Consistent relationship between automated office blood pressure recorded in different settings

Myers, Martin G.; Valdivieso, Miguel; Kiss, Alexander

doi:10.1097/mbp.0b013e32832c5167

Cited by 68 publications

(54 citation statements)

References 13 publications

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“…Although AOBP in our study was recorded in a pharmacy setting, studies [16][17][18] have shown that AOBP readings are independent of the location in which they are taken, provided that the principles of AOBP are followed: multiple readings recorded automatically with the patient resting undisturbed in a quiet place. Of direct relevance to the present study, AOBP readings performed in community pharmacies using the CHAP protocol should be similar to the AOBP readings taken in the offices of the patients' own family physicians.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Risk in Hypertension in Relation to Achieved Blood Pressure Using Automated Office Blood Pressure Measurement

et al. 2016

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T wo aspects of hypertension that have received considerable attention in recent years are the threshold blood pressure (BP) for diagnosing hypertension and the optimum BP target after drug therapy has been initiated. In each instance, greater emphasis is now given to systolic BP, primarily because it has been shown in numerous studies to be the best predictor of cardiovascular risk. Thresholds for the initiation of therapy based on increases in future cardiovascular events in relation to BP have been determined 1-3 for 24-hour ambulatory BP monitoring, home BP, and electronic, automated office BP (AOBP). As for conventional manual office BP, treatment thresholds were mainly derived from placebo-controlled clinical trials. For example, in the SHEP trial (Systolic Hypertension in the Elderly Program), 4 hypertension was defined as a systolic BP of 160 mm Hg or higher, and the target BP was a decrease of at least 20 mm Hg to <150 mm Hg. This study provided evidence to support treating isolated systolic hypertension of 160 mm Hg or higher in the elderly. Clinical outcome data that would justify treating uncomplicated, mild diastolic hypertension (90-99 mm Hg) based on placebo-controlled clinical trials are lacking. Other epidemiological studies 5 have shown an increase in cardiovascular events in mixed treated and untreated populations starting at a BP ≥115/75 mm Hg. However, these findings only relate BP to the future risk of a cardiovascular event and do not address the optimum BP after drug therapy has been started. Overall, convincing evidence for initiating drug therapy for uncomplicated, mild hypertension (BP 140-159/90-99 mm Hg) based on office BP is limited.There has also not been a specific target BP for treating systolic hypertension, with some guidelines recommending a <150 mm Hg target in the elderly based on the results of the SHEP trial, whereas others have maintained the Abstract-The SPRINT (Systolic Blood Pressure Intervention Trial) reported that some older, higher risk patients might benefit from a target systolic blood pressure (BP) of <120 versus <140 mm Hg. However, it is not yet known how the BP target and measurement methods used in SPRINT relate to cardiovascular outcomes in real-world practice. SPRINT used the automated office BP technique, which requires the patient to be resting quietly and alone, with multiple readings being recorded automatically using an electronic oscillometric sphygmomanometer. We studied the relationship between achieved automated office BP at baseline and cardiovascular events in 6183 community-dwelling residents of Ontario aged ≥66 years who were receiving antihypertensive therapy and followed for a mean of 4.6 years. Adjusted hazard ratios (95% confidence intervals) were computed for 10 mm Hg increments in achieved automated office BP at baseline using Cox proportional hazards regression and the BP category with the lowest event rate as the reference category.

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Section: Discussionmentioning

confidence: 99%

Cardiovascular Risk in Hypertension in Relation to Achieved Blood Pressure Using Automated Office Blood Pressure Measurement

et al. 2016

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“…Readings recorded in an ABPM unit or in an office waiting room are similar to AOBP recorded in a physician's examining room. [10][11][12] As a corollary to the present study, 275 residents aged over 65 years in 2 midsized communities in Ontario, Canada, had their BP recorded using standard AOBP procedures in a local pharmacy. 13 Mean AOBP values were similar to AOBP measurements taken on a visit to the subject's own family physician, indicating that AOBP-type measurements can also be taken in a pharmacy.…”

Section: Hypertensionmentioning

confidence: 96%

Thresholds for Diagnosing Hypertension Based on Automated Office Blood Pressure Measurements and Cardiovascular Risk

et al. 2015

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Abstract--The risk of cardiovascular events in relation to blood pressure is largely based on readings taken with a mercury sphygmomanometer in populations which differ from those of today in terms of hypertension severity and drug therapy. Given replacement of the mercury sphygmomanometer with electronic devices, we sought to determine the blood pressure threshold for a significant increase in cardiovascular risk using a fully automated device, which takes multiple readings with the subject resting quietly alone. Participants were 3627 community-dwelling residents aged >65 years untreated for hypertension. Automated office blood pressure readings were obtained in a community pharmacy with subjects seated and undisturbed. This method for recording blood pressure produces similar readings in different settings, including a pharmacy and family doctor's office providing the above procedures are followed. Subjects were followed for a mean (SD) of 4.9 (1.0) years for fatal and nonfatal cardiovascular events. Adjusted hazard ratios (95% confidence intervals) were computed for 10 mm Hg increments in blood pressure (mm Hg) using Cox proportional hazards regression and the blood pressure category with the lowest event rate as the reference category. A total of 271 subjects experienced a cardiovascular event. There was a significant (P=0.02) increase in the hazard ratio of 1.66 (1.09, 2.54) at a systolic blood pressure of 135 to 144 and 1.72 (1.21, 2.45; P=0.003) at a diastolic blood pressure of 80 to 89. A significant (P=0.03) increase in hazard ratio of 1.73 (1.04, 2.86) occurred with a pulse pressure of 80 to 89. These findings are consistent with a threshold of 135/85 for diagnosing hypertension in older subjects using automated office blood pressure.

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“…A recent study found no difference between AOBP obtained during a visit to the physician compared to readings taken in a nontreatment setting. 31 More than 14 000 individuals whose BP was recorded using the BpTRU device are currently being followed-up for cardiovascular morbidity and mortality to relate their BP levels to clinical endpoints. 32 A recent Canadian BP survey 33 of Ͼ2500 residents in the Province of Ontario successfully used the BpTRU to record BP.…”

Section: Recent Research Involving Aobpmentioning

confidence: 99%

Measurement of Blood Pressure in the Office

et al. 2010

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T he widely accepted cut-point for normal blood pressure (BP) in the office setting evolved over several decades, based on data derived from a variety of sources. The Actuarial Society of America was one of the first organizations to publish BP data on thousands of community residents, followed by other classic studies such as Framingham, Western Electric Company, Kaiser Permanente, and the Multiple Risk Factor Intervention Trial. 1,2 In every instance, BP readings were based on measurements taken by specially trained health professionals following guidelines for proper BP measurement. As a result of these and other population studies examining the association between different BP levels and cardiovascular outcomes, the importance of systolic and diastolic hypertension was recognized and an office BP of 140/90 mm Hg became the universally established cut-point for separating normal BP from hypertension. Hypertension Is Not Defined by 140/90 in the "Real World"There are robust scientific data to support the use of 140/90 mm Hg to define hypertension in clinical practice guidelines. However, the guidelines do not take into account widely recognized problems associated with the quality of manual BP measurement in routine clinical practice. 3 More recent recommendations 4 for diagnosing hypertension clearly acknowledge that an increase in BP attributable to the "white coat response" is frequently associated with manual BP recordings performed in community-based practice. In recognizing this limitation of manual office BP, some guidelines have gone so far as to recommend that home BP and 24-hour ambulatory BP monitoring (ABPM) may need to be performed to obtain an accurate measure of a patient's BP status. The greater reliance on 24-hour ABPM and home BP in the diagnosis and management of hypertension is the result of numerous clinical outcome studies 5,6 that show that these measurement techniques are better predictors of cardiovascular events when compared to manual BP readings, even when manual readings are taken carefully in accordance with guidelines.However, most guidelines do not seem to have fully considered the impact conventional routine office BP might have on both the cut-point and ongoing management of hypertension as experienced by primary care physicians. In most instances, an office BP of 140/90 mm Hg is equated to a mean home BP or mean awake ambulatory BP of 135/ 85 mm Hg. However, this relationship has been based on BP readings carefully recorded in accordance with guidelines 4 for proper BP measurement (research-quality office BP readings) and may not reflect the BP obtained by doctors, nurses, and other health professionals in routine office practice. Comparison of Casual and Research-Quality Manual BP MeasurementWhen the primary care physician records BP using a mercury or aneroid device, the resulting value frequently tends to be higher than what it would be if measurement guidelines were strictly adhered to. In a 1995 report from one of our centers, 7 BP data were obtained from 147 hypertensiv...

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Consistent relationship between automated office blood pressure recorded in different settings

Abstract: Mean automated office BP readings are consistent from visit-to-visit regardless of the setting in which they are taken and they are similar to the mean awake ambulatory BP.

Cited by 68 publications

References 13 publications

Cardiovascular Risk in Hypertension in Relation to Achieved Blood Pressure Using Automated Office Blood Pressure Measurement

Cardiovascular Risk in Hypertension in Relation to Achieved Blood Pressure Using Automated Office Blood Pressure Measurement

Thresholds for Diagnosing Hypertension Based on Automated Office Blood Pressure Measurements and Cardiovascular Risk

Measurement of Blood Pressure in the Office

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