Office Readings Research Articles

Renal function outcomes and kidney biopsy features of living kidney donors with hypertension.

The medium- to long-term outcomes of living kidney donors with hypertension compared to normotensive donors are not well understood, especially with the recent changes in hypertension guidelines. We studied a cohort of 950 living kidney donors using different definitions of hypertension based on either ≥140/90 or ≥130/80mmHg thresholds and based on either office or ambulatory blood pressure readings. Microstructural features on kidney biopsy at the time of donation were compared using different definitions of hypertension. After adjusting for years of follow-up, age, sex, and baseline eGFR, hypertension (by any definition) did not significantly predict an eGFR<45ml/min/1.73m2 at a median follow-up of 10years postdonation, though there was a borderline association with ambulatory blood pressure≥130/80mmHg predicting a 40% decline in eGFR (OR=1.53, 1.00-2.36; p=.051). Proteinuria was predicted by office blood pressure≥140/90mmHg and by nondipper profile on nocturnal ambulatory blood pressure measurements. At the time of donation, larger glomeruli and arterial hyalinosis on biopsy were associated with hypertension defined by either ≥140/90 or ≥130/80mmHg (by office or ambulatory measurements). Nocturnal nondipper status was associated with larger glomeruli size but not arteriolar hyalinosis when compared to dippers. In programs that accept donors with controlled hypertension, various definitions of hypertension are associated with histological findings in the donated kidney, but none predict a clinically significant decline in kidney function 10years after donation. These data support allowing healthy individuals with controlled hypertension to donate a kidney. However, donors with office hypertension (≥140/90mmHg) and nondippers (regardless of hypertension status) are at greater long-term risk for proteinuria, and particularly for these donors, longer follow-up is warranted.

Automated office blood pressure is in agreement with awake and mean 24-hour ambulatory blood pressure at the lower blood pressure range.

Automated office blood pressure measurement eliminates the white coat effect and is associated with awake ambulatory blood pressure. This study examined whether automated office blood pressure values at lower limits were comparable to those of awake and mean 24-hour ambulatory blood pressure. A total of 552 patients were included in the study, involving 293 (53.1%) men and 259 (46.9%) women, with a mean age 55.0±12.5, of whom 36% were treated for hypertension. Both systolic and diastolic automated office blood pressures exhibited lower values compared to awake ambulatory blood pressure among 254 individuals with systolic automated office blood pressure <130mmHg (119±8mmHg vs 125±11mmHg, P<.0001 and 75±9mmHg vs 79±9mm Hg, P<.0001 for systolic and diastolic BPs, respectively). Furthermore, the comparison of systolic automated office blood pressure to the mean 24-hour ambulatory blood pressure levels also showed lower values (119±8 vs 121±10, P=.007), whereas the diastolic automated office blood pressure measurements were similar to 24-hour ambulatory blood pressure values. Our findings show that when automated office blood pressure readings express values <130/80mmHg in repeated office visits, further investigation should be performed only when masked hypertension is suspected; otherwise, higher automated office blood pressure values could be used for the diagnosis of uncontrolled hypertension, especially in individuals with organ damage.

SO035EFFECT OF DIETARY SALT REDUCTION ON BLOOD PRESSURE IN KIDNEY TRANSPLANT PATIENTS: A RANDOMISED CONTROLLED TRIAL

Abstract Background and Aims Cardiovascular morbidity and mortality are increased in kidney transplant patients. High blood pressure (BP) contributes significantly to this risk and is associated with shortened allograft survival. Dietary salt reduction is widely recommended as a strategy to lower BP in the general population and in chronic kidney disease. Due to a lack of evidence there is currently no consensus on dietary salt restriction in kidney transplant patients. The primary aim of the study was to examine the impact of reduced dietary salt intake on BP in kidney transplant patients. Method Sixty stable kidney transplant patients, ≥ 6-months post-transplantation, with BP ≥120/80 mmHg, and sodium intake ≥80 mmol/24hrs, were randomised in this parallel-designed study to receive either a regular-salt diet (target 150 mmol/24hr) or a low-salt diet (target 80 mmol/24hr) for 8-weeks. The primary outcome measure was systolic and diastolic BP. Secondary outcome measures included 24-hour ambulatory BP (ABP) and proteinuria. Dietary salt intake was assessed by 48-hour urinary sodium excretion. Results At baseline, patients (72% men) were 56±11 years with estimated glomerular filtration rate (eGFR) 53±18 mL/min/1.73m2. Mean urinary sodium was 128±42 mmol/24hr, mean systolic BP was 132±12 mmHg, and mean diastolic BP was 77±10 mmHg. At the end of the intervention period sodium excretion was significantly lower in the low-salt group compared with the regular-salt group (90±37 vs. 132±51 mmol/24hr; adjusted mean difference, -36 [95% CI, -59 to -14] mmol/24hr; P=0.002). We found no difference in systolic BP (adjusted mean difference, -2 [95% CI, -12 to 9] mmHg; P=0.750), diastolic BP (adjusted mean difference, 0 [95% CI, -4 to 4] mmHg; P=0.887), 24-hour systolic ABP (adjusted mean difference, -3 [95% CI, -9 to 2] mmHg; P=0.213) or 24-hour diastolic ABP (adjusted mean difference, -2 [95% CI, -5 to 1] mmHg; P=0.267). There was no significant effect on proteinuria or eGFR. Conclusion In this study baseline urinary sodium was lower than expected and baseline BP was well controlled. Reducing dietary salt by 2g/day did not have a significant effect on office blood pressure readings.

The relationship between nocturnal blood pressure drop and body composition indices among hypertensive patients.

Among hypertensive subjects, the lack of physiological blood pressure drop as part of diurnal blood pressure variations is termed as non-dipper blood pressure. Herein, we investigated the relationship between hypertension character and body composition indices. This study included a total of 104 patients (54 M, mean age: 47.6±12.1years). Patients' heights, weights, and waist and hip circumferences were measured, and body composition indices were calculated. All patients' office blood pressure measurements and 24-hour ambulatory blood pressure readings were recorded. A blood pressure drop of at least 10% compared with daytime blood pressure readings is called dipper blood pressure, while a drop of less than 10% is termed as non-dipper blood pressure. Based on ambulatory blood pressure readings, the patients were grouped into Group 1 (dipper pattern; 51 pts, 34 M, mean age 45.6±12.3) and Group 2 (non-dipper pattern, 53 pts; 20 M, mean age 49.6±11.6). The proportion of females and smokers were significantly lower in Group 1 than Group 2. BRI, BAI, waist-to-height ratio, and waist circumference were significantly higher in Group 2 than Group 1. There were significant positive correlations between body roundness index (BRI), body adiposity index (BAI), waist-to-weight ratio, and WC and nocturnal mean systolic and diastolic blood pressure readings. Percent systolic nocturnal drop was significantly correlated with waist-to-height ratio, BAI, and BRI. Similarly, percent diastolic nocturnal drop and waist-to-height ratio, BAI, and BRI were correlated. In conclusion, the relatively new body composition indices, namely BRI and BAI, are more closely related to nocturnal blood pressure readings among non-dipper subjects.

Twenty-Four-Hour Ambulatory Blood Pressure Monitoring.

The diagnosis, management, and estimated mortality risk in patients with hypertension have been historically based on clinic or office blood pressure readings. Current evidence indicates that 24-hour ambulatory blood pressure monitoring should be an integral part of hypertension care. The 24-hour ambulatory monitors currently available on the market are small devices connected to the arm cuff with tubing that measure blood pressure every 15 to 30 minutes. After 24 hours, the patient returns, and the data are downloaded, including any information requested by the physician in a diary. The most useful information includes the 24-hour average blood pressure, the average daytime blood pressure, the average nighttime blood pressure, and the calculated percentage drop in blood pressure at night. The most widely used criteria for 24-hour measurements are from the American Heart Association 2017 guidelines and the European Society of Hypertension 2018 guidelines. Two important scenarios described in this document are white coat hypertension, in which patients have normal blood pressures at home but high blood pressures during office visits, and masked hypertension, in which patients are normotensive in the clinic but have high blood pressures outside of the office. The Centers for Medicare and Medicaid Services has made changes in its policy to allow reimbursement for a broader use of 24-hour ambulatory blood pressure monitoring within some specific guidelines. Primary care physicians should make more use of ambulatory blood pressure monitoring, especially in patients with difficult to manage hypertension.

From Clinical Trials to Bedside: the Use of Antihypertensives in Aged Individuals. Part 1: Evaluation and Evidence of Treatment Benefit

Use of antihypertensives in older adults can be complicated by the potential for undesired effects on comorbidities, adverse effects of the drugs, and overall medication burden. The purpose of this two-part review is to discuss contemporary issues encountered in the management of hypertension in aged individuals, with a particular focus on the individualization of treatment. In part 1, we discuss the evaluation of the aged hypertensive patient and review the clinical trial evidence for treatment benefit of hypertension in the elderly. Elderly patients with suspected hypertension need careful evaluation of their blood pressure, as errors in measurement technique, inaccurate devices, or overreliance on office blood pressure readings may lead to under- or over-treatment, thereby increasing risks of adverse medication effects and/or cardiovascular events. Epidemiologic evidence in older adults suggests a link between low blood pressure and increased mortality. However, key prospective hypertension trials such as HYVET and SPRINT, which were focused in mostly healthy, community-dwelling elderly cohorts, have unequivocally demonstrated benefits of lowering blood pressure in reducing cardiovascular events in the very elderly. Recent evidence also suggests benefit in reducing the risks of cognitive impairment. Hypertension is a major modifiable risk factor and the benefits of treatment in lowering cardiovascular events are realized for most individuals, even at advanced ages.

Self-blood pressure monitoring as a tool to increase hypertension awareness, adherence to antihypertensive therapy, and blood pressure control.

Self-blood pressure monitoring as a tool to increase hypertension awareness, adherence to antihypertensive therapy, and blood pressure control.

ACCURACY OF SEQUENTIAL BLOOD PRESSURE MEASUREMENTS IN COMPARISON TO AMBULATORY BLOOD PRESSURE MEASUREMENTS

Objective: Accurate blood pressure measurement is crucial for diagnosis and follow up hypertension. Office blood pressure may be misleading in certain situations. Our study aimed to compare the accuracy and degree of agreement of automated sequential blood pressure with office blood pressure and ambulatory blood pressure readings Design and method: This was a cross sectional observational study that included patients who were known to be hypertensive and coming to check up their blood pressure. The study was conducted in Kasr El-Aini Specialized hypertension clinic. Full medical history, clinical examination, electrocardiogram, fundus examination and essential labs (e.g. urine analysis, fasting blood sugar, serum potassium, creatinine, lipid profile and hemoglobin) were done for each patient. Office blood pressure was recorded by using digital sphygmomanometer device (Omrone-6 automated device), automated sequential blood pressure by using the Mobile-O- Graph, PWA device over half an hour. The ambulatory blood pressure readings were taken within 24 hours from the previous measurements. All measurements were taken according to the European society guidelines for the management of hypertension. Results: 64 patients were included. Their age ranged between 20 and 85 years (mean ± SD of age 50.0 ± 15.0 years). There were 51.1% female. The office blood pressure readings were significantly higher than the automated sequential blood pressure (142.7 ± 15.5 versus 137.8 ± 16.7 mmHg, P < 0.0001) for systolic blood pressure and (88.5 ± 12.3 versus 86.1 ± 13.8 mmHg, P < 0.0001) for diastolic blood pressure. And higher than the day time ambulatory blood pressure readings (142.7 ± 15.5 versus 135.8 ± 15.7 mmHg, P < 0.0001) for systolic blood pressure and (88.5 ± 12.3 versus 82.1 ± 13.7 mmHg, P < 0.0001) for diastolic blood pressure. The automated sequential blood pressure has a strong positive correlation with day time ambulatory blood pressure(r = 0.74, P < 0.0001). There is a moderate degree of agreement between sequential systolic blood pressure and day time systolic ambulatory blood pressure (kappa = 0.59, P < 0.001). Conclusions: Automated sequential blood pressure measurement is significantly lower than office blood pressure measured by semi-automated electronic devices, and provides a reading which has significant correlation with the day time ambulatory blood pressure.

Reproducibility of masked uncontrolled hypertension detected through home blood pressure monitoring.

Masked uncontrolled hypertension (MUCH) is an entity described in treated hypertensive subjects, where office blood pressure (BP) is well controlled and out-of-office BP is elevated. It has been related to a higher cardiovascular risk. However, the reproducibility of MUCH has been scarcely studied. In this study, we aimed to determine the reproducibility of MUCH detected through home blood pressure monitoring (HBPM). Two sets of measurements were performed in hypertensive adults under stable treatment with a 1-week interval. Each set of measurements included three office BP readings and a 4-day HBPM with duplicate readings in the morning, afternoon, and evening (the same validated oscillometric device was employed in both settings). We determined the percentage of agreement regarding the presence of MUCH in the two sets of measurements and quantified such agreement through the Cohen's kappa coefficient (κ), its 95% confidence interval, and P value. We included 105 patients (median age 58.6 [IQR 45.6-67.2] years old, 53.4% men). MUCH prevalence on at least one occasion was 22.3% (95% CI: 15.2-31.5). The reproducibility of MUCH was scant: κ=0.19 (95% CI: 0.0002-0.38), P=0.02, due to the poor reproducibility of the office BP component of MUCH in comparison with the home BP component: κ=0.21 (95% CI: 0.03-0.39), P=0.01 vs κ=0.48 (95% CI 0.29-0.67), P<0.001, respectively. In conclusion, the reproducibility of MUCH detected through HBPM is minimal, mainly due to the poor reproducibility of office BP measurements. An HBPM-based strategy for the management of patients with MUCH may be more adequate in terms of cardiovascular morbidity and mortality.

Review: Automated office BP measures are similar to awake ambulatory BP and lower than other office BP measures.

Source Citation Roerecke M, Kaczorowski J, Myers MG. Comparing automated office blood pressure readings with other methods of blood pressure measurement for identifying patients with possible hyper...

Ambulatory Blood Pressure Monitoring: Profiles in Chronic Kidney Disease Patients and Utility in Management.

Optimal control of blood pressure (BP) may reduce the risk of progression of CKD. Misclassification of hypertension (HTN) and status of control may result in suboptimal management. Clinic or home BP may overestimate or underestimate status of control compared with ambulatory BP monitoring (ABPM), which is considered the gold standard. The latter relates not only to the superiority of ABPM concerning outcome prognosis but also to its ability to accurately diagnose white coat and masked HTN, which is critical in assuring adequate BP control. However, ABPM has not gained widespread use in practice because of limited third-party reimbursement and a paucity of high quality randomized controlled intervention studies evaluating its use. Herein, we review HTN phenotypes that have been identified in patients with CKD, and the potential value of ABPM in this high-risk population.

Comparing Automated Office Blood Pressure Readings With Other Methods of Blood Pressure Measurement for Identifying Patients With Possible Hypertension

ImportanceAutomated office blood pressure (AOBP) measurement involves recording several blood pressure (BP) readings using a fully automated oscillometric sphygmomanometer with the patient resting alone in a quiet place. Although several studies have shown AOBP measurement to be more accurate than routine office BP measurement and not subject to a “white coat effect,” the cumulative evidence has not yet been systematically reviewed.ObjectiveTo perform a systematic review and meta-analysis to examine the association between AOBP and office BP readings measured in routine clinical practice and in research studies, and ambulatory BP recorded during awake hours, as the latter is a standard for predicting future cardiovascular events.Data SourcesThe MEDLINE, Embase, and Cochrane Library were searched from 2003 to April 25, 2018.Study SelectionStudies on systolic and diastolic BP measurement by AOBP in comparison with awake ambulatory BP, routine office BP, and research BP measurements were included if they contained 30 patients or more.Data Extraction and SynthesisStudy characteristics were abstracted independently and random effects meta-analyses and meta-regressions were conducted.Main Outcomes and MeasuresPooled mean differences (95% CI) of systolic and diastolic BP between types of BP measurement.ResultsData were compiled from 31 articles comprising 9279 participants (4736 men and 4543 women). In samples with systolic AOBP of 130 mm Hg or more, routine office and research systolic BP readings were substantially higher than AOBP readings, with a pooled mean difference of 14.5 mm Hg (95% CI, 11.8-17.2 mm Hg; n = 9; I2 = 94.3%; P < .001) for routine office systolic BP readings and 7.0 mm Hg (95% CI, 4.9-9.1 mm Hg; n = 9; I2 = 85.7%; P < .001) for research systolic BP readings. Systolic awake ambulatory BP and AOBP readings were similar, with a pooled mean difference of 0.3 mm Hg (95% CI, −1.1 to 1.7 mm Hg; n = 19; I2 = 90%; P < .001).Conclusions and RelevanceAutomated office blood pressure readings, only when recorded properly with the patient sitting alone in a quiet place, are more accurate than office BP readings in routine clinical practice and are similar to awake ambulatory BP readings, with mean AOBP being devoid of any white coat effect. There has been some reluctance among physicians to adopt this technique because of uncertainty about its advantages compared with more traditional methods of recording BP during an office visit. Based on the evidence, AOBP should now be the preferred method for recording BP in routine clinical practice.

Office blood pressure measurement in the 21st century.

Measurement of blood pressure (BP) using the auscultatory method must follow specific rules and conditions to be reliable. Nonetheless, these requirements are often not followed in clinical practice, resulting in inaccurate BP readings. Simply replacing manual sphygmomanometers with an oscillometric device may still produce readings that are associated with a white coat effect. These limitations can be overcome by using an oscillometric sphygmomanometer that automatically records multiple readings with the patient resting quietly and alone, called automated office (AO)BP. AOBP produces office readings with a reduced white coat effect, which are also similar to the awake ambulatory BP. There is also evidence that AOBP is a better predictor of target organ damage than attended office BP. Furthermore, clinical outcome data support AOBP as having both a similar diagnostic threshold as awake ambulatory BP and a lower treatment target. Using AOBP in clinical practice simplifies recording office BP by not requiring an additional period of rest before activation of the device and by not having staff present during the actual measurements. Recent studies have reported that automatic BP measurements taken by staff in research studies with close adherence to guidelines using AOBP devices may produce similar readings to AOBP. Further research is needed to determine the best method for recording BP at systolic targets <130mm Hg and the relationship of office BP to ambulatory BP and home BP.

Attended and Unattended Automated Office Blood Pressure Measurements Have Better Agreement With Ambulatory Monitoring Than Conventional Office Readings.

BackgroundAutomated office blood pressure (AOBP) measurement is superior to conventional office blood pressure (OBP) because it eliminates the “white coat effect” and shows a strong association with ambulatory blood pressure.Methods and ResultsWe conducted a cross‐sectional study in 146 participants with office hypertension, and we compared AOBP readings, taken with or without the presence of study personnel, before and after the conventional office readings to determine whether their variation in blood pressure showed a difference in blood pressure values. We also compared AOBP measurements with daytime ambulatory blood pressure monitoring and conventional office readings. The mean age of the studied population was 56±12 years, and 53.4% of participants were male. Bland–Altman analysis revealed a bias (ie, mean of the differences) of 0.6±6 mm Hg systolic for attended AOBP compared with unattended and 1.4±6 and 0.1±6 mm Hg bias for attended compared with unattended systolic AOBP when measurements were performed before and after conventional readings, respectively. A small bias was observed when unattended and attended systolic AOBP measurements were compared with daytime ambulatory blood pressure monitoring (1.3±13 and 0.6±13 mm Hg, respectively). Biases were higher for conventional OBP readings compared with unattended AOBP (−5.6±15 mm Hg for unattended AOBP and oscillometric OBP measured by a physician, −6.8±14 mm Hg for unattended AOBP and oscillometric OBP measured by a nurse, and −2.1±12 mm Hg for unattended AOBP and auscultatory OBP measured by a second physician).ConclusionsOur findings showed that independent of the presence or absence of medical staff, AOBP readings revealed similar values that were closer to daytime ambulatory blood pressure monitoring than conventional office readings, further supporting the use of AOBP in the clinical setting.

Influence of SPRINT Study Type Automated Office Blood Pressure Measurements on Hypertension Diagnosis in Kidney Transplant Patients

Background/Aims: We compare conventional office blood pressure measurements with automated SPRINT-study type readings in kidney transplant recipients in order to determine the impact of the white coat effect in a prospective observational study. Methods: Adult patients with a functional renal transplant not dependent on dialysis were eligible. Readings were taken in the office in presence of the physician with an oscillometric method. Afterwards, readings were repeated with the patients resting alone in a quiet examination room with an automated blood pressure monitor. After 5 minutes of rest, 3 readings were taken at 1 minute intervals, with an average of these 3 readings calculated by the monitor. Results: 120 patients with an average age of 58.5±12.2 years were included. Mean time since transplantation was 7.95±6.48 years. Mean eGFR (CKD-EPI) was 48.5±18.3 ml/min. SPRINT-study type readings were significantly lower than office readings (139.01±18.45 vs. 149.00±21.02 mmHg systolic, p<0.001; 80.88±11.63 mmHg vs. 84.35±12.41 mmHg diastolic, p <0.001). Correlation analysis for many potentially influencing factors (diabetes mellitus, transplant vintage, proteinuria, age, immunosuppression, donor type) was not significant but obese women were significantly more prone to white coat hypertension. Conclusion: Automated office blood pressure measurements should be considered the method of choice in kidney transplant recipients.

Application and Effects of Ambulatory Blood Pressure Monitoring in Primary Care

ABSTRACT Ambulatory blood pressure monitoring (ABPM) is well-recognized as a valuable tool in diagnosing and managing hypertension and is more predictive of cardiovascular events than office or home blood pressure readings. Yet concerns remain, particularly in the US, about whether ABPM can be implemented in a primary care practice, be delivered in an efficient manner, and yield influential information. ABPM was made available within a 17-physician internal medicine primary care clinic and was utilized for routine blood pressure management. Patients wore the ABPM device for 24 hours, with readings taken every 20 to 30 minutes. Data were collected on 3,217 patients who underwent ABPM between January 2013 and October 2016. Of the 3,217 patients who underwent ABPM, 43% of patients had their blood pressure control status reclassified. Reclassification was not limited to near-normal office blood pressure readings. Among those with systolic blood pressure >160 mm Hg, 38% were reclassified as normotensive. Among...

Renal functional reserve in children with a solitary functioning kidney and chronic kidney disease

O bjective – To examine renal functional reserve (RFR) and blood pressure (BP) in children with a solitary functioning kidney (SFK) and stage 1-3 chronic kidney disease (CKD). M ethod – RFR was measured in 48 children with SFK and in 10 healthy children, as the difference between unstimulated and stimulated clearance of endogenous creatinine by a meat-free oral protein load (OPL). Cimetidine was given 48 h prior to the measurement when the study subjects were on a diet free of meat, fish and poultry. Serum cystatin C and urinary protein (UPRT)/urinary creatinine (UCr) were examined before and 2 hours after OPL. BP was determined by office and by 24-h ambulatory BP monitoring (ABPM). R esults – The majority of the patients (79.6%) had congenital SFK, while the remaining had acquired SFK due to unilateral nephrectomy. Sixteen patients had CKD1, 19 patients had CKD2 and 13 had CKD3. The patients and controls did not differ in terms of age, gender, body size, office and 24-h blood pressure readings and basal GFR. Kidney size was greater and serum cystatin C was higher in patients than in controls. Increased proteinuria and arterial hypertension were found in 24.3% and 18.9% of the patients, respectively. Nocturnal hypertension was more common than that during the daytime. After OPL, GFR significantly increased, more in controls than in patients. Among the patients, the RFR was the highest in the CKD3 group. Conclusion – OPL induced an increase in GFR above its basal value. This response was higher in healthy children than in those with SFK. The positive relationship between RFR and CKD stage and the highest RFR in CKD3 patients suggests well preserved renal functional reserve in patients with moderate renal failure. ABPM is necessary for BP evaluation in children with SFK.

A comparison of blood pressure in community pharmacies with ambulatory, home and general practitioner office readings: systematic review and meta-analysis.

Blood pressure (BP) readings are traditionally taken in a clinic setting, with treatment recommendations based on these measurements. The clinical interpretation of BP readings taken in community pharmacies is currently unclear. This study aimed to systematically review all literature comparing community pharmacy BP (CPBP) readings with ambulatory BP monitoring (ABPM), home BP monitoring and general practitioner clinic readings. Studies were included if they compared CPBP with at least one other measurement modality used for the diagnosis or management of hypertension. Mean CPBP readings were compared with other measurement modalities and summarized using random-effects meta-analyses. The primary outcome was to compare CPBP with gold standard ABPM readings. Searches generated 3815 studies of which eight were included in the meta-analyses. The mean systolic CPBP-daytime ABPM difference was small [+1.6 mmHg (95% confidence interval -1.2 to 4.3) three studies, n = 319]. CPBP was significantly higher than 24-h ABPM [+7.8 mmHg (95% confidence interval 1.5-14.1) three studies n = 429]. Comparisons with general practitioner clinic readings (six studies, n = 2100) were inconclusive with significant heterogeneity between studies. CPBP and home BP monitoring readings (five studies, n = 1848) were nonsignificantly different. Diastolic comparisons mirrored systolic comparisons in all but the CPBP-daytime ABPM comparison, where CPBP was significantly higher. Current evidence around the clinical interpretation of CPBP is inconclusive. Although this review suggests that adopting the 135/85 mmHg threshold for hypertension might be reasonable and potentially result in a higher sensitivity for detecting patients with truly raised BP in pharmacies, the impact of this lower threshold on increased referrals to general practice clinics must be considered.

"Do it-yourself": Home blood pressure as a predictor of traditional and everyday cognition in older adults.

BackgroundHypertension guidelines recommend home blood pressure (HBP) monitoring in adjunct to office blood pressure (OBP) for its greater reproducibility and prognostic utility in the prevention of cardiovascular outcomes, especially stroke. To date, the relationship between HBP and cognitive function remains unexplored.MethodsWe examined HBP as a cognitive predictor in a multi-ethnic group of community-dwelling adults aged 60 and over (N = 133) using neuropsychological measures and analyzed the data using multiple regression analyses. We also employed “everyday cognition” measures that have been found to have higher prognostic utility for real-world functioning than traditional cognitive tasks.ResultsGood to perfect HBP monitoring compliance over seven days was achieved by 88.7% of the participants with superior reliability (ICC≥.96) to office readings. Higher home systolic BP and pulse pressure predicted worse processing speed, executive function, and everyday cognitive function, whereas lower home diastolic BP predicted worse everyday cognition. Office readings were similarly associated with everyday cognitive function but with no other cognitive measures.ConclusionOur findings are the first to validate HBP as a predictor of neuropsychological function in older adults beyond cognitive screening. Differential relationships among blood pressure variables and specific cognitive domains were observed. With proper standardization and training, we demonstrated that HBP can be obtained in a multi-ethnic community-dwelling older adult cohort. Our findings emphasize the importance of employing blood pressure and cognitive measures that are adequately sensitive to detect vascular-related cognitive impairment in a relatively healthy population. Implications regarding proper HBP measurement for hypertension management, cognitive health, and everyday function are discussed.

Office blood pressure measurements with oscillometric devices in adolescents: a comparison with home blood pressure

Purpose: Compare multiple in office BP measurements in adolescents using an oscillometric device with out-of-office blood pressure measurements (home blood pressure monitoring – HBPM).Materials and methods: Office measurements were performed with validated semi-automatic devices twice (3 minutes interval) in two different moments (1 week apart), with a total of four readings. These BP readings were named R1, R2, R3 and R4 (following the sequence they were performed), FDM (mean of two readings on first day) and SDM (mean of two readings on second day) and SRM (R2–R4 means). The HBPM protocol included two day-time and two evening-time measurements over 6 days.Results: A total of 1024 students between 12 and 17 years were included (mean age 14.68 years; 52.4% females). The mean systolic blood pressure (SBP) values of R2, SDM and SRM were similar to HBPM values. Regarding diastolic blood pressure (DBP) HBPM value was different than R4. High SBP and DBP correlation coefficients with HBPM values were found for R2, SDM and SRM values.Conclusion: The second office BP measurement performed with an oscilometric device in adolescents was comparable to HBPM values, suggesting that two office readings might be suitable to rule out hypertension in this age group.