Home Blood Pressure Measurement Research Articles

MO088: Peridialytic and Intradialytic Blood Pressure Measurements are Not Valid Estimates of 44-Hour Ambulatory Blood Pressure in Patients With Intradialytic Hypertension

Abstract BACKGROUND AND AIMS In contrast with pre- and post-dialysis blood pressure (BP), intradialytic and home BP measurements are accurate metrics of ambulatory BP load in hemodialysis patients. This study assessed the agreement of peridialytic, intradialytic and scheduled interdialytic recordings with 44-h interdialytic BP in a distinct hemodialysis population, patients with intradialytic-hypertension (IDH). METHOD 45 patients with IDH (defined as: SBP rise ≥ 10 mmHg from pre- to post-dialysis and post-dialysis SBP ≥ 150 mmHg) with valid 48-h ABPM and 197 without IDH were included in this analysis. With 44-h BP used as reference method, we tested the accuracy of the following BP metrics: Pre- and post-dialysis, intradialytic, intradialytic plus pre/post-dialysis readings and scheduled interdialytic BP (out-of-dialysis day: readings at 8:00 am, 8:00 pm or their average). RESULTS In patients with IDH, peri-dialytic and intradialytic BP metrics showed at best moderate correlations, while averaged-interdialytic-SBP/DBP exhibited strong correlation (r = 0.882/r = 0.855) with 44-h SBP/DBP. Bland-Altman plots showed large between-method difference for peri- and intradialytic BP, but only + 0.7 mmHg between-method difference and good 95% limits-of-agreement for averaged-interdialytic-SBP. The sensitivity/specificity and κ-statistic for diagnosing 44-h SBP ≥ 130 mmHg were low for pre-dialysis (72.5%/40.0%, κ-statistic = 0.074) and post-dialysis (90.0%/0.0%, κ-statistic = −0.110), intradialytic (85.0%/40.0%, κ-statistic = 0.198) and intradialytic plus pre/post-dialysis SBP (85.0%/20.0%, κ-statistic = 0.043). Averaged-interdialytic-SBP showed high values of sensitivity/specificity (97.5%/80.0%) and strong agreement (κ-statistic = 0.775). In ROC-analyses, the peri- and intradialytic BP metrics showed bad performance with low Area-Under-the-Curve values; scheduled interdialytic SBP/DBP had the largest AUC (0.967/0.951), along with the highest sensitivity(90.0%/88.0%) and specificity(100.0%/90.0%) for detecting elevated 44-h BP. CONCLUSION In patients with IDH, averaged-scheduled-interdialytic but not pre- and post-dialysis, nor intradialytic BP recordings show reasonable agreement with ambulatory BP. Interdialytic BP recordings only could be used for hypertension diagnosis and management in these subjects.

Associations between fruit consumption and home blood pressure in a randomly selected sample of the general Swedish population

Frequent fruit consumption has been associated with lower office blood pressure. Less is known about associations between fruit consumption and home blood pressure. Our aim was to study the correlation between consumption of specific fruits and home blood pressure in a large randomly selected study population. The main outcome was systolic home blood pressure. Home blood pressure measurements were performed with calibrated oscillometric meters during seven consecutive days. Means for all available measurements were used. Validated food frequency questionnaires were used for estimating frequency of fruit consumption. The specified fruits were bananas, apples/pears and oranges/citrus fruit. Complete case analysis regarding fruit consumption, office‐ and home blood pressure measurements and other relevant variables was performed in 2283 study participants out of 2603 available. Multivariable linear regression analysis was performed. There were statistically significant associations between consumption of all fruit types and lower systolic home blood pressure unadjusted (p for trend; bananas, apples/pears and oranges/citrus fruit p < .001). The numerical differences between most and least frequent consumption of fruit were for bananas ‐2.7 mm Hg, apples/pears ‐3.9 mm Hg and for oranges/citrus fruit ‐3.4 mm Hg. When adjusted for covariates, both consumption of apples/pears and oranges/citrus fruit had an independent statistically significant association with lower blood pressure (p = .048 resp. p = .009). Future controlled interventional studies are needed to evaluate the effect of specific fruit on home blood pressure.

PD56-04 ASSESSMENT OF CHANGES IN ARTERIAL BLOOD PRESSURE AFTER NEPHRECTOMY FOR KIDNEY CANCER VAPANCR (UROCCR 26)_PROSPECTIVE STUDY

You have accessJournal of UrologyCME1 May 2022PD56-04 ASSESSMENT OF CHANGES IN ARTERIAL BLOOD PRESSURE AFTER NEPHRECTOMY FOR KIDNEY CANCER VAPANCR (UROCCR 26)_PROSPECTIVE STUDY Pierre Bigot, Jean-Christophe Bernhard, Nicolas Doumerc, François-Xavier Nouhaud, Idir Ouzaid, Patrick Saulnier, Arnaud Mejean, Morgan Rouprêt, and Karim Bensalah Pierre BigotPierre Bigot More articles by this author , Jean-Christophe BernhardJean-Christophe Bernhard More articles by this author , Nicolas DoumercNicolas Doumerc More articles by this author , François-Xavier NouhaudFrançois-Xavier Nouhaud More articles by this author , Idir OuzaidIdir Ouzaid More articles by this author , Patrick SaulnierPatrick Saulnier More articles by this author , Arnaud MejeanArnaud Mejean More articles by this author , Morgan RouprêtMorgan Rouprêt More articles by this author , and Karim BensalahKarim Bensalah More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002636.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Kidney is an essential regulator of arterial blood pressure (ABP) via the renin-angiotensin system. The impact of kidney surgery on ABP is debated. Our objective was to evaluate the consequences of kidney surgery for cancer on ABP. METHODS: We carried out a multicenter prospective study (NCT03218319) and included 200 patients who underwent nephrectomy for cancer between January 2018 and September 2020 at 7 academic centers from the UROCCR network. The study obtained approval from Ethical Committee (2017-A00127-46). Inclusions criteria were a localized cancer eligible to nephrectomy and the absence of pre-existing hypertension. ABP was monitored according to the recommendations for home blood pressure measurement. Four measurements were taken after 5 minutes of sitting rest, before breakfast and four additional measurements were taken in the evening before bedtime. Measurements were done during three consecutive days (average of 18 values). ABP evaluation was done the week before nephrectomy, one month and six months after nephrectomy. A renin assessment was done one week before surgery and 6 months after surgery. The primary endpoint was the occurrence of a clinically significant change in ABP at 6 months. A change in ABP was considered clinically significant if the variation in systolic and / or diastolic ABP was ≥ 5 mmHg or if medical anti-hypertensive treatment was required. RESULTS: ABP and renin measurements were evaluable for 182 (91%) and 136 (68%) patients, respectively. There were 112 males and 88 females with a median age of 54 years. Radical (RN) and Partial nephrectomy (PN) were performed in 42 (21%) and 158 (79%) patients, respectively. At 6 months, 55 (30.2%) patients had a significant increase in their ABP and 12 (6.5%) patients started an antihypertensive treatment. Type of surgery was not associated with increases in ABP (31.6 % PN vs 25% RN; p=0.559) nor prescription of antihypertensive drug (4.79% PN vs 12.5 % RN; p=0.089). At 6 months, renin was not significantly higher than before surgery (16.098 vs 15.231, p=0.686). In multivariable analysis, type of surgery, age, sex, BMI, smoking, diabetes and dyslipidemia were not associated with significant changes in ABP. CONCLUSIONS: Renal surgery for cancer induces significant variations in ABP in 30% of patients. Type of surgery is not associated with ABP outcomes. ABP after surgery seems not be related to renin secretion. Longer follow-up and additional patients will be necessary to determine whether this rise in ABP can have a consequence on the occurrence of cardio-vascular events. Source of Funding: This study was granted by the French Association of Urology (AFU) © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e954 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pierre Bigot More articles by this author Jean-Christophe Bernhard More articles by this author Nicolas Doumerc More articles by this author François-Xavier Nouhaud More articles by this author Idir Ouzaid More articles by this author Patrick Saulnier More articles by this author Arnaud Mejean More articles by this author Morgan Rouprêt More articles by this author Karim Bensalah More articles by this author Expand All Advertisement PDF DownloadLoading ...

Self-Monitoring Home Blood Pressure in Community-Dwelling Older People: Age Differences in White-Coat and Masked Phenomena and Related Factors-The SONIC Study.

Some studies reported that home blood pressure (HBP) monitoring was conducted by community-dwelling older people themselves, but there have been few studies on HBP including very old populations aged over 90 years old. Thus, the aim of the present study was to clarify the current situation of white-coat and masked phenomena defined by on-site and home BP measurements in community-dwelling old and oldest-old populations. The study subjects were 380 participants from the SONIC study, a cohort study of a community-dwelling old population, who measured their HBP in a series of 3–5 days by themselves and brought their HBP records to the venue on the survey day. Study participants' characteristics were as follows: female, 185 (48.7%); male, 195 (51.3%); 70s, 95 (25.0%); 80s, 245 (64.5%); and 90s, 40 (10.5%). A total of 344 (90.5%) participants had hypertension. A total of 291 (76.6%) hypertensive participants taking antihypertensive medication were analyzed in the present study. Regarding the types of hypertension defined by home and on-site BP, they showed white-coat phenomenon, 183 (48.2%); masked phenomenon, 115 (30.3%); sustained hypertension, 130 (34.2%); and normotension, 82 (21.6%). On comparison of age groups, there was a tendency for the white-coat phenomenon to be common in young-old people in their 70s and the masked phenomenon to be common in very old people in their 90s. Therefore, since the detection of white-coat and masked phenomena is closely associated with appropriate BP management, it is very important for community-dwelling older populations to self-monitor HBP.

Home Blood Pressure Measurement and Self-Interpretation of Blood Pressure Readings During Pregnancy: Hy-Result e-Health Prospective Study.

IntroductionHy-Result is a rule management system designed to help patients to be compliant with the home blood pressure measurement (HBPM) monitoring schedule and to understand their BP readings. The aim of the Hy-Result e-Health prospective study is to evaluate the practice and experience of women using the Hy-Result coaching app for self-interpretation of BP readings during and after pregnancy.MethodsParticipants were asked to: i) measure their BP at home; ii) use the Hy-Result app and send their PDF report to the researcher; iii) answer anonymously to 3 online independent questionnaires (Q).ResultsA total of 107 women accepted to measure their BP and use the app. Among them 82 (77%) performed HBPM and used successfully the system and 72 (88%) shared to the investigator their PDF report by email. Of these, 95% declared the software was “easy” or “very easy” to use; 93% believe the software helps them to monitor their BP more effectively (74% agree, 18% somewhat agree); 94% that the color code classification was “clear”; 76 (93%) affirmed that the app helped them when consulting their physician for their BP evaluation. Majority (87%) perceived the software to be reliable. Furthermore, 71 (87%) said they trust the system and 51 (62%) declared that performing HBPM and self-interpret their readings was “reassuring” whereas 6 (7%) felt that it was “a concern”.ConclusionThis study shows that the majority (88%) of pregnant women performed HBPM and successfully used the Hy-Result software for self-interpretation of the BP readings. The use of the validated Hy-Result system by pregnant women may thus be recommended in common practice by healthcare professionals and patient associations.

290 Implementing a Multi-Component Intervention to Reduce Hypertension Through DASH Diet Congregate Meals and Self-Measured BP (SMBP) at Two NYC Senior Centers

OBJECTIVES/GOALS: To test whether implementing DASH-aligned meals in a congregate meal program, combined with Self-Measured Blood Pressure (SMBP) monitoring, lowers systolic blood pressure in community-living seniors at two senior centers. Secondary Aims included cognitive and behavioral change, and attention to client preferences. METHODS/STUDY POPULATION: The Carter Burden Network (CBN) provides services and congregate meals to older adults in NYC, many with low income, and unmet health needs. Eligible participants at two CBN sites, aged 60 or older and consuming &gt;4 congregate meals/week, were recruited. After baseline assessments, participants received DASH-aligned meals onsite, education on nutrition and BP management, and personal devices and support for self-measured blood pressure (SMBP) monitoring. Primary outcome data (BP measured by health professional) was collected at Month 1, with secondary assessments at Months 3 and 6. Staff downloaded SMBP data regularly. Study surveys tracked cognitive and behavioral changes. Qualitative feedback from a project Advisory Committee, participants and study partners was collected throughout implementation. RESULTS/ANTICIPATED RESULTS: 97 Participants enrolled (49% White, 32% Black, 19% Other races; mean age 73). At Baseline, 67% were overweight/obese; 80% were hypertensive (32% Stage I; 48% Stage 2). Primary outcome: Mean change in systolic BP at Month 1 compared to Baseline, was -4.41 mmHg (n= 61; p=0.07). By multiple regression analysis, change in BP at Month 1 was associated with BMI, age, and baseline blood pressure (p= .02, .04, .00, respectively). SMBP: Mean change in systolic SMBP by End-of-Study was -6.9 mmHg (p=.003). 56% participants completed SMBP through Month 1 and 30% to End-of-Study. Mean frequency of &gt; 1 SMBP measure/day was 3 days/week. Women (n= 22, 88%) and Black participants (n= 15, 60%) were more likely to continue taking their home blood pressure measurements to End-of-Study (p=.002, p=.037, respectively). DISCUSSION/SIGNIFICANCE: This study provides the first data to support the potential of DASH as part of an effective community-implemented program for seniors and demonstrates the feasibility of implementing a multi-component intervention using existing congregate meal programs at senior centers that can reach minority and low-income communities.

Pilot Results of a Digital Hypertension Self-management Program Among Adults With Excess Body Weight: Single-Arm Nonrandomized Trial.

BackgroundHome-measured blood pressure (HMBP) in combination with comprehensive medication support and lifestyle change are the mainstays of evidence-based hypertension (HTN) management. To date, the precise components needed for effective HTN self-management programs have yet to be defined, and access to multicomponent targeted support for HTN management that include telemonitoring remain inaccessible and costly.ObjectiveThe aim of this pilot study was to evaluate the impact of a digital HTN self-management program on blood pressure (BP) control among adults with excess body weight.MethodsA single-arm, nonrandomized trial was performed to evaluate a digital HTN self-management program that combines comprehensive lifestyle counseling with HTN education, guided HMBP, support for taking medications, and led by either a registered nurse or certified diabetes care and education specialist. A sample of 151 participants were recruited using a web-based research platform (Achievement Studies, Evidation Health Inc). The primary outcome was change in systolic BP from baseline to 3 months, and secondary outcomes included change in diastolic BP and medication adherence.ResultsParticipants’ mean age was 44.0 (SD 9.3) years and mean BP was 139/85 mm Hg. At follow-up, systolic and diastolic BP decreased by 7 mm Hg (P<.001, 95% CI –9.3 to –4.7) and 4.7 mm Hg (P<.001, 95% CI –6.3 to –3.2), respectively. Participants who started with baseline BP at goal remained at goal. For participants with stage 1 HTN, systolic and diastolic BP decreased by 3.6 mm Hg (P=.09, 95% CI –7.8 to 0.6) and 2.5 mm Hg (P=.03, 95% CI –4.9 to –0.3). Systolic and diastolic BP decreased by 10.3 mm Hg (P<.001, 95% CI –13.4 to –7.1) and 6.5 mm Hg (P<.001, 95% CI –8.6 to –4.4), respectively, for participants with stage 2 HTN. Medication adherence significantly improved (P=.02).ConclusionsThis pilot study provides initial evidence that a digital HTN self-management program improves BP and medication adherence.

Association of Night-to-Night Adherence of Continuous Positive Airway Pressure With Day-to-Day Morning Home Blood Pressure and Its Seasonal Variation in Obstructive Sleep Apnea.

BackgroundThe aim of this study was to investigate the association between night‐to‐night adherence to continuous positive airway pressure (CPAP) therapy and both home blood pressure (BP) level on the following day and seasonal variation in home BP in patients with obstructive sleep apnea.Methods and ResultsWe analyzed 105 participants who had been diagnosed with obstructive sleep apnea (average apnea‐hypopnea index, 49.7±18.4 per hour) and who were already receiving CPAP therapy. Home BP (twice every morning and evening) and CPAP adherence data were automatically transmitted to a server for 1 year. A mixed‐effects model for repeated measures analysis was used to examine associations of night‐to‐night good CPAP adherence with day‐to‐day home BP within the same patient after adjusting for covariates. The average number of days in which patients achieved both CPAP adherence and morning or evening home BP measurement was 206.6±122.7 days (21 487 readings) and 191.2±126.3 days (20 170 readings), respectively. Good CPAP adherence (>4 hours per night of use) was achieved on the evening or morning before home BP measurements (86.8% and 86.9%, respectively). After adjustment for confounders, good CPAP adherence was negatively associated with morning home systolic BP (β, −0.663; P=0.004) and diastolic BP (β, −0.829; P<0.001). Morning home systolic BP in winter in the individuals with good CPAP adherence was significantly lower than that in individuals without such adherence (P<0.05). These associations were not found in evening home BP.ConclusionsGood adherence to CPAP therapy was negatively associated with morning home BP on the following day in patients with obstructive sleep apnea. The association was remarkable in the winter season.

Angiotensin Receptor Blockers Evaluated by Office and Home Blood Pressure Measurements. TeleHBPM Study.

ResumoFundamento O tratamento adequado e a obtenção das metas na hipertensão arterial são importantes na redução dos desfechos cardiovasculares.Objetivos Descrever os bloqueadores do receptor de angiotensina (BRA) em monoterapia ou combinação dupla e a taxa de controle da hipertensão arterial.Métodos Estudo transversal que avaliou pacientes em uso de BRA entre 2017 e 2020. Foram excluídos aqueles em uso de três ou mais anti-hipertensivos. As variáveis analisadas foram: sexo, idade, índice de massa corporal, medidas válidas da medida residencial da pressão arterial (MRPA); pressão arterial sistólica (PAS) e diastólica (PAD) obtidas pela MRPA e de forma casual; variabilidade pressórica; classe dos anti-hipertensivos e dos BRAs. Foram utilizados testes de t pareado, qui-quadrado e Fisher, além de sobreposição dos intervalos de confiança de 95% com nível de significância de 5% (p < 0,05).Resultados Foram selecionados 17.013 pacientes; destes, 12.813 preencheram os critérios, dos quais 62,1% eram do sexo feminino. O número médio de medidas válidas foi de 23,3 (±2,0), com médias para a PAS de 126,8±15,8 mmHg e 133,5±20,1 mmHg (p < 0,001) e para a PAD de 79,1±9,7 mmHg e 83,6±11,9 mmHg (p < 0,001) pela MRPA e medida casual, respectivamente. Losartana foi o BRA mais utilizado e o que apresentou comportamentos mais elevados da pressão arterial. As combinações de BRA com diuréticos ou com antagonistas de canal de cálcio tiveram menores valores de pressão arterial.Conclusões Losartana foi utilizada em mais da metade dos pacientes, apesar de ser a menos eficiente na redução e no controle da pressão arterial.

Clinic, Home, and Kiosk Blood Pressure Measurements for Diagnosing Hypertension: a Randomized Diagnostic Study

BackgroundThe US Preventive Services Task Force recommends blood pressure (BP) measurements using 24-h ambulatory monitoring (ABPM) or home BP monitoring before making a new hypertension diagnosis.ObjectiveCompare clinic-, home-, and kiosk-based BP measurement to ABPM for diagnosing hypertension.Design, Setting, and ParticipantsDiagnostic study in 12 Washington State primary care centers, with participants aged 18–85 years without diagnosed hypertension or prescribed antihypertensive medications, with elevated BP in clinic.InterventionsRandomization into one of three diagnostic regimens: (1) clinic (usual care follow-up BPs); (2) home (duplicate BPs twice daily for 5 days); or (3) kiosk (triplicate BPs on 3 days). All participants completed ABPM at 3 weeks.Main MeasuresPrimary outcome was difference between ABPM daytime and clinic, home, and kiosk mean systolic BP. Differences in diastolic BP, sensitivity, and specificity were secondary outcomes.Key ResultsFive hundred ten participants (mean age 58.7 years, 80.2% white) with 434 (85.1%) included in primary analyses. Compared to daytime ABPM, adjusted mean differences in systolic BP were clinic (−4.7mmHg [95% confidence interval −7.3, −2.2]; P<.001); home (−0.1mmHg [−1.6, 1.5];P=.92); and kiosk (9.5mmHg [7.5, 11.6];P<.001). Differences for diastolic BP were clinic (−7.2mmHg [−8.8, −5.5]; P<.001); home (−0.4mmHg [−1.4, 0.7];P=.52); and kiosk (5.0mmHg [3.8, 6.2]; P<.001). Sensitivities for clinic, home, and kiosk compared to ABPM were 31.1% (95% confidence interval, 22.9, 40.6), 82.2% (73.8, 88.4), and 96.0% (90.0, 98.5), and specificities 79.5% (64.0, 89.4), 53.3% (38.9, 67.2), and 28.2% (16.4, 44.1), respectively.LimitationsSingle health care organization and limited race/ethnicity representation.ConclusionsCompared to ABPM, mean BP was significantly lower for clinic, significantly higher for kiosk, and without significant differences for home. Clinic BP measurements had low sensitivity for detecting hypertension. Findings support utility of home BP monitoring for making a new diagnosis of hypertension.Trial RegistrationClinicalTrials.gov NCT03130257 https://clinicaltrials.gov/ct2/show/NCT03130257

Abstract P225: Depressive Symptoms Are Not Associated With Clinically Important Levels Of Home Blood Pressure In The Electronic Framingham Heart Study

Introduction: Depressive symptoms are common and share many biopsychosocial mechanisms with hypertension, but cross-sectional studies on their association have produced inconsistent results. The emergence of digital home blood pressure (BP) measurements may provide additional insight into the relationship. Hypothesis: We hypothesized that depressive symptoms would be modestly associated with higher home BP and hypertension prevalence in participants of the electronic Framingham Heart Study (eFHS). Methods: FHS participants who attended research exam 3 (2016-2019) were invited to enroll in eFHS. They downloaded a smartphone app and were provided a digital BP cuff to measure their weekly BP for up to 1 year. Participants who had at least 3 home BPs were included. Depressive symptoms were measured at the exam using the Center for Epidemiological Studies Depression Scale (CES-D) scored 0-60. We used linear mixed regression models to test the association of CES-D score (independent) with home SBP and DBP (dependent) and a logistic regression model to evaluate the association of depressive symptoms (defined as CES-D ≥16) with prevalent hypertension, adjusting for age, sex, cohort, lifestyle factors, diabetes, and CVD. Results: The study sample included 855 eFHS participants (mean age 53 years, 59% women, 9% multi-ethnic). The prevalence of depressive symptoms was 7% (CES-D score mean±SD, 5.7±6.6). The mean SBP and DBP were 119 and 76 mmHg; the prevalence of hypertension was 48%. CES-D score was modestly associated with home BP; a 1 SD higher CES-D corresponded with 0.9 and 0.6 mmHg higher mean SBP and DBP respectively (Table). Depressive symptoms were not significantly associated with home BP or hypertension prevalence (OR=3.16, 95% CI, 0.96-10.43). Antidepressant use attenuated the relationship. Conclusion: CES-D score had a small positive association with digital home BP, but it was not clinically substantive. The association of depression and hypertension risk warrants more data, which may be supported by mobile health.

Blood Pressure Checks for Diagnosing Hypertension: Health Professionals' Knowledge, Beliefs, and Practices.

The US Preventive Services Task Force recommends out-of-office blood pressure (BP) measurement before making a new hypertension diagnosis and initiating treatment, using 24-hour ambulatory (ABPM) or home BP monitoring. However, this approach is not common. e-mail-linked surveys were sent to primary care team members (n = 421) from 10 clinics. The sample included medical assistants, licensed practical nurses, registered nurses, and advanced practice registered nurses (LPN/RN/APRNs), physician assistants (PAs), and physicians. Those licensed to diagnosis hypertension (physician/PA/APRNs) received additional questions. Data were collected from November 2017 to July 2019. 2-thirds of invitees responded (163 MA/LPN/RNs, 86 physicians, and 33 PA/APRNs). When making a new hypertension diagnosis, most respondents believed that BP measured manually with a stethoscope (78.6%) or ABPM (84.2%) were very or highly accurate. In contrast, most did not believe that automated clinic BPs, home BP, or kiosk BP measurements were very or highly accurate. Almost all reported always or almost always relying on clinic BP measurements in making a diagnosis (95.7%), but most physician/PA/APRNs (60.5%) would prefer ABPM if it was readily available. Very few physician/PA/APRNs used the guideline-concordant diagnostic threshold (135/85 mmHg) with home monitoring (14.0%) or ABPM (8.4%), with 140/90 mmHg the most commonly reported threshold for home (59.4%) and ABPM (49.6%). Our study found health care professional knowledge, beliefs, and practices gaps in diagnosing hypertension. These gaps could lead to clinical care that is not aligned with guidelines. System changes and interventions to increase use of evidence-based practices could improve hypertension diagnosis and outcomes.

Home Telemonitoring of Arterial Hypertension With Antihypertensive Treatment Titration: Protocol for a Randomized Controlled Prospective Trial (HOROSCOPE Study).

BackgroundDespite the availability of effective treatment, the control of hypertension remains insufficient. Telemonitoring in the management of hypertension would be an effective way to improve blood pressure control.ObjectiveThe aim of our study will be to evaluate the effects of telemonitoring with antihypertensive treatment titration on blood pressure control in Tunisian patients with hypertension.MethodsOur trial will be a prospective, rater-blinded randomized controlled trial carried out with primary care physicians in the Sahel region of Tunisia. Patients will be eligible for enrollment if they are aged over 35 years, are newly diagnosed with hypertension, or are known to be poorly controlled on antihypertensive therapy. Participants will be randomly assigned in a 1:1 ratio to the telemonitoring arm or usual care arm. The telemonitoring arm will involve a weekly telephone call for the collection of the home blood pressure measurements, therapeutic education, and treatment compliance assessment as well as a monthly call for treatment titration and a side effect check. Randomization will be done via the use of an interactive web responsive system, and patients will be stratified by investigation center. Neither participants nor investigators will be masked to the group assignments. The primary outcome will be the change in mean 24-hour systolic blood pressure from baseline to the 6-month follow-up in the 2 groups. All randomized patients who attend the follow-up visit at 6 months and have no missing data for the primary outcome will be included in the analysis.ResultsRecruitment to the trial started in July 2020. The study was initiated with 17 primary care physicians. We expect the inclusion period to last for approximately 6 months. We expect to complete data collection by the end of 2021 and plan to disseminate the results subsequently.ConclusionsThe HOROSCOPE (Home Telemonitoring of Arterial Hypertension With Antihypertensive Treatment Titration: Randomized Controlled Prospective Trial) study will provide important new evidence that could shed some light on the feasibility and impact of telemonitoring and self-monitoring in a Tunisian population of patients with hypertension who consult primary care physicians.Trial RegistrationClinicalTrials.gov NCT04607239; https://clinicaltrials.gov/ct2/show/NCT04607239International Registered Report Identifier (IRRID)DERR1-10.2196/26184

Clinical Accuracy of the Withings BPM Connect for Self-Blood Pressure Measurements in Pregnancy and Pre-Eclampsia: Validation According to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization Universal Standard.

BackgroundElectronic devices for blood pressure (BP) measurements require independent clinical validation as recommended by various authorities/societies, both in general and special populations such as pregnancy.ObjectiveTo assess the accuracy of the Withings BPM Connect device in pregnancy and pre-eclampsia according to the Universal Standard Validation Protocol.MethodsThe Withings BPM Connect device measures BP at the brachial level using the oscillometric method. The study was performed according to the so-called “modified AAMI/ESH/ISO (ISO 81060-2:2018) protocol” or the “Universal Standard Protocol”. The validation study included 45 pregnant women in the second and third gestational trimester: 15 with pre-eclampsia, 15 with gestational hypertension and 15 normotensives. Differences between mercury sphygmomanometer BP measurements (reference) and device BP values (test) and their standard deviation (SD) were calculated.ResultsThe mean differences between the mercury standard and device BP values in pregnancy (n = 45) were −0.5 ± 5.7 mmHg for systolic BP (SBP) and −0.8 ± 3.8 mmHg for diastolic BP (DBP). In the preeclamptic patients (n = 15), the mean differences were 0.14 ± 5.5 mmHg for SBP and 0.39 ± 3.7 mmHg for DBP. These results fulfilled the protocol requirements (<5 ± 8 mmHg).ConclusionThe Withings BPM Connect fulfills the validation protocol criteria in pregnancy and pre-eclampsia. Consequently, this device can be recommended for home BP measurements in this specific pregnancy population.

Accuracy of the Withings BPM Connect Device for Self-Blood Pressure Measurements in General Population - Validation According to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization Universal Standard.

BackgroundAs recommended by various authorities and scientific societies, electronic devices for blood pressure (BP) measurements must undergo independent clinical validations for accuracy assessment.ObjectiveTo assess the accuracy of the Withings BPM Connect device in the general population according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization “AAMI/ESH/ISO Universal Standard (ISO 81060–2:2018)”.MethodsThe Withings BPM Connect device measures BP at the brachial level using the oscillometric method. According to this protocol using the same-arm sequential BP measurement method, subjects (n ≥ 85) fulfilling the age, gender, BP and cuff distribution criteria must be included. Two criteria are used for the analysis: Criterion 1: differences between observers’ mercury sphygmomanometer reference measurements and test device BP values (test versus reference) and their standard deviation (SD) must be ≤5 ± 8 mmHg for both systolic (SBP) and diastolic BP (DBP). Criterion 2: the SD of the mean BP differences between the test device and reference BP per subject must be ≤6.91/6.62 mmHg for SBP/DBP.ResultsNinety-two subjects were selected, 85 of whom were included. For validation criterion 1, the mean difference ± SD between the reference and device BP values was 0.6 ± 5.3 mmHg for SBP and 2.1 ± 4.3 mmHg for DBP. For criterion 2, the SD of the mean BP differences between the test device and reference BP per subject was 4.2/3.6 mmHg (SBP/DBP). These results fulfilled the AAMI/ESH/ISO Universal Standard (ISO 81060–2:2018) protocol requirements.ConclusionThe Withings BPM Connect oscillometric device for home BP measurement fulfilled all of the accuracy requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060–2:2018) in general population and consequently can be recommended for home BP measurements.

Accuracy of the COMBEI BP118A Device for Self-Blood Pressure Measurements in General Population - Validation According to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization Universal Standard.

BackgroundElectronic devices for blood pressure (BP) measurements must undergo independent clinical validation as recommended by various authorities and scientific societies.ObjectiveTo assess the accuracy of the Combei BP118A device in the general population according to the Universal Standard Validation Protocol.MethodsThe new-developed Combei BP118A device measures BP at the brachial level using the oscillometric method. The study was performed according to the “AAMI/ESH/ISO Universal Standard (ISO 81060–2:2018) protocol”. Subjects (n = 88) were recruited to fulfill the age, gender, BP and cuff distribution criteria according to the protocol requirements using the same arm sequential BP measurement method. Differences between observers’ mercury sphygmomanometer reference measurements and device BP values (test versus reference) and their standard deviation (SD) were calculated.ResultsNinety-one subjects were selected, 88 of whom were included. The mean BP differences between the simultaneous observers’ reference measurements were −0.2 ± 1.7 mmHg for systolic BP (SBP) and −0.2 ± 1.7 mmHg for diastolic BP (DBP). For validation criterion 1, the mean difference ± SD between the reference and device BP values were 3.6 ± 5.5 mmHg for SBP and 1.4 ± 4.5 mmHg for DBP. For criterion 2, the SD of the mean BP differences between the test device and reference BP per subject was 5/4.1 mmHg for SBP/DBP (≤5.9/6.8). These results fulfilled the protocol requirements.ConclusionThe Combei BP118A oscillometric device for home BP measurement fulfilled all of the requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060–2:2018) in general population and consequently can be recommended for home BP measurements.

Agreement between attended home and ambulatory blood pressure measurements in adolescents with chronic kidney disease.

This study aimed to compare attended home blood pressure (BP) measurements (HBPM) with ambulatory BP monitor (ABPM) readings and examine if level of agreement between measurement modalities differs overall and by subgroup. This was a secondary analysis of data from a 2-year, multicenter observational study of children 11-19years (mean 15, SD = 2.7) with chronic kidney disease. Participants had 3 standardized resting oscillometric home BPs taken by staff followed by 24-h ABPM within 2weeks of home BP. BP indices (measured BP/95%ile BP) were calculated for mean triplicate attended HBPM and mean ABPM measurements. Paired HBPM and ABPM measurements taken during any of 5 study visits were compared using linear regression with robust standard errors. Generalized estimating equation-based logistic regression determined sensitivity, specificity, negative, and positive predictive values with ABPM as the gold standard. Analyses were conducted for the group overall and by subgroup. A total of 103 participants contributed 251 paired measurements. Indexed systolic BP did not differ between HBPM and daytime APBM (mean difference - 0.002; 95% CI: - 0.006, 0.003); the difference in indexed diastolic BP was minimal (mean difference - 0.033; 95% CI: - 0.040, - 0.025). Overall agreement between HBPM and 24-h ABPM in identifying abnormal BP was high (81.8%). HBPM had higher sensitivity (87.5%) than specificity (77.4%) and greater negative (89.8%) than positive (73.3%) predictive value, and findings were consistent in subgroups. Attended HBPM may be reasonable for monitoring BP when ABPM is unavailable. The greater accessibility and feasibility of attended HBPM may potentially help improve BP control among at-risk youth. A higher resolution version of the Graphical abstract is available as Supplementary information.

Methods of Blood Pressure Measurement to Predict Hypertension-Related Cardiovascular Morbidity and Mortality.

As the evidence on different blood pressure phenotypes and their cardiovascular risks evolve, it is imperative to evaluate the reliability of office blood pressure (OBP), ambulatory blood pressure (ABP), and home blood pressure (HBP) measurements and their associations with cardiovascular morbidity and mortality. HBP is more reliable in diagnosis of hypertension than OBP or ABP. HBP correlates better with left ventricular mass index (LVMI). Increasing systolic HBP is associated with a higher risk of all-cause mortality, cardiovascular mortality, and cardiovascular events. An elevated systolic ABP is also associated with a higher risk of cardiovascular events and mortality. ABP is a better predictor of cardiovascular events than OBP in diabetics. ABP and HBP furnish additional information beyond OBP. They correlate better with cardiovascular outcomes and are more helpful with monitoring therapy than OBP. Comparative effectiveness studies of all three methods associating with cardiovascular outcomes are warranted.

Patients' and Providers' Perspectives on and Needs of Telemonitoring to Support Clinical Management and Self-care of People at High Risk for Preeclampsia: Qualitative Study.

BackgroundPreeclampsia is one of the leading causes of maternal mortality worldwide, with a global prevalence at 2%-8% of pregnancies. Patients at high risk for preeclampsia (PHRPE) have an increased risk of complications, such as fetal growth restriction, preterm delivery, abnormal clotting, and liver and kidney disease. Telemonitoring for PHRPE may allow for timelier diagnosis and enhanced management, which may improve maternal and perinatal outcomes.ObjectiveThe objective of this study is to determine the perceptions and needs of PHRPE and their health care providers with respect to telemonitoring through semistructured interviews with both groups. This study explored (1) what the needs and challenges of monitoring PHRPE are during pregnancy and in the postpartum period and (2) what features are required in a telemonitoring program to support self-care and clinical management of PHRPE.MethodsThis study used a qualitative descriptive approach, and thematic analysis was conducted. PHRPE and health care providers from a high-risk obstetrical clinic in a large academic hospital in Toronto, Canada, were asked to participate in individual semistructured interviews. Two researchers jointly developed a coding framework and separately coded each interview to ensure that the interviews were double-coded. The software program NVivo version 12 was used to help organize the codes.ResultsIn total, 7 PHRPE and 5 health care providers, which included a nurse practitioner and physicians, participated in the semistructured interviews. Using thematic analysis, perceptions on the benefits, barriers, and desired features were determined. Perceived benefits of telemonitoring for PHRPE included close monitoring of home blood pressure (BP) measurements and appropriate interventions for abnormal BP readings; the development of a tailored telemonitoring system for pregnant patients; and facilitation of self-management. Perceived barriers to telemonitoring for PHRPE included financial and personal barriers, as well as the potential for increased clinician workload. Desired features of a secure platform for PHRPE included the facilitation of self-management for patients and decision making for clinicians, as well as the inclusion of evidence-based action prompts.ConclusionsThe perceptions of patients and providers on the use of telemonitoring for PHRPE support the need for a telemonitoring program for the management of PHRPE. Recommendations from this study include the specific features of a telemonitoring program for PHRPE, as well as the use of frameworks and design processes in the design and implementation of a telemonitoring program for PHRPE.

Association of peridialytic, intradialytic, scheduled interdialytic and ambulatory BP recordings with cardiovascular events in hemodialysis patients.

Ambulatory-BP-monitoring (ABPM) is recommended for hypertension diagnosis and management in hemodialysispatients due toits strong association with outcomes. Intradialytic and scheduled interdialytic BP recordings show agreement with ambulatory BP. This study assesses in parallel the association of pre-dialysis, intradialytic, scheduled interdialytic and ambulatory BP recordings with cardiovascular events. We prospectively followed 242 hemodialysis patients with valid 48-h ABPMs for a median of 45.7months to examine the association of pre-dialysis, intradialytic, intradialytic plus pre/post-dialysis readings, scheduled interdialytic BP, and 44-h ambulatory BP with outcomes. The primary end-point was a composite one, composed of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, resuscitation after cardiac arrest, hospitalization for heart failure, coronary revascularization procedure or peripheral revascularization procedure. Cumulative freedom from the primary end-point was significantly lower with increasing 44-h SBP (group 1, < 120mmHg, 64.2%; group 2, ≥ 120 to < 130mmHg 60.4%, group 3, ≥ 130 to < 140mmHg 45.3%; group 4, ≥ 140mmHg 45.5%; logrank-p = 0.016). Similar were the results for intradialytic (logrank-p = 0.039), intradialytic plus pre/post-dialysis (logrank-p = 0.044), and scheduled interdialytic SBP (logrank-p = 0.030), but not for pre-dialysis SBP (logrank-p = 0.570). Consideringgroup 1 as the reference group, the hazard ratios of the primary end-point showed a gradual increase with higher BP levels with all BP metrics, except pre-dialysis SBP. This pattern was confirmedin adjusted analyses. An inverse association of DBP levels with outcomes was shown with all BP metrics, which was no longer evident in adjusted analyses. Averaged intradialytic and scheduled home BP measurements (but not pre-dialysis readings) display similar prognostic associations with 44-h ambulatory BP in hemodialysis patients and represent valid metrics for hypertension management in these individuals.