Self-blood pressure measurement as compared to office blood pressure measurement in a large Indian population; the India Heart Study

Abstract

Objective: India Heart Study (IHS) is aimed at investigating the agreement between office blood pressure measurement (OBPM) and self (S)BPM in a hypertension-naive population. Methods: A total of 18 918 individuals (aged 42.6 ± 11.7 years, 62.7% men), visiting 1237 primary care physicians across India, underwent OBPM. They performed SBPM for a period of 1 week using a validated oscillometric BP monitor that was preprogrammed to adhere to a guideline-based SBPM-schedule and blinded to the results. Thereafter, individuals underwent a second OBPM. Available laboratory results were obtained. Thresholds for elevated OBPM and SBPM were 140/90 and 135/85 mmHg, respectively. Results: On the basis of first-visit OBPM and SBPM, there were 5787 (30.6%) individuals with normotension; 5208 (27.5%) with hypertension; 4485 (23.7%) with white-coat hypertension (WCH) and 3438 (18.2%) with masked hypertension. Thus, a diagnosis contradiction between SBPM and first-visit OBPM was seen in 9870 (41.9%) individuals. On the basis of second-visit OBPM, the normotension, hypertension, WCH and masked hypertension prevalence values were 7875 (41.6%); 4857 (25.7%); 2397 (12.7%) and 3789 (20.0%). There was poor agreement (kappa value 0.37) between OBPM of visit 1 and 2 with a diagnosis difference in 6027 (31.8%) individuals. The majority of masked hypertension and WCH individuals had BP values close to thresholds. Conclusion: There was a poor agreement between OBPM of visit1 and visit 2. Likewise, the agreement between OBPM at both visits and SBPM was poor. SBPM being considered to have a better correlation with patient prognosis should be the preferred method for diagnosing hypertension.

Nationwide surveillance for S-metoprolol treatment effect on blood pressure control against sympathetic overdrive in Indian patients with hypertension (PROTECT)

“…10 Reported prevalence of higher resting heart rate is in line with the recently published India Heart study which has reported higher average resting heart rate of 80 beats per minute in Indian patients with hypertension. 11 Available Indian epidemiological data suggests the ongoing epidemic of uncontrolled hypertension, strongly leading to various CV complications. Almost 71% higher risk of death attributable to cerebrovascular disease and around 31% higher risk of death attributable to CVD in uncontrolled hypertensives in India.…”

Beta-Adrenergic Blockade: Is It the Prudent Choice against Sympathetic Overdrive in Patients with Hypertension or Heart Failure?

“…This evidence supported to look for the use of antihypertensive drugs with HR-lowering effects in Indian patients with hypertension. 12 In case of HF, SO is (i) directly related to the severity of symptoms and thus with the New York Heart Association (NYHA) functional class; (ii) inversely related to measures of left ventricular function, such as left ventricular stroke work, stroke volume, and ejection frac-tion; and (iii) independent of the ischemic or idiopathic nature of the disease. 13…”

GeogRaphic and socioecoNomic Distribution of real‐world Indian data of home blood pressure monitoring (GRAND Study): Study protocol for an observational study in 18 medical centers across India

“…A vast body of international evidence shows HBPM to have a superior prognostic value and as a better predictor over CBP for CVD outcomes and target organ damage 21 . A finding from the India Heart Study which investigated the agreement of two visits CBP and 7 days home blood pressure (HBP) showed poor agreement between the two readings, and stated the conclusion that when it comes to diagnosing hypertension, HBP should be the preferred method 22 . Summarizing the evidence thus far, HBPM appears to provide close to the true value of an individual's BP control better than CBP, while it shows benefit over ABPM as the patient can measure their BP multiple times for long period on several occasions at their own convenience 19–20 .…”