Variability of office, 24-hour ambulatory, and self-monitored blood pressure measurements

Warren, R. E.; Marshall, Tom; Padfield, P. L.; Chrubasik, Sigrun

doi:10.3399/bjgp10x515403

Cited by 62 publications

(54 citation statements)

References 14 publications

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“…27 Ambulatory BP captures and averages many values >24 hours, thereby providing a more accurate assessment of a patient's real BP than office measurements with less influence by regression to the mean. 20,28 Furthermore, 24-hour mean BP is more closely related to end-organ damage 29 and is a more sensitive predictor of morbidity and mortality than office BP. [30][31][32] This makes the ambulatory SBP reductions seen after RDN of special interest.…”

Section: Discussionmentioning

confidence: 99%

“…27 La PA ambulatoria registra y promedia muchos valores > 24 horas, suministrando así una evaluación más precisa de la PA real de un paciente que las mediciones en consultorio, con menos influencia por la regresión a la media. 20,28 Asimismo, la PA media de 24 horas se relaciona más estrechamente con el daño de órga-nos blanco29 y constituye una variable predictiva más sensible de morbimortalidad que la PA en consultorio. [30][31][32] Esto hace que las reducciones de la PAS ambulatoria observadas después de la DR sean de interés especial.…”

Section: Böhm Et Alunclassified

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First Report of the Global SYMPLICITY Registry on the Effect of Renal Artery Denervation in Patients With Uncontrolled Hypertension

et al. 2015

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Abstract-This study aimed to assess the safety and effectiveness of renal denervation using the Symplicity system in realworld patients with uncontrolled hypertension (NCT01534299). The Global SYMPLICITY Registry is a prospective, open-label, multicenter registry. Office and 24-hour ambulatory blood pressures (BPs) were measured. Change from baseline to 6 months was analyzed for all patients and for subgroups based on baseline office systolic BP, diabetic status, and renal function; a cohort with severe hypertension (office systolic pressure, ≥160 mm Hg; 24-hour systolic pressure, ≥135 mm Hg; and ≥3 antihypertensive medication classes) was also included. The analysis included protocol-defined safety events. Six-month outcomes for 998 patients, including 323 in the severe hypertension cohort, are reported. Mean baseline office systolic BP was 163.5±24.0 mm Hg for all patients and 179.3±16.5 mm Hg for the severe cohort; the corresponding baseline 24-hour mean systolic BPs were 151.5±17.0 and 159.0±15.6 mm Hg. At 6 months, the changes in office and 24-hour systolic BPs were −11.6±25.3 and −6.6±18.0 mm Hg for all patients (P<0.001 for both) and −20.3±22.8 and −8.9±16.9 mm Hg for those with severe hypertension (P<0.001 for both). Renal denervation was associated with low rates of adverse events. After the procedure through 6 months, there was 1 new renal artery stenosis >70% and 5 cases of hospitalization for a hypertensive emergency. In clinical practice, renal denervation resulted in significant reductions in office and 24-hour BPs with a favorable safety profile. Greater BP-lowering effects occurred in patients with higher baseline pressures. Clinical Trial Registration-URL: www.clinicaltrials.gov. Unique identifier: NCT01534299 ) in which sympathetic hyperactivity may play a role in addition to and independently of the BP increase. 5Because RDN is an interventional procedure that may expose patients to some risks and could increase costs, large databases on safety and efficacy in clinical practice settings, without the strict inclusion and exclusion criteria and site selection used in clinical trials, are needed. The Global SYMPLICITY registry (GSR) 19 will provide data on periprocedural and renal safety as well as the effectiveness of BP reduction in such a real-world population of patients undergoing RDN. Herein, the GSR investigators report on the 6-month follow-up of the largest group of hypertensive patients to undergo RDN in an uncontrolled global clinical setting. Methods DesignThis analysis is based on 998 patients with complete safety and office BP data at baseline and 6 months of follow-up, who underwent RDN from February 1, 2012, to September 9, 2013. One-hundred thirtyfour centers in Canada, Western Europe, Latin America, Eastern Europe, South Africa, Middle East, Asia, Australia, and New Zealand were involved (see online-only Data Supplement).The study design of the prospective, open-label, multicenter GSR has been published previously. 19 In brief, the registry will include ≤5000 patients with hy...

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Section: Discussionmentioning

confidence: 99%

Section: Böhm Et Alunclassified

First Report of the Global SYMPLICITY Registry on the Effect of Renal Artery Denervation in Patients With Uncontrolled Hypertension

et al. 2015

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“…40 Compared with 24-h ambulatory BP, office BP is more susceptible to white coat hypertension, Hawthorne effect, measurement bias, and measurement variability. 41 The 24-h ambulatory BP also includes nighttime measurements when BP tends to be lower than during the daytime, when office BP is measured.…”

Section: Discussionmentioning

confidence: 99%

Impact of Renal Denervation on Patients With Obstructive Sleep Apnea and Resistant Hypertension　– Insights From the SYMPLICITY HTN-3 Trial –

Kario

Bhatt

Kandzari

et al. 2016

Circ J

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“…Also, we did not standardize the timing of antihypertensive medication relative to HBP (other than asking patients to measure morning blood pressure before taking medication), nor attempt to control other daily life activity that may affect consistency of HBP (ie, exercise habits, food and drink intake). Nonetheless, better reproducibility and confidence in underly- ing blood pressure is achievable when HBP is recorded by a standardized method, 48,49 such as that used in this current study and recommended in guidelines. 19,21 Overall, the best clinical approach would be using a validated blood pressure monitor with a memory function and automated averaging, and a standard method taking into account timing of antihypertensive medications.…”

Section: Discussionmentioning

confidence: 99%

Pragmatic Method Using Blood Pressure Diaries to Assess Blood Pressure Control

Sharman

Blizzard

Kosmala

et al. 2016

The Annals of Family Medicine

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PURPOSE Twenty-four-hour ambulatory blood pressure (ABP) is the reference standard of blood pressure control. Home blood pressure (HBP) is superior to clinic blood pressure for assessing control, but a barrier to its use is the need for physicians to calculate average blood pressure from patient diaries. We sought to develop a quick and pragmatic method to assess blood pressure control from patients' HBP diaries.METHODS Seven-day HBP and 24-hour ABP were measured in 286 patients with uncomplicated treated hypertension (aged 64 ± 8 years; 53% female). We determined the optimal ratio of home systolic blood pressure readings above threshold (≥135 mm Hg) for the last 10 recorded that would best predict elevated 24-hour ABP. Uncontrolled blood pressure was defined as 24-hour ABP systolic blood pressure ≥130 mm Hg or 24-hour ABP daytime systolic blood pressure ≥135 mm Hg. Validation by corroborative evidence was tested by association with markers of end-organ disease. RESULTSThe best predictor of 24-hour ABP systolic blood pressure above treatment/target threshold was having 3 or more (≥30%) of the last 10 home systolic blood pressure readings ≥135 mm Hg (area under the receiver operating characteristic curve = 0.71). Importantly, patients meeting this criterion had evidence of target organ disease, with significantly higher aortic stiffness, left ventricular relative wall thickness, and left atrial area, and lower left ventricular ejection fraction, compared with those who did not meet this criterion.CONCLUSIONS To facilitate uptake of HBP monitoring, we propose that physicians can determine the percentage of the last 10 home systolic blood pressure values ≥135 mm Hg for a patient and tailor management accordingly. INTRODUCTIONC linic blood pressure is widely used for patient management, but the method has some limitations that may result in inaccurate assessment of true underlying blood pressure.1 Methods to assess out-of-clinic blood pressure using self-measured home blood pressure (HBP, the average blood pressure over 7 days) or 24-hour ambulatory blood pressure (ABP) have demonstrated superior prognostic utility with respect to target organ disease (eg, cardiac hypertrophy), 2-4 cardiovascular events, and cardiovascular and all-cause mortality.5-9 HBP has an advantage of already being in wide use, even if not in a standardized fashion. 10,11 It also helps to reduce health system costs, improve adherence to therapy, and achieve better blood pressure control.12-17 Accordingly, use of HBP as a tool to help guide management of high blood pressure is advocated in many countries. [18][19][20][21][22][23][24][25] A disadvantage of HBP is the requirement for manual calculation of the average of multiple values from patient diaries (eg, up to 28 recordings over 7 days) when using blood pressure devices that do not have storage memory, which currently predominate the market. If the patient has not calculated the average (which has its own reliability issue), the physician is James E. Sharman, BHMS (Hons) 64unlike...

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Variability of office, 24-hour ambulatory, and self-monitored blood pressure measurements

Abstract: Background

Cited by 62 publications

References 14 publications

First Report of the Global SYMPLICITY Registry on the Effect of Renal Artery Denervation in Patients With Uncontrolled Hypertension

First Report of the Global SYMPLICITY Registry on the Effect of Renal Artery Denervation in Patients With Uncontrolled Hypertension

Impact of Renal Denervation on Patients With Obstructive Sleep Apnea and Resistant Hypertension　– Insights From the SYMPLICITY HTN-3 Trial –

Pragmatic Method Using Blood Pressure Diaries to Assess Blood Pressure Control

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Variability of office, 24-hour ambulatory, and self-monitored blood pressure measurements

Abstract: Background

Cited by 62 publications

References 14 publications

First Report of the Global SYMPLICITY Registry on the Effect of Renal Artery Denervation in Patients With Uncontrolled Hypertension

First Report of the Global SYMPLICITY Registry on the Effect of Renal Artery Denervation in Patients With Uncontrolled Hypertension

Impact of Renal Denervation on Patients With Obstructive Sleep Apnea and Resistant Hypertension – Insights From the SYMPLICITY HTN-3 Trial –

Pragmatic Method Using Blood Pressure Diaries to Assess Blood Pressure Control

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Product

Resources

About

Impact of Renal Denervation on Patients With Obstructive Sleep Apnea and Resistant Hypertension　– Insights From the SYMPLICITY HTN-3 Trial –