Normal values of blood pressure self-measurement in view of the 1999 World Health Organization-International Society of Hypertension guidelines

Weisser, Burkhard; Mengden, Thomas; Düsing, Rainer; Vetter, Hans; Vetter, W

doi:10.1016/s0895-7061(00)00259-4

Cited by 35 publications

(21 citation statements)

References 11 publications

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“…Because home BP measurements average 6-8 SBP/5-6 DBP mmHg lower than values obtained during routine clinic visits, 12 intervention trigger alerts were designed based on a 2-week average home BP of ≥135/85 mmHg for nondiabetics. 13 Concern over the possibility of treatment goals leading to excessively low diastolic BPs for patients with diabetes resulted in basing the trigger alerts on a 2-week home BP average of ≥135/80 mmHg for diabetic patients.…”

Section: Interventionsmentioning

confidence: 99%

Racial Differences in the Effect of a Telephone-Delivered Hypertension Disease Management Program

et al. 2012

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(152), Durham, NC, USA.BACKGROUND: African Americans are significantly more likely than whites to have uncontrolled hypertension, contributing to significant disparities in cardiovascular disease and events. OBJECTIVE: The goal of this study was to examine whether there were differences in change in blood pressure (BP) for African American and non-Hispanic white patients in response to a medication management and tailored nurse-delivered telephone behavioral program. PARTICIPANTS: Five hundred and seventy-three patients (284 African American and 289 non-Hispanic white) primary care patients who participated in the Hypertension Intervention Nurse Telemedicine Study (HINTS) clinical trial. INTERVENTIONS: Study arms included: 1) nurseadministered, physician-directed medication management intervention, utilizing a validated clinical decision support system; 2) nurse-administered, behavioral management intervention; 3) combined behavioral management and medication management intervention; and 4) usual care. All interventions were activated based on poorly controlled home BP values. MAIN MEASURES: Post-hoc analysis of change in systolic and diastolic blood pressure. General linear models (PROC MIXED in SAS, version 9.2) were used to estimate predicted means at 6-month, 12-month, and 18-month time points, by intervention arm and race subgroups (separate models for systolic and diastolic blood pressure). KEY RESULTS: Improvement in mean systolic blood pressure post-baseline was greater for African Ameri-

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Section: Interventionsmentioning

confidence: 99%

Racial Differences in the Effect of a Telephone-Delivered Hypertension Disease Management Program

et al. 2012

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“…Consistent with current guidelines, the home BP target was defined as Ͻ135/85 mm Hg for patients without diabetes mellitus. 14,20 Home BP targets for patients with diabetes mellitus were not well defined at study initiation, and a target of Ͻ135/80 mm Hg was chosen based on the recommendations of an internal consensus panel. In the medication management and combined arms of the trial, receipt of an intervention alert prompted the study team to consider medication intensification.…”

Section: Intervention Alerts In Hintsmentioning

confidence: 99%

Treatment Intensification in a Hypertension Telemanagement Trial

et al. 2011

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Abstract-Clinical inertia represents a barrier to hypertension management. As part of a hypertension telemanagement trial designed to overcome clinical inertia, we evaluated study physician reactions to elevated home blood pressures. We studied 296 patients from the Hypertension Intervention Nurse Telemedicine Study who received telemonitoring and study physician medication management. When a patient's 2-week mean home blood pressure was elevated, an "intervention alert" prompted study physicians to consider treatment intensification. We examined treatment intensification rates and subsequent blood pressure control. Patients generated 1216 intervention alerts during the 18-month intervention. Of 922 eligible intervention alerts, study physicians intensified treatment in 374 (40.6%). Study physician perception that home blood pressure was acceptable was the most common rationale for nonintensification (53.7%).When "blood pressure acceptable" was the reason for not intensifying treatment, the mean blood pressure was lower than for intervention alerts where treatment intensification occurred (135. Previous studies provide evidence for improved BP control using telemanagement models in selected patient populations. [11][12][13] Compared with clinic BP measurement, home telemonitoring may also better predict cardiovascular risk and is less subject to observer bias (white-coat hypertension and masked hypertension). 14 -18 The Hypertension Intervention Nurse Telemedicine Study (HINTS) was an 18-month randomized, controlled trial designed to circumvent factors contributing to clinical inertia. 19 We examined data from the medication management arms of HINTS to determine how physicians reacted to elevated BP values, why they reacted as they did, and how their decisions impacted subsequent patient BP control after episodes of elevated BP. Our goal was to determine whether clinical inertia persisted in HINTS despite the efforts to overcome it. Methods HINTS DesignHINTS randomized 593 eligible veterans into 4 groups: (1) a nurse-administered behavioral management intervention; (2) a nurse-administered, physician-directed medication management intervention using a validated clinical decision support system; (3) a combined behavioral management and medication management intervention; and (4) usual care. Eligible patients received primary care at the Durham Veterans Affairs Medical Center, had a diagnosis of hypertension, used BP-lowering medication, and had inadequate BP control (Ͼ140/90 mm Hg for all patients) based on the average of the previous 12 months' clinic BP measurements obtained from electronic medical charts. Exclusion criteria were receipt of dialysis; a serum creatinine Ͼ2.5 or no documentation of renal function; history of organ transplant; hospitalization for stroke, myocardial infarction, or coronary artery revascularization within 3 months of contact; diagnosis of metastatic cancer or dementia; lack of a home telephone; residence in a nursing home; receipt of home health care; or severely impaired hearing ...

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“…Thus, ambulatory BP is always lower than office BP [6][7][8][9][10] and lower than work self-measured BP. 11 However, these measurements may also vary, depending on the observer or healthcare professional: BP values obtained by the nursing staff are lower than those obtained by the physician.…”

Section: Introductionmentioning

confidence: 99%

Blood pressure measurement in an ambulatory setting: concordance between physician and patient self-measurement

Vinyoles¹,

Blancafort²,

Lopez-Quinones³

et al. 2003

J Hum Hypertens

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The aim of this study was to determine concordance between physician and patient blood pressure (BP) measurements in an ambulatory setting. A diagnostic intervention cross-sectional study using a convenience sample was employed. A total of 106 hypertensive patients were included in the study. Patients who were unable to perform their self-measurement or those with cardiac arrhythmia were excluded. BP was determined nine times in each subject in the medical office in a randomised order: BP was taken three times by the physician using a mercury sphygmomanometer (SPHHg), three times by the physician using a validated, automated oscillometer (Omron HEM 705 CP), and three times by the patient himself with the same device. The intraclass correlation coefficient was calculated. In all, 59 women and 47 men aged 65.7 (10) years were analysed. Mean BP measurements for the physician using the mercury sphygmomanometer, the physician using the Omron, and the patient using the same device were: 136 (15.8)/80 (11), 137 (17.9)/80 (10), and 139* (17.6)/80 (10) mmHg, respectively. BP control was 48.1, 48.1, and 36.8*% (*Po0.05), respectively. Intraclass correlation coefficients for systolic/diastolic pressures were: 0.77/0.65 (physicianFsphygmomanometer Hg, physicianFOmron;Po0.001), 0.75/0.64 (physicianFsphygmomanometer Hg, patientFOmron, Po0.001), and 0.83/0.83 (physicianFOmron, patientFOmron; Po0.001). In conclusion, the three types of measurement in the medical office were significantly concordant. Patient office self-measurement showed a tendency to increase systolic BP and worsen BP control.

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Normal values of blood pressure self-measurement in view of the 1999 World Health Organization-International Society of Hypertension guidelines

Cited by 35 publications

References 11 publications

Racial Differences in the Effect of a Telephone-Delivered Hypertension Disease Management Program

Racial Differences in the Effect of a Telephone-Delivered Hypertension Disease Management Program

Treatment Intensification in a Hypertension Telemanagement Trial

Blood pressure measurement in an ambulatory setting: concordance between physician and patient self-measurement

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