Actual Blood Pressure Research Articles

팔뚝형 자동혈압계 평가용 혈압 시뮬레이터 개발

Abstract Blood pressure is possible to diagnose a disease associated with blood pressure and judgment the current health of patients.Automatic blood pressure monitor capable of measuring a blood pressure easily in hospital and at home have become spread.In this study, we developed the blood pressure simulator (BPS) that can test the arm-type automatic blood pressure monitorthat is commonly used in hospital. BPS is to produce a pressure similar to the pressure wave generated in the human bloodusing a servo disk motor. Then, using the silicon tube, it implements the situations such as human blood vessels, and to outputthe generated pressure waveform. Simply the BPS's phantom put on the cuff and it is able to simulate blood pressure. So anyonecan quickly test the blood pressure monitor within one minute and it is possible to shorten the test time required for the auto-matic blood pressure monitor. In Performance test, the trends and the standard deviation of the values measured in the BPSis similar to the value of the measured pressure from people with normal blood pressure. Thus, the development BPS showeda possibility of taking into account the actual blood pressure measurement environment simulator.Keywords: Simulator, Blood pressure, Automatic blood pressure monitor, Test

What Metabolic Syndrome Contributes to Brain Outcomes in African American & Caucasian Cohorts.

Metabolic syndrome (MetS), i.e., meeting criteria for any three of the following: hyperglycemia, hypertension, hypertriglyceridemia, low high-density lipoprotein and/or abdominal obesity, is associated with negative health outcomes. For example, MetS negatively impacts cognition; however, less is known about incremental MetS risk, i.e., meeting 1 or 2 as opposed to 3 or more criteria. We hypothesized incremental MetS risk would negatively contribute to cognition and relevant neuroanatomy, e.g., memory and hippocampal volumes, and that this risk extends to affective functioning. 119 non-demented/non-depressed participants (age=60.1+12.9;~50% African American) grouped by incremental MetS risk-no (0 criteria met), low (1-2 criteria met), or high (3+ criteria met)-were compared across cognition, affect and relevant neuroanatomy using multivariable linear regressions. Exploratory analyses, stratified by race, consider the role of health disparities in disease severity of individual MetS component (e.g., actual blood pressure readings) on significant results from primary analyses. Incremental MetS risk contributed to depressive symptomatology (no<low<high), learning and memory performance (no>low=high) after controlling for age, race (n.s.) and IQ. Different indices of disease severity contributed to different aspects of brain structure and function by race providing empirical support for future studies of the impact distinct health disparities in vascular risk have on brain aging. MetS compromised mood, cognition and hippocampal structure with incremental risk applying to some but not all of these outcomes. Care providers may wish to monitor a broader spectrum of risk including components of MetS like blood pressure and cholesterol levels when considering brain-behavior relationships in adults from diverse populations.

BioWatch: A Noninvasive Wrist-Based Blood Pressure Monitor That Incorporates Training Techniques for Posture and Subject Variability.

Noninvasive continuous blood pressure (BP) monitoring is not yet practically available for daily use. Challenges include making the system easily wearable, reducing noise level and improving accuracy. Variations in each person's physical characteristics, as well as the possibility of different postures, increase the complexity of continuous BP monitoring, especially outside the hospital. This study attempts to provide an easily wearable solution and proposes training to specific posture and individual for further improving accuracy. The wrist watch-based system we developed can measure electrocardiogram and photoplethysmogram. From these two signals, we measure pulse transit time through which we can obtain systolic and diastolic blood pressure through regression techniques. In this study, we investigate various functions to perform the training to obtain blood pressure. We validate measurements on different postures and subjects, and show the value of training the device to each posture and each subject. We observed that the average RMSE between the measured actual systolic BP and calculated systolic BP is between 7.83 to 9.37 mmHg across 11 subjects. The corresponding range of error for diastolic BP is 5.77 to 6.90 mmHg. The system can also automatically detect the arm position of the user using an accelerometer with an average accuracy of 98%, to make sure that the sensor is kept at the proper height. This system, called BioWatch, can potentially be a unified solution for heart rate, SPO2 and continuous BP monitoring.

LB03.09

Objective: Rates of blood pressure (BP) control are poor in China, even among patients receiving treatment. A real-world survey – Hypertension Attitude PersPEctives and Needs (HAPPEN) – was conducted to examine the role of physician and patient attitudes in BP control. Design and method: Tier 3 hospitals (Beijing [n = 34], Shanghai [n = 18] and Guangzhou [n = 25]) were randomly selected for surveying. Cardiologists, nephrologists and patients with hypertension at these hospitals were randomly screened to participate. Physician inclusion criteria included practising for> = 5 years and seeing >=100 patients with hypertension every month. Eligible patients were visiting a cardiologist or nephrologist, had a diagnosis of hypertension for >=1 year and were receiving prescription treatment for >=6 months. Questionnaires were conducted by trained interviewers following the ESOMAR Code of Conduct. The survey was completed by 100 cardiologists, 30 nephrologists and 400 patients (primary hypertension [n = 160], hypertension with chronic kidney disease [n = 100], diabetes [n = 58], coronary artery disease [n = 51], stroke [n = 15] or others [16]). Results: Although physicians claimed to inform 90% of patients of their BP target, only 67% (n = 263) of patients knew their target. Of these patients, 31% (n = 81) were achieving their BP target according to measurements recorded in the previous 2 weeks. This agrees with previously reported BP control rates of 31.6% among treated patients with hypertension in tier 3 hospitals. In contrast, perceived levels of BP control were high; 85% (n = 223) of patients aware of their BP target claimed to reach it all/most of the time. Similarly, physicians claimed 70% of their patients achieve target BP and 62% were completely or somewhat satisfied with the proportion of their patients that reach target. Only 14% of patients reported they were concerned if they did not achieve BP control, and 88% were satisfied with their current treatment. Conclusions: In this study, physicians and patients in China overestimated BP control rates. The large gap between perceived and actual BP control rates may contribute to therapeutic inertia and poor BP control among treated patients with hypertension.

Strengths and limitations of current pediatric blood pressure nomograms: a global overview with a special emphasis on regional differences in neonates and infants.

The availability of robust nomograms is essential for the correct evaluation of blood pressure (BP) values in children. A literature search was conducted by accessing the National Library of Medicine by using the keywords BP, pediatric and reference values/nomograms. A total of 43 studies that evaluated pediatric BP nomograms were included in this review. Despite the accuracy of the latest studies, many numerical and methodological limitations still remain. The numerical limitations include the paucity of data for neonates/infants and for some geographic areas (Africa/South America/East Europe/Asia) and ethnicities. Furthermore, the data on ambulatory BP and response to exercise are extremely limited, and the criteria for stress-test interruption are lacking. There was heterogeneity in the methodologies employed to perform the measurements, in the inclusion/exclusion criteria (often not reported), in the data normalization and the data expression (Z-scores/percentiles/mean values). Although most studies adjusted the measurements for age and/or height, the classification by specific age/height subgroups varied. Gender differences were generally considered, whereas other confounders (that is, ethnicity/geographic area/environment) were seldom evaluated. As a result, nomograms were heterogeneous, and when comparable, at times showed widely different confidence intervals. These differences are most likely because of both methodological limitations and differences among the populations studied. Some robust nomograms exist (particularly those from the USA); however, it has been demonstrated that if adopted in other countries/continents, they may generate an unpredictable bias in the evaluation of BP values in children. Actual pediatric BP nomograms present consistent limitations that affect the evaluation of BP in children. Comprehensive nomograms, which are based on a large population of healthy children (including neonates/infants) and use standardized methodology, are warranted for every country/region.

Pressure-dependence of arterial stiffness: potential clinical implications.

Arterial stiffness measures such as pulse wave velocity (PWV) have a known dependence on actual blood pressure, requiring consideration in cardiovascular risk assessment and management. Given the impact of ageing on arterial wall structure, the pressure-dependence of PWV may vary with age. Using a noninvasive model-based approach, combining carotid artery echo-tracking and tonometry waveforms, we obtained pressure-area curves in 23 hypertensive patients at baseline and after 3 months of antihypertensive treatment. We predicted the follow-up PWV decrease using modelled baseline curves and follow-up pressures. In addition, on the basis of these curves, we estimated PWV values for two age groups (mean ages 41 and 64 years) at predefined hypertensive (160/90 mmHg) and normotensive (120/80 mmHg) pressure ranges. Follow-up measurements showed a near 1 m/s decrease in carotid PWV when compared with baseline, which fully agreed with our model-prediction given the roughly 10 mmHg decrease in diastolic pressure. The stiffness-blood pressure-age pattern was in close agreement with corresponding data from the 'Reference Values for Arterial Stiffness' study, linking the physical and empirical bases of our findings. Our study demonstrates that the innate pressure-dependence of arterial stiffness may have implications for the clinical use of arterial stiffness measurements, both in risk assessment and in treatment monitoring of individual patients. We propose a number of clinically feasible approaches to account for the blood pressure effect on PWV measurements.

Night time blood pressure dip.

The advent of ambulatory blood pressure monitoring permitted examination of blood pressures during sleep and recognition of the associated circadian fall in pressure during this period. The fall in pressure, called the "dip", is defined as the difference between daytime mean systolic pressure and nighttime mean systolic pressure expressed as a percentage of the day value. Ten percent to 20% is considered normal. Dips less than 10%, referred to as blunted or absent, have been considered as predicting an adverse cardiovascular event. This view and the broader concept that white coat hypertension itself is a forerunner of essential hypertension is disputable. This editorial questions whether mean arterial pressures over many hours accurately represent the systolic load, whether nighttime dipping varies from measure to measure or is a fixed phenomenon, whether the abrupt morning pressure rise is a risk factor or whether none of these issues are as important as the actual night time systolic blood pressure itself. The paper discusses the difference between medicated and nonmedicated white coat hypertensives in regard to the cardiovascular risk and suggests that further work is necessary to consider whether the quality and duration of sleep are important factors.

Adolescent blood pressure pattern in Rivers State, Nigeria: A rural - urban comparison

Background : Childhood and adolescent blood pressure pattern have been known to predict adult blood pressure levels and development of hypertension. Hypertension, once rare in traditional African societies, is now the commonest non-communicable disease in Nigeria. There are few studies on adolescent blood pressure pattern, especially in adolescents living in rural areas. It is therefore important to identify blood pressure differences, if any, between adolescents living in rural areas compared to their urban counterparts. Objective : To determine and compare the blood pressure pattern of apparently healthy adolescents in rural and urban areas, and to determine the association between blood pressure and body mass index in these children. Subjects and Methods : A cross sectional population based blood pressure survey was carried out on 2,136 Nigerian school adolescents (1080 were resident in rural areas and 1056 in urban areas) aged 10-18 years, selected from 26 secondary schools using a multi-stage stratified sampling technique. Blood pressure measurements were taken by auscultatory method. An average of three readings was taken as the actual blood pressure. Results : Systolic and diastolic blood pressure increased with age in both rural and urban subjects. The mean systolic blood pressure of the rural subjects (111.10 ± 14.72 mm Hg) was significantly (p= < 0.001) higher than that of the urban subjects (108.09 ±15.40 mm Hg), whilst the mean diastolic blood pressure of the urban subjects (66.88 ± 11.27 mmHg) was slightly higher than those of the rural subjects (66.32±11.71 mmHg. Urban subjects had a higher mean body mass index (19.82± 3.57kg/m2) than their ruralcounterparts (19.59±2.78 kg/ m2).Systolic and diastolic blood pressure showed a positive significant (p= <0.001) correlation with BMI in subjects in rural and urban schools. Conclusion : Significant differences in blood pressure were observed between rural and urban adolescents in Rivers State, with a positive significant correlation between BMI and blood pressure. We recommend blood pressure surveillance as part of the School Health Programme. Keywords : adolescent, blood pressure, rural-urban, Nigeria

Erratum to: Is ambulatory blood pressure monitoring useful in patients with chronic autonomic failure?

Management of blood pressure (BP) abnormalities in patients with autonomic failure is usually based on office BP readings. It is uncertain whether office readings reflect actual BP’s during a typical day. Therefore, in 45 patients with autonomic failure we compared office BP values during a tilt test with those captured on a 24-h BP ambulatory monitor. Office BP values while supine predicted well the level of nighttime hypertension. However, in only 33 % of patients office values during tilt test accurately reflected hypotension during a typical day. Therefore, BP ambulatory monitoring is useful to gauge the true severity of hypotension in patients with autonomic failure.

Subjective well-being and hypertension: Effects of diagnostic labelling, antihypertensive medication and actual blood pressure

Subjective well-being and hypertension: Effects of diagnostic labelling, antihypertensive medication and actual blood pressure

Is ambulatory blood pressure monitoring useful in patients with chronic autonomic failure?

Management of blood pressure (BP) abnormalities in patients with autonomic failure is usually based on office BP readings. It is uncertain, whether office readings reflect actual BP's [corrected] during a typical day. Therefore, in 45 patients with autonomic failure, we compared office BP values during a tilt test with those captured on a 24-h BP [corrected] ambulatory monitor. Office BP values while supine predicted well the level of nighttime hypertension. However, in only 33% of patients, office values during tilt test accurately reflected hypotension during a typical day. Therefore, BP [corrected] ambulatory monitoring is useful to gauge the true severity of hypotension in patients with autonomic failure.

Time‐Trend Analysis on the Framingham Risk Score and Prevalence of Cardiovascular Risk Factors in Patients Undergoing Percutaneous Coronary Intervention Without Prior History of Coronary Vascular Disease Over the Last 17 Years: A Study From the Mayo Clinic PCI Registry

There is a paucity of data on the temporal trends of cardiovascular risk factors in patients undergoing percutaneous coronary intervention (PCI). We investigated the secular trends of risk profiles of patients undergoing PCI without prior history of cardiovascular disease (CVD). CVD risk factors are changed over time. This time-trend analysis from 1994 to 2010 was performed within the Mayo Clinic PCI Registry. Outcome measures were prevalence of CVD risk factors, including the Framingham risk score (FRS), at the time of admission for PCI. During this period, 12,055 patients without a history of CVD (mean age, 65.0 ± 12.4 years, 67% male) underwent PCI at the Mayo Clinic. Age distribution slightly shifted toward older age (P for trend <0.05), but sex did not change over time. Despite a higher prevalence of hypertension, hypercholesterolemia, and diabetes mellitus over time, actual blood pressure and lipid profiles improved (P for trend <0.001). Over time, FRS and 10-year CVD risk improved significantly (7.3 ± 3.2 to 6.5 ± 3.3, P for trend <0.001; and 11.0 to 9.0, P for trend <0.001, respectively). Body mass index, not included in the FRS, increased significantly (29.0 ± 5.2 to 30.1 ± 6.2 kg/m(2) , P for trend <0.001), whereas smoking prevalence did not change. The current study demonstrates that although traditional FRS and its associated predicted 10-year cardiovascular risk declined over time, the prevalence of risk factors increased in patients undergoing PCI. The study suggests the need for a new risk-factor assessment in this patient population.

Nifedipine-Sensitive Blood Pressure Component in Hypertensive Models Characterized by High Activity of Either Sympathetic Nervous System or Renin-Angiotensin System

High blood pressure (BP) of spontaneously hypertensive rats (SHR) is maintained by enhanced activity of sympathetic nervous system (SNS), whereas that of Ren-2 transgenic rats (Ren-2 TGR) by increased activity of renin-angiotensin system (RAS). However, both types of hypertension are effectively attenuated by chronic blockade of L-type voltage-dependent calcium channel (L-VDCC). The aim of our study was to evaluate whether the magnitude of BP response elicited by acute nifedipine administration is proportional to the alterations of particular vasoactive systems (SNS, RAS, NO) known to modulate L-VDCC activity. We therefore studied these relationships not only in SHR, in which mean arterial pressure was modified in a wide range of 100-210 mm Hg by chronic antihypertensive treatment (captopril or hydralazine) or its withdrawal, but also in rats with augmented RAS activity such as homozygous Ren-2 TGR, pertussis toxin-treated SHR or L-NAME-treated SHR. In all studied groups the magnitude of BP response to nifedipine was proportional to actual BP level and it closely correlated with BP changes induced by acute combined blockade of RAS and SNS. BP response to nifedipine is also closely related to the degree of relative NO deficiency. This was true for both SNS- and RAS-dependent forms of genetic hypertension, suggesting common mechanisms responsible for enhanced L-VDCC opening and/or their upregulation in hypertensive animals. In conclusions, BP response to nifedipine is proportional to the vasoconstrictor activity exerted by both SNS and RAS, indicating a key importance of these two pressor systems for actual L-VDCC opening necessary for BP maintenance.

Circadian Blood Pressure Profile and Associated Cardiovascular Risk Factors in Non-Dippers

Introduction: Ambulatory blood pressure accurately reflects a patient's actual blood pressure than casual or office blood pressure. This study aims to describe the circadian blood pressure profile of hypertensive patients and to identify the associated cardiovascular risk factors in non-dippers. Methods: A cross-sectional study was conducted from 1st January 2008 to 30th June 2008 among hypertensive patients attending Family Medicine Clinic HUSM. Schiller BR-102 plus was used to get 24 hours blood pressure (BP) reading. Mean of two offices BP were also taken. Non-dippers are defined as a systolic or diastolic nocturnal drop of less than 10%. Analysis was done using SPSS Version 12. Results: 105 patients were recruited with mean (SD) age of 51.8 (9.34) year old. The mean (SD) 24-hour systolic and diastolic BP was 128.4 (12.7) mmHg and 79.7 (8.74) mmHg respectively. Mean (SD) daytime systolic and diastolic BP was 132.1 (11.72) mmHg and 82.4 (9.41) mmHg while for the night time were 123.3 (12.78) mmHg and 76.2 (9.01) mmHg. Mean (SD) systolic and diastolic office BP was 144.2(15.16) mmHg and 90.2(9.71) mmHg. Percentage of non dippers were 68.6% for systolic and 61.9% for diastolic. Conclusion: Mean 24 hours and daytime ambulatory BP was normal but the mean night time diastolic and office BP was above-normal value. Majority of the patients were categorized as non dippers. Therefore, using ambulatory BP is clinically important to get a better understanding of blood pressure fluctuations over 24-hour periods compared to simple clinical measurements.

Blood pressure fluctuation and hypertension in patients with Parkinson's disease

ObjectivesBlood pressure (BP) abnormalities have been known in Parkinson's disease (PD) patients. The present study aimed at determining how the BPs of PD patients fluctuate in a day.MethodsA total of 37 PD patients and 44 OD (other disease) patients, all of who were inpatients, were monitored every 30 min by 24-h ambulatory blood pressure monitoring (ABPM).ResultsThe average systolic BP and the number of patients who showed postprandial hypotension were not different between the two groups. However, occurrence of nocturnal hypertension, BP fluctuation of over 100 mmHg in a day and BP of over 200 mmHg were significantly more frequently observed in the PD patients than in the OD patients. In the PD patients, these parameters were not different between those who were suffering from the disease for less than 10 years and those with the disease for 10 years or longer, as well as between those who had a Hoehn–Yahr staging scale of 2–3 and those with a scale of 4–5.ConclusionTwenty-four-hour ABPM, not BP measurement once a day, enables us to determine the actual BP in PD patients. Although hypotension is a severe risk factor for falling and syncope, we emphasize the importance of monitoring rather hypertension and fluctuating BP in PD patients that may lead to a variety of other undesirable conditions. Management of hypotension, hypertension, and BP fluctuation is an important issue in the future.

Clinical Hypotension with Co-prescription of Macrolide Antibiotics and Calcium-Channel Blockers in Haemodialysis Patients: A Retrospective Chart Review

Macrolide antibiotics inhibit the cytochrome p450 enzyme system, which metabolizes calcium-channel blockers. This may result in a clinically significant interaction, causing hypotension in patients co-prescribed these two drugs. Since these drugs are frequently used in the haemodialysis population, we studied the effect of their co-prescription on actual blood pressure. A retrospective chart review of all haemodialysis patients was conducted to identify patients co-prescribed a macrolide and a dihydropyridine calcium-channel blocker. Blood pressure measurements before and during the macrolide co-prescription were abstracted and compared using a student's t test. We identified 154 haemodialysis patients concurrently prescribed a macrolide antibiotic and a dihydropyridine calcium-channel blocker. There was no significant difference in episodes of intra-dialytic hypotension or actual blood pressure measurements in the period before macrolide co-prescription and the period during macrolide co-prescription. In contrast to hospitalized patients receiving dihydropyridine calcium-channel blockers, concurrent administration of a macrolide antibiotic for infection did not result in hypotension in haemodialysis outpatients. Further research should be undertaken before a change in clinical practice against their co-prescription is considered.

A systematic review of the pharmacological management of orthostatic hypotension

The 'short' and 'long-term' benefits of pharmacological interventions to treat orthostatic hypotension (OH) remain unclear. The aim was to systematically examine the published literature on the effectiveness of different drug regimens for the treatment of OH. Systematic review. MEDLINE (1950-Week 7, 2011), EMBASE (1980-Week 7, 2011), CINAHL (1981-Week 7, 2011) databases and hand-searching of bibliographies were used to identify suitable papers. Studies selected were those, which investigated drug treatment of OH in a single- or double-blind randomised controlled trial (RCT) in humans over 18 years of age. Data were extracted from suitable full-text articles by three investigators independently. The 13 trials met the criteria for systematic review amongst which was considerable variation in the size of postural blood pressure (BP) change with active treatment. However, there was evidence that commonly used drugs midodrine or fludrocortisone therapy did increase standing or head-up-tilt (HUT) systolic blood pressure in certain patient groups. The evidence that pharmacological therapy is of benefit for the treatment of OH is limited by the lack of good quality clinical trial evidence. Further well-designed RCTs of pharmacological treatment of OH investigating the impact on postural symptoms as well as actual BP changes are needed.

Definition of White Coat Hypertension

See related article, pp 168–174 The use of blood pressure (BP)-measuring techniques outside the clinical setting, such as self-measurement at home or ambulatory BP monitoring (ABPM), has grown considerably, and they are useful tools in the diagnosis and management of patients with hypertension. Obtaining a BP measurement that is closer to the individual’s actual BP, reducing the impact of a generally hostile medical setting, and providing information about the effects of the main sources of BP variability all seem to be beneficial for patient diagnosis and therapeutic management.1 The 2 main problems when measuring BP outside the clinical setting are, on the one hand, the limited available data for establishing normality criteria in the various measurement estimators2 (24-hour, daytime and nighttime pressures) and, on the other, the appearance of new patient categories according to whether values measured in the clinical setting and those measured at home or in ABPM match or not. Indeed, the difference between such values has given rise to 2 new patient categories: patients with normal values at doctor’s office but who present elevated ones at home or during 24-hour ABPM (24-hour or daytime), who are classified as presenting with masked hypertension, and patients with elevated values at the doctor’s office and normal figures at home or in ABPM, known as having white coat hypertension. In the group of patients with masked hypertension, which can affect ≤10% of the population (more common in treated patients), although there are few prospective data, there is a general consensus that this situation involves high cardiovascular risk, and even more so because it could go unnoticed. Subjects with this condition therefore tend to be excluded from the benefits of treatment or, in the treated population, …

Utility of the theory of planned behavior to predict nursing staff blood pressure monitoring behaviours

To evaluate constructs from the theory of planned behavior (TPB, Ajzen 2002) - attitudes, sense of control, subjective norms and intentions - as predictors of accuracy in blood pressure monitoring. Despite numerous initiatives aimed at teaching blood pressure measurement techniques, many healthcare providers measure blood pressures incorrectly. Descriptive, cohort design. Medical assistants and licensed practical nurses were asked to complete a questionnaire on TPB variables. These nursing staff's patients had their blood pressures measured and completed a survey about techniques used to measure their blood pressure. We correlated nursing staff's responses on the TBP questionnaire with their intention to measure an accurate blood pressure and with the difference between their actual blood pressure measurement and a second measurement taken by a researcher immediately after the clinic visit. Patients' perceptions of MAs' and LPNs' blood pressure measurement techniques were examined descriptively. Perceived control and social norm predicted intention to measure an accurate blood pressure, with a negative relationship between knowledge and intention. Consistent with the TPB, intention was the only significant predictor of blood pressure measurement accuracy. Theory of planned behavior constructs predicted the healthcare providers' intention to measure blood pressure accurately and intention predicted the actual accuracy of systolic blood pressure measurement. However, participants' knowledge about blood pressure measurement had an unexpected negative relationship with their intentions. These findings have important implications for nursing education departments and organisations which traditionally invest significant time and effort in annual competency training focused on knowledge enhancement by staff. This study suggests that a better strategy might involve efforts to enhance providers' intention to change, particularly by changing social norms or increasing perceived control of the behaviour by nursing staff.

Modelling of blood pressure outcomes in patients with and without established cardiovascular or renal disease following treatment with valsartan (the PREVIEW study)

Hypertensive patients with established cardiovascular or renal disease (ECVRD) have an added 10-year risk of cardiovascular events, classified by the European Society of Hypertension/European Society of Cardiology as 'very high'. To identify determinants of blood pressure (BP) outcomes in hypertensive patients with and without ECVRD treated in second-line with valsartan. This was a subgroup analysis comparing patients with and without ECVRD who participated in the PREVIEW study, a 90-day observational prospective effectiveness study of valsartan, conducted in Belgium. Two-level (patients 'nested' under physicians) hierarchical linear and logistic modelling of BP values and BP control (140/90 mmHg; 130/80 mmHg for diabetics) at 90 days was applied to data from 1107 patients with and 2087 patients without ECVRD treated with valsartan by 504 general practitioners. Absolute reductions in BP were similar across subgroups, with minor variations in actual BP levels in general and by subgroup. Fewer patients with versus without ECVRD achieved targets for systolic BP, diastolic BP and combined systolic/diastolic BP control. Variability in BP values and control at 90 days attributable to a physician-level class effect ranged from 24.6% to 28.1% and 15.0% to 22.4%, respectively. Physician- and patient-related determinants of 90-day BP outcomes varied considerably between the two subgroups. Several determinants of BP outcomes were identified comparing patients with and without ECVRD, including amenable physician-level and patient-level factors and warning signs for continued risk of uncontrolled BP. ECVRD patients present with differential characteristics, conditions and determinants that mandate individualized attention to complement general evidence-based antihypertensive treatment.