitus, kidney disease or myocardial infarction.…”

Section: Discussionmentioning

confidence: 94%

Cardiovascular outcomes in the first trial of antihypertensive therapy guided by self-measured home blood pressure

et al. 2012

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Hypertension guidelines recommend blood pressure self-measurement at home (HBP), but no previous trial has assessed cardiovascular outcomes in hypertensive patients treated according to HBP. The multicenter Hypertension Objective Treatment Based on Measurement by Electrical Devices of Blood Pressure (HOMED-BP;-2010 trial involved 3518 patients (50% women; mean age 59.6 years) with an untreated systolic/diastolic HBP of 135-179/85-119 mm Hg. In a 2 Â 3 design, patients were randomized to usual control (125-134/80-84 mm Hg (UC)) vs. tight control (o125/o80 mm Hg (TC)) of HBP and to initiation of drug treatment with angiotensin converting enzyme inhibitors, angiotensin receptor blockers or calcium channel blockers. During follow-up, a computer algorithm automatically generated treatment recommendations based on HBP. At the last follow-up (median 5.3 years), TC patients used more antihypertensive drugs than UC patients (1.82 vs. 1.74 defined daily doses, P ¼ 0.045) and had a greater HBP reduction (21.3/13.1 mm Hg vs. 22.7/13.9 mm Hg, P ¼ 0.018/0.020), but they less frequently achieved the lower HBP targets (37.4 vs. 63.5%, Po0.0001). The primary end point, cardiovascular death plus stroke and myocardial infarction, occurred in 25 UC and 26 TC patients (hazard ratio, 1.02; 95% confidence interval, 0.59-1.77; P ¼ 0.94). Rates were similar (PX0.13) in the three drug groups. In all patients combined, the risk of the primary end point independently increased by 41% (6-89%; P ¼ 0.019) and 47% (15-87%; P ¼ 0.0020) for a 1-s.d. increase in baseline (12.5 mm Hg) and follow-up (13.2 mm Hg) systolic HBP. The 5-year risk was minimal (p1%) if on-treatment systolic HBP was 131.6 mm Hg or less. HOMED-BP proved the feasibility of adjusting antihypertensive drug treatment based on HBP and suggests that a systolic HBP level of 130 mm Hg should be an achievable and safe target.

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Section: Discussionmentioning

confidence: 94%

Cardiovascular outcomes in the first trial of antihypertensive therapy guided by self-measured home blood pressure

et al. 2012

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“…5 It would seem appropriate to encourage the widespread use of self-recorded BP as an important adjunct to the clinical care of the patient with hypertension. 6,7 Particular attention must be paid to ensure the accuracy of the devices used. Validation of automatic BP measuring devices (AU) is a relatively new field of research.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of the OMRON M4 automatic blood pressure measuring device

et al. 2000

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Despite widespread use of the automatic blood pressure (BP) measuring device OMRON M4, there is little formal validation on its accuracy. A study was conducted to assess the accuracy of the OMRON M4 compared with the true indirect BP measured by mercury sphygmomanometer (MS). A rapid method for the evaluation of automatic blood pressure measurement devices (READ) was applied for this study. The READ is based on numerous BP measurements at rest and during a standardised postural challenge in a small number of subjects who exhibit a wide range of BPs. Blood pressure measurements were done in supine position for 10 min followed by head-up tilt for 30 min and again supine for 10 min. The automatic device (AU) and the MS were connected to one arm-cuff by means of a T connector. A stethoscope with dual sets of ear-pieces was used for duplicate MS measurements (MS1 and MS2). The MS1, MS2 and AU measurements were taken simultaneously in a blinded manner. Three units of the automatic instrument were evaluated. An average of 111 measurements per unit were performed, every BP category being present in у15 MS measurements. The differences between MS1 and MS2 measurements (⌬BP: MS1-MS2)

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“…The interpretation/ impact of these studies was considered in the context of the cumulative evidence of past publications. For 2005, we incorporated the SHEAF Study, 5 the Ohasama Cohort, 6,7 the OvA Study, 8 Staessen et al, 9 Thijs et al, 10 VALUE, 11 ACTION, 12 INVEST 13 and VALIANT, 14 as well as a range of smaller studies and systematic reviews (particularly the Blood Pressure Lowering Treatment Trialists Collaboration 15 and the calcium channel blockers meta-analysis 16 ). The CHEP guidelines are based solely on efficacy data and do not include physicians/experts preferences and cost-effectiveness analysis.…”

Section: Methodsmentioning

confidence: 99%

“…It is now firmly established that other modalities are as, or more effective, in the measurement/evaluation and prognostic determination of blood pressure elevations, than the clinic evaluation. [5][6][7][8][9][10] …”

Section: Diagnosis and Techniquementioning

confidence: 99%

Hypertension and Stroke: 2005 Canadian Hypertension Educational Program Recommendations

Boulanger¹,

Hill²,

Chep³

2005

Can. j. neurol. sci.

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Stroke is the leading cause of disability in North America and the third leading cause of death. 1 Hypertension is well recognized as the most important modifiable risk factor for both ischemic stroke and intracerebral hemorrhage. 2 A significant number of Canadians have one or more major risk factors for stroke. More than 50% of Canadians aged from 55 to 74 years old are hypertensive. 3 More than 160,000 people in the United States in 2001 had a fatal stroke and about 540,000 more people suffered a non fatal stroke in the same period. 1 A recent population-based study using an administrative health database showed an incidence of stroke in urban and rural Alberta of 132.4 /100,000 population/year and 138.2/100,000 population/year respect-ively. 4 For males over 80 years old, the incidence of stroke reaches 500/100 000 population/year. 4 In ABSTRACT: Background: Hypertension is the most important modifiable cause of stroke. The Canadian Hypertension Educational Program, representing Canada's experts in the field of hypertension, publishes annual evidence-based recommendations on the diagnosis and treatment of hypertension. Methods: We present the 2005 Canadian Hypertension Educational Program guidelines regarding the management of hypertension in patients with stroke. Results: The diagnosis of hypertension should be expedited and can be made as early as the second visit in patients with stroke. Unless contraindicated, a combination of angiotensin-converting-enzyme (ACE) inhibitors and diuretics is the preferred therapy in these patients. A target blood pressure below 140/90mmHg for non-diabetic patients, below 130mmHg/80mmHg for diabetic patients and below 125mmHg/75mmHg for those with renal disease and proteinuria (≥ 1 gram per day) should be reached. Lifestyle interventions may be as effective as medication and should be used in conjunction with medical management. Waist circumference should be less than 102cm for men and 88cm for women. There remains uncertainty about the management of high blood pressure in the context of acute stroke. Conclusions: A combination of ACE-inhibitors and diuretics is recommended in hypertensive stroke patients. Blood pressure should be maintained below 140/90 mmHg.

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Reference Values for Self-recorded Blood Pressure

Abstract: Until the relationship between self-recorded pressure and the incidence of cardiovascular morbidity and mortality is further clarified by prospective studies, a mean self-recorded blood pressure above 135 mm Hg systolic or 85 mm Hg diastolic may be considered hypertensive.

Cited by 119 publications

References 44 publications

Cardiovascular outcomes in the first trial of antihypertensive therapy guided by self-measured home blood pressure

Cardiovascular outcomes in the first trial of antihypertensive therapy guided by self-measured home blood pressure

Accuracy of the OMRON M4 automatic blood pressure measuring device

Hypertension and Stroke: 2005 Canadian Hypertension Educational Program Recommendations

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