Automated Office Blood Pressure Research Articles

Integration of Automated Office Blood Pressure Measurement Into a General Internal Medicine Residency Clinic.

Integration of Automated Office Blood Pressure Measurement Into a General Internal Medicine Residency Clinic.

Pharmacist-led rapid medication titration for hypertension management by telehealth: A quality improvement initiative.

Hypertension guidelines recommend team-based care for the treatment of high blood pressure (BP). Clinical pharmacists can help patients get to goal BP with rapid medication titration in conjunction with telehealth visits. We conducted a pharmacist-led home BP monitoring pilot program from June 2020 to September 2021. Forty-two patients with a SBP ≥140 despite using ≤2 antihypertensive medications were referred for pharmacist telehealth with expedited medication titration to achieve a BP goal <130/80. The mean enrollment SBP/DBP was 155.2 (SD, 15.8)/89.7 (SD, 11.5) mm Hg, and the mean completion SBP/DBP was 132.1 (SD, 10.9)/77.6 (SD, 10). The number of hypertension medications prescribed increased from 1.3 to 1.6 with no instances of falls or hypotension. At completion, 31% of patients had an automated office blood pressure (AOBP) with SBP <130mm Hg and DBP <80mm Hg. A pharmacist-led, home BP monitoring telehealth pilot program helped patients safely achieve BP goals.

Improvement of in-office Blood Pressure targets in an Academic primary care setting

Background &#x0D; Accurate blood pressure (BP) measurement in an office-based setting is essential for diagnosis and management of hypertension. Staff education on proper blood pressure measurement technique and recording is a focus of recent hypertension guidelines. (1) Compared with other methods, unattended Automated Office Blood Pressure (AOBP) devices reduce measurement errors and improve BP Management. (2,3,4) The addition of AOBP to staff education needs to be assessed objectively. &#x0D; &#x0D; Objectives &#x0D; To determine the effect of staff education on proper BP measurement and addition of AOBP devices on BP targets in an academic general internal medicine clinic. &#x0D; &#x0D; Methods &#x0D; Education was provided to the medical staff on how to appropriately check BP in general and on the proper use of the AOBP devices. Education was repeated in several intervals to ensure consistency in practice. Six AOBP Hillrom (Welch Allyn spot 4400) devices were deployed for the clinic. Devices allowed for three automated readings 1 minute apart eliminating the first reading and keeping the other 2 readings. Staff were instructed to document two blood pressure readings into the electronic medical record. The number of patients who completed two BP measurements documented in the EMR over time. &#x0D; &#x0D; Results &#x0D; Our results showed timely education with refreshers, increased BP measurement protocol and improvement in BP recordings. Adherence to 2 BP checks increased from 40% in Dec-21 to 99% Jun-23. The percentage of patients with improved BP increased from 40% to 76% after staff education and addition of AOBP. &#x0D; &#x0D; Conclusion &#x0D; Timely education of medical staff and the addition of AOBP could increase the accuracy of in-office BP measurement. &#x0D; &#x0D; Key word: Internal medicine &#x0D; Type of submission: Abstract

Automated office blood pressure measurement with the assistance of an instructional video in patients with hypertension.

Automated office blood pressure (AOBP) measurement often requires assistance. Accompanied by an instructional video, AOBP measurement could be performed independently by patients. Seventy-five patients with hypertension were enrolled. AOBP was measured three times at 1-min intervals after 5 min of rest by an automated BP measurement device with the assistance of an animated instructional video. The video was designed originally to instruct patients on the way to measure BP appropriately. Perceived stress was evaluated using a questionnaire after the AOBP measurement. Office BP was measured three times using the same device. Home BP measurement was performed on 5 consecutive days. The mean age of the patients was 74.5 ± 10.6 years, and 96% were taking antihypertensive drugs. Mean AOBP, office BP and home BP measurements were 135.2 ± 17.2/81.3 ± 11.1, 139.3 ± 16.3/78.6 ± 10.9 and 129.2 ± 16.7/72.7 ± 8.9 mmHg, respectively. Regarding SBP, the mean AOBP was significantly lower than office BP ( P = 0.005) and higher than home BP ( P = 0.004). The differences in SBP and DBP between AOBP and home BP measurements were significantly related to patients' perceived stress when performing AOBP measurements ( r = 0.289; P = 0.013 and r = 0.328; P = 0.004). In a multivariate analysis, patients' perceived stress was a significant predictor of the difference between AOBP and home BP ( P = 0.013), even after adjusting for age, sex, BMI and mean of AOBP and home BP. AOBP values measured with the assistance of an instructional video were between conventional office and home BP measurements. Perceived stress during AOBP measurement was related to the difference in AOBP from home BP.

Abstract 13836: Percentage of Patients Achieving Blood Pressure Goals With Aprocitentan, a Dual Endothelin Receptor Antagonist: Results From a Randomized, Controlled Phase 3 Study (PRECISION)

Background: In the phase 3 PRECISION trial, aprocitentan (APRO) lowered BP in patients with resistant hypertension. Research Question: How effective is APRO for achieving the following BP goals over 4 weeks: mean 24-hour ambulatory BP monitoring (ABPM) measurements &lt;130/80 mmHg, daytime ABPM &lt;135/85 mmHg, nighttime ABPM &lt;120/70 mmHg, reduction in 24-hour ABPM ≥5 mmHg, mean trough unattended automated office BP &lt;130/80 mmHg, and reduction in office systolic BP (SBP) ≥10 mmHg? Aim: To evaluate percentages of patients achieving BP goals with APRO or placebo (PBO) after 4 weeks of treatment. Methods: Patients had sitting unattended automated office SBP ≥140 mmHg despite prescription of ≥3 antihypertensives of different classes in the year prior to enrollment. After 4 weeks of standardized triple therapy (amlodipine, valsartan, hydrochlorothiazide), those still hypertensive could enter a 4-week single-blind placebo (PBO) run-in period, followed by a 4-week double-blind period wherein patients were randomized 1:1:1 to APRO 12.5 mg, 25 mg, or PBO added to background therapy. We evaluated percentages of patients achieving BP goals during the double-blind period. Results: The APRO 12.5 mg, APRO 25 mg, and PBO groups comprised 243, 243, and 244 patients, respectively. Among 633 patients with ABPM data, 41.1%, 51.6%, and 29.6% in the APRO 12.5 mg, APRO 25 mg, and PBO groups had 24-hour mean ABPM &lt;130/80 mmHg. Similarly, 47.4%, 52.7%, and 35.8% in the APRO 12.5 mg, APRO 25 mg, and PBO groups had daytime ABPM &lt;135/85 mmHg; 37.9%, 44.0%, and 22.9%, respectively, had nighttime ABPM &lt;120/70 mmHg. In the APRO 12.5 mg, APRO 25 mg, and PBO groups, 61.7%, 64.8%, and 39.7% had reductions in ABPM of ≥5 mmHg. Overall, 25.1%, 24.2%, and 16.5% in the APRO 12.5 mg, APRO 25 mg, and PBO groups achieved mean office BP &lt;130/80 mmHg; 65.0%, 65.8%, and 55.8%, respectively, had reductions in office SBP of ≥10 mmHg. APRO was generally well tolerated. Edema or fluid retention occurred in 9%, 18%, and 2% of patients in the APRO 12.5 mg, 25 mg, and PBO groups, respectively, during the 4-week double-blind period. Conclusion: Greater proportions of patients receiving APRO versus PBO achieved BP goals at 4 weeks. Based on ABPM, treatment benefits with APRO showed dose-dependency, with a larger effect for APRO 25 mg.

The superiority of bioimpedance vs. echocardiography and pitting edema in predicting automated office blood pressure in continuous ambulatory peritoneal dialysis patients.

To achieve optimal blood pressure control in continuous ambulatory peritoneal dialysis (CAPD) patients, identifying methods of volume assessment with the strongest correlation with blood pressure is essential. In this cross-sectional study, 52 CAPD patients were assigned to automated office blood pressure (AOBP) measurement, assessment of pedal pitting edema, bioimpedance analysis (BIA), and inferior vena cava collapsibility index (IVCCI%) measurement. Data were analyzed using STATA ver.17, and the significance level was p < 0.05. Fifty-two patients were divided based on their AOBP readings. 29 (55.8%) of patients had uncontrolled AOBP. Overhydration (OH) and the grade of pitting edema were significantly higher in the uncontrolled AOBP group. OH was identified as the best variable for predicting blood pressure (p ≤ 0.001) and detecting uncontrolled blood pressure (AUC = 0.832) using multivariate linear regression and ROC analysis, respectively. BIA-derived OH was the best variable for predicting systolic and diastolic AOBP, outperforming IVCCI% and pitting edema.

Abstract P111: Comparison Of Automated Office Blood Pressure And Self-Measured Blood Pressure: Results From An Ongoing Self-Measured Blood Pressure Program

Background: HTN treatment based on AOBP lowers risk of CVD. SMBP has been promoted as an alternative to AOBP that could improve access and achieve more timely BP control. However, questions remain about the concordance between SMBP and AOBP. Objective: To compare SMBP and AOBP measurements in a 6-month SMBP program. Methods: In this quality improvement study, we examined data from an ongoing SMBP pilot program in a large general medicine practice in Boston. Referred patients underwent AOBP during an initialization clinic visit and then performed SMBP for a week each month over a 6 month period. During the 6 th month of the program, patients performed a final week of SMBP and returned to clinic for an AOBP assessment. We compared the 6 th month mean BPs via paired t-tests. Results: Of 129 patients referred, 74 underwent an initialization visit and at least 1 month of monitoring (mean age 59±13, 53% female, 28% Black). The mean referral BP was 140±11/84±11 mm Hg. In contrast, during program initialization, mean AOBP was 131±13/79±10 (difference compared to referral BP was -9/-5 mm Hg; P &lt;0.001 for both). The mean BP measured the month after initialization using the 1-week SMBP protocol was 133±12/83±7 (difference compared to AOBP was +2/+4; P =0.18 for SBP; P &lt;0.001 for DBP). For the 12 patients that completed 6-months thus far, mean AOBP at the 6-month visit was 127±10/76±8. The mean BP the week of SMBP during the 6 th month of the program was 124±9/79±5 (difference compared to 6-month AOBP was -3/+2 mm Hg; P &gt;0.05 for both) ( Figure ). Conclusion: BP measures from SMBP tracked well with in-office AOBP measurements. These findings add to existing evidence that SMBP might be used in lieu of AOBP for HTN management.

#4623 A NOVEL ELECTRO-HYDRAULIC ACOUSTIC THERAPY REDUCES BLOOD PRESSURE IN HYPERTENSIVE PATIENTS WITH CHRONIC KIDNEY DISEASE: PRELIMINARY RESULTS

Abstract Background and Aims Arterial hypertension (HTN) in association with chronic kidney disease (CKD) is a global healthcare burden, yet clinically proven treatments are limited. electro-Hydraulic Acoustic Therapy (eHAT), using ∼10% of the energy used in shockwave lithotripsy, is a promising technique to ameliorate ischemia and regenerate tissues. eHAT has been demonstrated to enhance healing in tissues such as bone, muscle, and myocardium, via several mechanisms, particularly by promoting neovascularization. Furthermore, previous animal studies demonstrated that eHAT reduces blood pressure (BP) and preserves renal function after ischemic kidney injury. The present pilot study explored the clinical safety and efficacy of eHAT and tested the hypothesis that eHAT would reduce BP and preserve renal function in patients with medically-treated hypertension and CKD. Method So far, a total of 15 patients with HTN and Stage III a/b CKD were enrolled in this prospective, single-arm study. The patients were treated with six sessions of eHAT during a 3-week period. At each session, 2400 shockwaves were applied to each kidney with 0.09 mJ/mm2 at 2.66Hz (NephrospecTM by Curespec LTD, Yehud, Israel). Follow-up (FU) visits were performed at 1, 3, and 6 months. Results The treatment was well tolerated with no major adverse events or need for analgesic treatment. Average Automated Office BP (AOBP) showed a strong tendency for a decrease in diastolic BP from baseline to the Primary Efficacy Objective at FU II (3 months post last treatment), which progressively decreased further at FU III (6 months) (Table 1). Similarly, average Office BP (OBP) detected a strong trend for a progressive decrease in systolic BP from baseline to the Primary Efficacy Objective (Table 1). Levels of eGFR appeared to slightly rise throughout the study, but this change has not reached statistical significance levels (Table 1). Conclusion The current study demonstrates that the eHAT procedure is tolerable and safe in this cohort. Moreover, a 3-week regimen tended to reduce BP and preserve eGFR in patients with controlled HTN and CKD. Therefore, electro-Hydraulic Acoustic Therapy may emerge as a novel, safe, and non-invasive alternative therapeutic approach in the management of HTN in the context of CKD.

The Benefit of Unattended Automated Office Blood Pressure Measurement on the White-coat Effect: A Cross-sectional Study

Objective: To compare blood pressure (BP) and heart rate measured by attended and unattended automated office blood pressure measurement (AOBPM) versus home blood pressure measurement (HBPM) and the effect of unattended AOBPM on the classification of BP phenotypes. Materials and Methods: The cross-sectional study was conducted at the outpatient department in Siriraj Hospital, Thailand. All participants measured their office BP using attended and unattended techniques in random order and recorded home BP twice a day for consecutive 7 days. The agreement between office BP from both AOBPM methods and that from HBPM was analyzed using the Bland-Altman plot. The change in the proportion of each BP phenotype was also analyzed. Results: We included 114 participants. The mean age was 57.96 + 15.07 years. The average BP from attended AOBPM, unattended AOBPM, and HBPM were 150.52 + 16.12/81.77 + 11.04, 139.68 + 13.80/78.55 + 11.71, and 126.91 + 9.80/76.40 + 8.37 mmHg, respectively. The BP and heart rate measured by these techniques were significantly different (p-value of &lt;0.001). Bland-Altman analysis showed the biases of attended and unattended SBP versus home SBP were 23.61 and 12.77 mmHg, respectively. Unattended AOBPM significantly decreased the numbers of patients classified as white-coat and sustained hypertension regardless of BP thresholds (p-value of &lt;0.001 for both groups). Conclusion: Unattended AOBPM significantly minimizes the white-coat effect in real-life clinical practice and may help physicians avoid overdiagnosis of hypertension. Nevertheless, it does not replace HBPM.

A NOVEL ELECTRO-HYDRAULIC ACOUSTIC THERAPY REDUCES BLOOD PRESSURE IN HYPERTENSIVE PATIENTS WITH CHRONIC KIDNEY DISEASE: PRELIMINARY RESULTS

Objective: Electro-Hydraulic Acoustic Therapy (eHAT), using ∼10% of the energy used in shockwave lithotripsy, is a promising technique to ameliorate ischemia and regenerate tissues. eHAT has been demonstrated to enhance healing in tissues such as bone, muscle, and myocardium, via several mechanisms, particularly by promoting neovascularization. Furthermore, previous animal studies demonstrated that eHAT reduces blood pressure (BP) and preserves renal function after ischemic kidney injury. The present pilot study explored the clinical safety and efficacy of eHAT and tested the hypothesis that eHAT would reduce BP and preserve renal function in patients with medically-treated hypertension and CKD. Design and method: So far, a total of 15 patients with HTN and Stage III a/b CKD were enrolled in this prospective, single-arm study. The patients were treated with six sessions of eHAT during a 3-week period. At each session, 2400 shockwaves were applied to each kidney with 0.09 mJ/mm2 at 2.66Hz (NephrospecTM by Curespec LTD, Yehud, Israel). Follow-up (FU) visits were performed at 1, 3, and 6 months. Results: The treatment was well tolerated with no major adverse events or need for analgesic treatment. Average Automated Office BP (AOBP) showed a strong tendency for a decrease in diastolic BP from baseline to the Primary Efficacy Objective at FU II (3 months post-last treatment), which progressively decreased further at FU III (6 months) (Table 1). Similarly, average Office BP (OBP) detected a strong trend for a progressive decrease in systolic BP from baseline to the Primary Efficacy Objective (Table 1). Levels of eGFR appeared to slightly rise throughout the study, but this change has not reached statistical significance levels (Table 1). Conclusions: The current study demonstrates that the eHAT procedure is tolerable and safe in this cohort. Moreover, a 3-week regimen tended to reduce BP and preserve eGFR in patients with controlled HTN and CKD. Therefore, electro-Hydraulic Acoustic Therapy may emerge as a novel, safe, and non-invasive alternative therapeutic approach in the management of HTN in the context of CKD.

The Prognostic Role of Automated Office Blood Pressure Measurement in Hypertensive Patients with Chronic Kidney Disease.

The aim of this study was to evaluate the prognostic value of automated office blood pressure (AOBP) measurement in patients with hypertension and chronic kidney disease (CKD) stage 3-5 not on dialysis. At baseline, 140 patients were recruited, and blood pressure (BP) measurements with 3 different methods, namely, office blood pressure (OBP), AOBP, and ambulatory blood pressure measurement (ABPM), were recorded. All patients were prospectively followed for a median period of 3.4 years. The primary outcome of this study was a composite outcome of cardiovascular (CV) events (both fatal and nonfatal) or a doubling of serum creatine or progression to end-stage kidney disease (ESKD), whichever occurred first. At baseline, the median age of patients was 65.2 years; 36.4% had diabetes; 21.4% had a history of CV disease; the mean of estimated glomerular filtration rate (eGFR) was 33 mL/min/1.73 m2; and the means of OBP, AOBP, and daytime ABPM were 151/84 mm Hg, 134/77 mm Hg, and 132/77 mm Hg, respectively. During the follow-up, 18 patients had a CV event, and 37 patients had a renal event. In the univariate cox regression analysis, systolic AOBP was found to be predictive of the primary outcome (HR per 1 mm Hg increase in BP, 1.019, 95% CI 1.003-1.035), and after adjustment for eGFR, smoking status, diabetes, and a history of CV disease and systolic and diastolic AOBP were also found to be predictive of the primary outcome (HR per 1 mm Hg increase in BP, 1.017, 95% CI 1.002-1.032 and 1.033, 95% CI 1.009-1.058, respectively). In patients with CKD, AOBP appears to be prognostic of CV risk or risk for kidney disease progression and could, therefore, be considered a reliable means for recording BP in the office setting.

Is a unified blood pressure threshold feasible in the current scenario?: Commentary on the article"130/80mmHg as a unifying hypertension threshold for office brachial, office central and ambulatory daytime brachial blood pressure": Commentary on the article"130/80mmHg as a unifying hypertension threshold for office brachial, office central and ambulatory daytime brachial blood pressure".

Is a unified blood pressure threshold feasible in the current scenario?: Commentary on the article"130/80mmHg as a unifying hypertension threshold for office brachial, office central and ambulatory daytime brachial blood pressure": Commentary on the article"130/80mmHg as a unifying hypertension threshold for office brachial, office central and ambulatory daytime brachial blood pressure".

Validation of the A&D UM-212BLE monitor according to ISO 81060-2, 2018: a device with clinically important programmability.

The objective of this report was to describe the validation of the A&D UM-212BLE automated oscillometric sphygmomanometer to the ISO 81060-2, 2018 protocol. The device is specifically designed for enhanced office and out-of-office programmability. A combined pediatric ( n = 35) and adult ( n = 50) population was studied at Clinmark LLC in Louisville, Colorado, USA. Same-arm sequential testing was performed following the ISO 81060-2, 2018 requirements. Five cuffs were tested with a total arm circumference range from 12 to 50 cm. Reference readings were done by two blinded observers performing simultaneous auscultation. For validation of Criterion 1 the mean ± SD (mmHg) of the device minus the reference differences were 3.94 ± 6.89 for SBP and 2.09 ± 6.68 for DBP. Both passed the Standard limits for Criterion 2; the systolic(S)SD achieved was 5.56 (5.70 permitted) and the diastolic(D)SD was 6.01 (6.62 permitted). All other Standard requirements were met. The UM-212BLE passed all requirements. The features that make this device clinically superior include settings for automated office BP, variable pressure inflation, dual measurement modes (oscillometry, auscultation), the wide range of cuffs tested, automated irregular heartbeat detection, and full validation in a pediatric population. The inclusion of all of these features makes the UM-212BLE a highly attractive device for both office and out-of-office BP estimation.

PS-BPC06-9: THE EFFECT OF COMMON SURGICAL MASKS ON UNATTENDED BLOOD PRESSURE CHANGES IN DRUG TREATED HYPERTENSIVE PATIENTS

Objective: While there are several studies that have focused on the role of face masks in preventing airborne transmission of SARS-CoV-2, few data are available on their effects on physiological measures, and no study has examined their effects on blood pressure (BP). The purpose of our study was to investigate the effect of surgical masks on BP in drug-treated hypertensive patients who had a routine follow-up visit to a university hospital outpatient hypertension clinic. Design and method: The study included already treated hypertensive patients aged &gt; 18 years, while the exclusion criteria were atrial fibrillation or any other arrhythmia affecting the BP measurement, an arm circumference &gt; 42 cm, mental disorders, Parkinson disease, pregnancy, intolerance to the BP measurement method, or unwillingness to participate. A new surgical mask was provided to all participants to replace the face mask that was already in use. After the routine mask-on office BP measurement, patients were left alone and randomized to automated office BP measurement, with measurements taken after first wearing a mask for 10 min, then without wearing the mask for 10 min, and vice versa. Results: A total number of 265 patients were included in the study. Among the participants, 115 were women (43.4%), the mean age was 62 ± 12 years, and the mean office BP was 134 ± 15 / 81 ± 12 mmHg. There was no significant difference between mask-on unattended systolic BP (133 ± 15 mmHg) and mask-off unattended systolic BP (132 ± 15 mmHg) (P = 0.13) or between mask-on unattended diastolic BP (77 ± 13 mmHg) and mask-off unattended diastolic BP (76 ± 13 mmHg) (P = 0.32). Moreover, there was no difference in the heart rate (mask-on first, 69 ± 11 bpm; mask-off first, 69 ± 11 bpm, P = 0.7). Conclusions: Common surgical masks do not affect systolic/diastolic BP levels during unattended BP measurements in treated hypertensive patients.

Blood pressure response to close or loose contact between physician and patient during attended office blood pressure measurement

Purpose Compared to unattended office blood pressure (uOBP), attended office blood pressure (aOBP) is higher. It is not known, however, to what extent distance between physician and patient influences blood pressure (BP) values. Materials and methods Participants were stable hypertensive patients, followed in the university hospital-based out-patient center. During a session, automated office BP was measured three times after a pre-set five-minute pause, using the Omron 907 device; both aOBP and uOBP were done, in a random order. Simultaneously, beat-to-beat BP measurement was performed using the Finapress device. During aOBP, some participants were in close contact with the physician while others were in loose contact where the doctor was sitting in the room about 2.5 m apart. One year later, the second session with the same protocol was organized, but the close and loose contact were interchanged. The data were analyzed using a paired t-test. Results Complete data were collected in 32 patients, baseline uOBP was 122.8 ± 14.8/69.5 ± 11.7 mmHg. Systolic and diastolic aOBP with close contact was higher by 4.6 ± 6.9 and 1.9 ± 3.4 mmHg (p < 0.0007 and 0.0039, respectively), while aOBP with loose contact was not different from uOBP. Beat-to-beat BP increased during aOBP by 6.5 ± 8.5/3.3 ± 4.8 mmHg. The increase persisted during all the three aOBP measurements (p < 0.0001 for all systolic and diastolic BP values); the results were similar for close and loose contact. The peak increase during uOBP was of similar magnitude as during aOBP but it lasted shorter: it reached the significance level of p < 0.0001 only during the first uOBP measurement. Conclusions Compared to uOBP, aOBP values were higher with close, but not with loose contact between physician and patient. These differences were, however, not detected by beat-to-beat BP measurement.

Pharmacist interventions to improve blood pressure control in primary care: a cluster randomised trial.

High blood pressure (BP) is the single largest contributor to mortality world-wide. To investigate the effectiveness of a pharmacists-led intervention to improve BP control using automated office blood pressure (AOBP). In this prospective parallel group, unblinded, cluster-randomised trial, 54 pharmacies enrolled pre-treated patients with uncontrolled AOBP above 135/85mmHg. In the interventional group, pharmacists referred patients to the treating physician for therapy intensification in a structured fashion. In the control group, AOBP was recorded until the end of the trial. The primary endpoint was the proportion of patients achieving BP control at the threshold of 135/85mmHg after 10weeks. Key secondary endpoints were systolic AOBP reductions after 10 and 20weeks. A total of 497 patients were included between 2017 and 2019. In the interventional and control group, 61.5% and 19.8% of patients underwent a therapy modification within 20weeks. The primary endpoint was achieved in 38.8% in the interventional group and 31.2% in the control group (mean difference 7.6%, 95% CI -8.1; 23.3, p = 0.336). Mean systolic AOBP reductions were greater in the interventional vs. control group at 10 and 20weeks (14.3 ± 7.4 vs. 6.9 ± 7.0mmHg, mean difference 7.3mmHg, 95% CI 3.2;11.5, p < 0.001, and 15.5 ± 9.0 vs. 9.8 ± 7.5mmHg, mean difference 5.8mmHg, 95% CI 0.8;10.7, p = 0.023). Atrial fibrillation was newly detected in 7.8% of patients. Through a pragmatic pharmacist-led disease management program, BP control was improved over time, without significant differences between groups. Greater systolic AOBP reductions were observed in the interventional vs. control group. (Pharmacists Intervention to Improve Hypertension Management in Primary Care:APOTHECARE; ClinicalTrials.gov registration NCT03274531).

Abstract P019: Clinical Impact Of A 3 Versus 5-minute Delay On Automated Office Blood Pressure Measurement

Background: Recent studies suggest that a reduced delay during automated office blood pressure (AOBP) measurement may be as accurate as a 5-minute delay. The clinical impact of this change compared to gold-standard assessments (i.e. 24-hour ambulatory BP monitoring, ABPM) has not been reported. Objective: To compare the impact of a 3- vs 5-minute delay on AOBP and its relation with average awake-time ABPM. Methods: Patients referred to a single hypertension (HTN) center had BP measurements with ABPM and one of two non-randomized, unattended AOBP protocols. Half of patients underwent AOBP with a 5-minute delay; the other half underwent AOBP with a 3-minute delay. All measurements were compared to the average awake-time ABPM. HTN was defined as SBP≥140 or DBP≥90 mmHg. We used linear regression adjusted for age, sex, and race to assess whether the 3-minute protocol was associated with a difference between mean AOBP and average awake-time ABPM. Results: Among 100 participants (mean age 59.7±15.5 years, 58% women, 26% Black), the average awake-time BP was 132.6±14.8/77.4±11 for the 5-minute protocol and 134.4±17/78.2±11 for the 3-minute protocol. HTN misclassification between groups based on awake-ABPM was similar (14% for 5- versus 12% for 3-minute delay, p=0.51). Compared to 5-minute delay, 3-minute delay was not associated with a significant difference between mean AOBP and mean awake-time ABPM for SBP (2.3 mm Hg; 95% CI: -3.7, 8.2) or DBP (1.2 mm Hg; 95% CI: -2.5, 4.8). Conclusion: Measuring AOBP with a 3-minute delay did not result in statistically different accuracy compared with average awake-time ABPM. However, this finding should be confirmed in a larger, clinic-based sample.

Automated Office Blood Pressure Measurement Requires Technology and Implementation

Automated Office Blood Pressure Measurement Requires Technology and Implementation

Smartphone Application-Assisted Home Blood Pressure Monitoring Compared With Office and Ambulatory Blood Pressure Monitoring in Patients With Hypertension: the AMUSE-BP Study.

Background:The development of automated, smartphone application (app)-assisted home blood pressure monitoring (HBPM) allows for standardized measurement of blood pressure (BP) at home. The aim of this study was to evaluate the (diagnostic) agreement between app-assisted HBPM, automated office BP (OBP), and the reference standard 24-hour ambulatory BP monitoring (ABPM).Methods:In this open randomized 5-way cross-over study, patients diagnosed with hypertension were randomized to one of 10 clusters, each containing 5 BP measurement methods (ABPM, HBPM, attended OBP, unattended OBP, and unattended 30-minute BP) in different order.Results:In total, 113 patients were included. The average 24-hour ABPM was 126±11/73±8 mm Hg compared with 141±14/82±10 mm Hg with app-assisted HBPM, 134±13/80±9 mm Hg with unattended 30-minute BP, 137±16/81±11 mm Hg with attended OBP, and 135±15/81±10 mm Hg with unattended OBP monitoring. Diagnostic agreement between app-assisted HBPM and 24-hour ABPM for diagnosing sustained (OBP >140/90 mm Hg and ABPM ≥130/80 mm Hg or HBPM ≥135/85 mm Hg), white-coat (OBP ≥140/90 mm Hg and ABPM <130/80 mm Hg or HBPM <135/85 mm Hg), and masked hypertension (OBP <140/90 mm Hg and ABPM ≥130/80 mm Hg or HBPM ≥135/85 mm Hg) was fair-to-moderate (κ statistics ranging from 0.34 to 0.40). App-assisted HBPM had high sensitivities (78%–91%) and negative predictive values (90%–97%) for diagnosing sustained and masked hypertension.Conclusions:This study showed a considerable (diagnostic) disagreement between app-assisted HBPM and ABPM. App-assisted HBPM had high sensitivity in the diagnosis of sustained and masked hypertension and may therefore be used as complementary to, but not a replacement of, ABPM.

Platelet-derived extracellular vesicles correlate with therapy-induced nocturnal blood pressure changes.

Elevated nocturnal blood pressure (BP) is closely associated with increased risk of cardiovascular (CV) events. Circulating extracellular vesicles (EVs) have been proposed as a potential CV risk biomarker and shown to correlate with BP. The present study aimed to assess whether a reduction in BP is paralleled by respective changes in EVs. Fifty-five hypertensive patients (age: 57.7 ± 14.1 years) were included in the study. EVs and BP were assessed at baseline and at 12 weeks follow-up. Interventions to lower BP included advice on life-style modification only or life-style advice combined with additional pharmacotherapy. EVs were evaluated by flow cytometry (CD41+/Annexin V+) and BP by unobserved automated office BP and ambulatory BP monitoring. Nocturnal systolic BP correlated with EV levels at baseline ( P = 0.01). Multivariable regression models showed that changes in nocturnal systolic BP (adjusted R2 = 0.23; P = 0.01) and diastolic BP (adjusted R2 = 0.18; P = 0.02) were associated with respective changes in EV levels. Furthermore, intervention-induced improvement of systolic dipping was associated with a reduction in EVs in the univariate analysis (adjusted R2 = 0.06; P = 0.03). In contrast, systolic office, 24 h- and daytime-BP did not show significant associations with EVs. Patients whose medication was up-titrated at baseline showed a trend towards lower EV levels at follow-up (absolute change of -1.7 ± 1.3 EV/μl; P = 0.057). Circulating platelet-derived EVs were positively associated with nocturnal BP and therapy-induced changes over a 12-week treatment period. EVs may provide an integrated measure of BP changes achieved with pharmacotherapy.