In-office and out-of-office blood pressure measurement

Asayama, Kei; Imai, Yutaka

doi:10.1038/s41371-021-00486-8

Cited by 17 publications

(15 citation statements)

References 43 publications

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“…Diagnosing WCH when clinic BP is ≥140/90 mm Hg, but out-of-office BP is <135/85 mm Hg is supported by 2018 ISSHP guidelines for HBPM in pregnancy and guidance for outside pregnancy. 1,23 However, a mean 24-hour ABPM <135/85 mm Hg is higher than the 2018 ISSHP recommendation to use <126/76 mm Hg, as well as the awake average BP of <132/79 mm Hg, or the sleep average BP <114/66 mm Hg before 22 weeks. 1 While all ISSHP values are lower than outside pregnancy and cutoffs have shown wide variation, 4,15 these results suggest that maternity care providers desire a threshold for abnormal BP out-of-office that is harmonized across methods for ease of implementation.…”

Section: Discussionmentioning

confidence: 97%

Diagnosis and Monitoring of White Coat Hypertension in Pregnancy: an ISSHP Consensus Delphi Procedure

et al. 2022

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Background: There is no accepted definition or standardized monitoring for white coat hypertension in pregnancy. This Delphi procedure aimed to reach consensus on out-of-office blood pressure (BP) monitoring, and white coat hypertension diagnostic criteria and monitoring. Method: Relevant international experts completed three rounds of a modified Delphi questionnaire. For each item, the predefined cutoff for group consensus was ≥70% agreement, with 60% to 70% considered to warrant reconsideration at the subsequent round, and <60% considered insufficient to warrant consideration. Results: Of 230 experts, 137 completed the first round and 114 (114/137, 83.2%) completed all three. For out-of-office BP monitoring, there was consensus that home BP monitoring (HBPM) should be chosen; instructions given, pairs of BP values taken, opportunity given for women to qualify values they do not regard as valid, and BP considered evaluated when ≥25% of values are above a cutoff. For HBPM, BP should be taken at least 2 to 3 d/wk, at minimum in the morning; however, many factors may affect frequency and timing. Experts endorsed a clinic BP <140/90 mm Hg as normal. While not reaching consensus, most agreed that HBPM values should be lower than clinic BP. Among those, HBPM <135/85 mm Hg was considered normal. There was consensus that white coat hypertension warrants: HBPM at least 1 d/wk before 20 weeks, 2 to 3 d/wk after 20 weeks or if persistent hypertension develops, and symptom monitoring (ie, headache, visual symptoms, and right upper quadrant/epigastric pain). Conclusions: Consensus-based diagnostic criteria and monitoring strategies should inform clinical care and research, to facilitate evaluation of out-of-office BP monitoring on pregnancy outcomes.

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Section: Discussionmentioning

confidence: 97%

Diagnosis and Monitoring of White Coat Hypertension in Pregnancy: an ISSHP Consensus Delphi Procedure

et al. 2022

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“…In the present study, the reproducibility of home blood pressure was high compared with unattended AOBP. The essentially similarly poor reproducibility of AOBP compared with conventional attended office blood pressure, even in those with the same drug regimen, might reduce the usefulness of AOBP, as stringent AOBP measurement is resource-intensive, and therefore, less feasible compared with conventional office blood pressure measurement [8,12,13]. Nevertheless, we would like to emphasize that usual office blood pressure is measured poorly [16], despite the recommended protocol provided by the guidelines [1][2][3]30].…”

Section: Discussionmentioning

confidence: 99%

Direct comparison of the reproducibility of in-office and self-measured home blood pressures

Asayama

Rakugi

Miyakawa³

et al. 2021

Journal of Hypertension

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The Japanese Society of Hypertension Working Group on the COmparison of Self-measured home, Automated unattended office, Conventional attended office blood pressure (COSAC) study Objective: The aim was to compare short-term and longterm reproducibilities of in-office unattended blood pressure (BP), namely automated office blood pressure (AOBP), conventionally measured attended office BP, and self-measured home BP.Methods: A multicentre, clinical study was conducted in Japan, and 287 Japanese outpatients on antihypertensive drug medication were followed-up for 1 year. Results:The intensity of drug treatment was sustained consistently throughout the study period (defined daily doses, 1.62-1.68; P ¼ 0.12). The mean SBP differences between baseline and 1 month later, as well as baseline and 1 year later, were less than 1.5 mmHg, whereas the standard deviations of the differences for home, AOBP, and attended office measurements for the 1-year interval were 7.7, 14.5, and 15.3 mmHg, respectively. The coefficients of variation were significantly smaller for home BP than for AOBP among all patients at both 1month and 1-year intervals (P < 0.0001). In the 1-month interval, partial correlation coefficients of home BP (r, 0.73/0.88 for systolic/diastolic measures) were significantly higher than of conventional BP (r, 0.47/0.69). However, the correlations converged to the modest level regardless of BP information (r, 0.49-0.54/0.63-0.73) when the 1year interval was assessed. Results were confirmatory when patients on the same drug regimen (n ¼ 167) were analysed. Conclusion:A higher reproducibility of home BP was demonstrated compared with in-office BP, including AOBP. However, the modest correlations for the 1-year interval support the importance of regular assessment of BP, regardless of in-office or home measurements for treatment of hypertension.

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“…It is known that selectins are involved in female reproduction by regulation of ovarian function and menopause [ 54 ] and this may explain the association of E-selectin with office BP reported in women [ 53 ]. Another explanation for our results is the white-coat effect which may have influenced office BP measurement [ 55 ]. However, the white-coat effect is not present in the 24 h BP monitoring and still, we found no significant association of E-selectin with mean systolic and diastolic BP measured during the daytime, nighttime and 24 h periods.…”

Section: Discussionmentioning

confidence: 99%

E-Selectin Is Associated with Daytime and 24-Hour Diastolic Blood Pressure Variability in Type 2 Diabetes

et al. 2022

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E-selectin is an endothelial cell adhesion molecule involved in vascular inflammation. Elevated E-selectin has been reported in patients with high blood pressure and diabetes. Given the increasing clinical relevance of parameters derived from ambulatory blood pressure monitoring, further investigation of their relationships with E-selectin is of interest. In this study, we aimed to investigate the association between serum E-selectin, office blood pressure and 24 h ambulatory blood pressure parameters in patients with type 2 diabetes. Blood pressure variability was assessed by computing the standard deviation of mean systolic and diastolic blood pressure separately for daytime and nighttime during 24 h ambulatory blood pressure monitoring in a cohort of patients with type 2 diabetes (n = 132). Additionally, were assessed nighttime systolic dipping and pulse pressure separately for daytime, nighttime, and 24 h. Serum E-selectin was measured using the enzyme-linked immunosorbent assay technique. We found that E-selectin was consistently associated with 24 h diastolic blood pressure variability (r = 0.238; p = 0.019) and daytime diastolic blood pressure variability (r = 0.258; p = 0.012), after adjustment for confounding factors. No association of E-selectin with office blood pressure and other 24 h ambulatory blood pressure parameters was observed. In conclusion, endothelial activation indicated by elevated serum E-selectin is associated with increased ambulatory diastolic blood pressure variability in patients with type 2 diabetes.

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In-office and out-of-office blood pressure measurement

Cited by 17 publications

References 43 publications

Diagnosis and Monitoring of White Coat Hypertension in Pregnancy: an ISSHP Consensus Delphi Procedure

Diagnosis and Monitoring of White Coat Hypertension in Pregnancy: an ISSHP Consensus Delphi Procedure

Direct comparison of the reproducibility of in-office and self-measured home blood pressures

E-Selectin Is Associated with Daytime and 24-Hour Diastolic Blood Pressure Variability in Type 2 Diabetes

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