Weak effect of hypertension and other classic risk factors in the elderly who have already paid their toll

Casíglia, Edoardo; Mazza, Alberto; Tikhonoff, Valérie; Pavei, Andrea; Privato, G; Schenal, N; Pessina, Achille C.

doi:10.1038/sj.jhh.1001288

Cited by 44 publications

(32 citation statements)

References 61 publications

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“…[1][2][3][4][5] However, several studies have shown that awareness of hypertension and BP control is still suboptimal, 1 and thus effective strategies should be developed to improve BP control and adherence to therapy. One of the methods used to achieve these goals is represented by self-measurement of BP at home by automatic devices.…”

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confidence: 99%

Poor Reliability of Wrist Blood Pressure Self-Measurement at Home

et al. 2016

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Blood pressure (BP) independently predicts cardiovascular risk in affluent countries. [1][2][3][4][5] However, several studies have shown that awareness of hypertension and BP control is still suboptimal, 1 and thus effective strategies should be developed to improve BP control and adherence to therapy. One of the methods used to achieve these goals is represented by self-measurement of BP at home by automatic devices. Many studies have shown that BP self-measurement at home allows a better BP control in hypertension and has a greater prognostic value than office BP. 6,7 In addition, self BP measurement is more appealing to the patient than the customary procedure in the physician's surgery often causing long waits. Upper-arm automatic devices gave fresh impetus to home self-measurement because of their user friendliness, 8 the only conditions to be respected being adequate cuff dimensions and correct positioning of the cuff on the patient's arm. [9][10][11][12][13][14] For reasons of market penetration and following a general tendency to miniaturization, many wrist devices recently appeared on the market 15 having the advantage of being smaller and easier to fit than upper-arm monitors, 16 and today wrist devices are used by a large portion of people who measure their BP at home. 17 However, in spite of technical improvement, their reliability in real-life conditions is not unanimously accepted. [18][19][20] Accuracy of BP measurement at wrist largely depends on the difference in height between the wrist and the heart because of the confounding effect of the hydrostatic pressure caused by the limb blood column.21-23 Wrists kept at a higher level in comparison with the heart lead to a false lower, and wrists at a lower level lead to a false higher BP values. Very rarely do patients receive appropriate training from family doctors or other healthcare personnel. Instructions attached to commercial packages require a certain degree of personal discernment, i.e., a good cognitive pattern. Only a few models have a position sensor to verify that the wrist is placed properly at heart level, 24 but even for these devices, no study has evaluated their reliability in real-life conditions.The aim of the present study was to ascertain whether wrist home BP is performed reliably or an error is present in measurement, and to identify the determinants of this error if any.To verify the reliability of wrist BP self-measurement, we determined at a population level the upper-arm−wrist BP difference in the office under a doctor's supervision and then verified whether this difference was maintained during home self-measurement.Abstract-The reliability of blood pressure measurement with wrist devices, which has not previously been assessed under real-life circumstances in general population, is dependent on correct positioning of the wrist device at heart level. We determined whether an error was present when blood pressure was self-measured at the wrist in 721 unselected subjects from the general population. After training, blood p...

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Poor Reliability of Wrist Blood Pressure Self-Measurement at Home

et al. 2016

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“…The lack of predictive value of lipids in hypertensive patients could be related to the significantly higher proportion of patients older than 60 years of age and the respectively lesser importance of lipid abnormalities in the pathogenesis of coronary events in this age group. 23 Limitations of this study include our classification of having a history of hypertension based on whether or not the patient ever received treatment for elevated blood pressure in the past instead of using serial blood pressure measurements. Because the original study was not focused on hypertension, multiple systematic blood pressure measurements were not recorded.…”

Section: Discussionmentioning

confidence: 99%

History of Hypertension and Enhanced Thrombogenic Activity in Postinfarction Patients

et al. 2003

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Abstract-Hypertension is a risk factor for coronary thrombosis and death in cardiac patients mediated in part by endothelial damage or dysfunction and increased thrombogenicity. However, there are no data regarding the association between hypertension and thrombogenic activity in stable patients after myocardial infarction and limited data about the prognostic significance of thrombogenic factors in hypertensive patients after infarction. Therefore, levels of thrombogenic, lipid, and inflammatory factors were measured 2 months after an acute myocardial infarction in 461 hypertensive and 582 nonhypertensive patients.

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“…In addition, in the very elderly there is also an element of selection bias (a biological survivor effect) that starts to mask the impact of many conventional population risk factors (including pulse pressure) in the individual. 13 The use of regression analysis is common in population samples and the assumptions made are many. One unjustified one that we perhaps too often forget (commentators, reviewers and editors included) is that parameters that are statistically correlated in a population sample do so because of causality in the individual.…”

Section: Is It a Valid Deduction?mentioning

confidence: 99%

Repeated measures of blood pressure and correlations between systolic pressure, pulse pressure and LV mass: a circular debate?

MacFadyen

Lee

2003

J Hum Hypertens

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This month's edition of the Journal contains an interesting contribution from Mule and colleagues from Palermo. The structure of the piece is very simple relating ambulatory blood pressure (ABP) measures for systolic, diastolic and pulse pressure to LV mass in hypertensive patients. The technique employed is linear correlation analysis. Pulse pressure is an area of interest of many of the readers, contributors and editorial board of the Journal. This is not a new area nor is this a new approach. The strategy of deriving biological inference from such data relevant to the individual by correlation analysis from a population sample deserves a closer and broader comment.

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Weak effect of hypertension and other classic risk factors in the elderly who have already paid their toll

Cited by 44 publications

References 61 publications

Poor Reliability of Wrist Blood Pressure Self-Measurement at Home

Poor Reliability of Wrist Blood Pressure Self-Measurement at Home

History of Hypertension and Enhanced Thrombogenic Activity in Postinfarction Patients

Repeated measures of blood pressure and correlations between systolic pressure, pulse pressure and LV mass: a circular debate?

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