Unattended Blood Pressure Measurement Research Articles

Unattended versus conventional blood pressure measurements in hospitalized hypertensive patients.

This study aims to compare the differences between unattended and conventional blood pressure measurements in hospitalized hypertensive patients. In fall of 2019, hypertensive patients at Ruijin Hospital underwent two rounds of unattended and conventional (nurse-monitored) blood pressure measurement. Both rounds used the same electronic blood pressure monitor with measurements taken three times, 30 s apart. Comparison was made using intra-class correlation coefficients, Bland-Altman plots, paired t-tests, etc. Among the 92 subjects in the study, the median age was 50 years old, with women accounting for 33.7%. Among the subjects, the median duration of hypertension was 8.0 years. The prevalence of diabetes, coronary heart disease, and stroke were 26.1%, 5.4%, and 6.5%, respectively. Whether unattended or conventional measurements were taken first, the average blood pressure measured first was slightly higher than the one measured later, but the difference was within 1-2 mmHg. Except that the average DBP during the round of conventional blood pressure measurements was significantly reduced by 1.6 mmHg compared to the conventional DBP, there were no other significant differences. Subgroup analysis by age, gender, BMI, and diabetes showed no significant difference in blood pressure measurement results between unattended and conventional methods. No significant difference was observed between unattended and conventional methods of blood pressure measurement in hospitalized hypertensive patients. Unattended blood pressure measurement can be adopted as the current standard for blood pressure management in hospitalized patients.

Unattended blood pressure measurement: is it really superior to traditional clinic readings?

Unattended blood pressure measurement: is it really superior to traditional clinic readings?

Prevalence of masked hypertension in attended versus unattended office blood pressure measurement.

There is a controversial debate regarding whether unattended blood pressure (BP) measurement should be regarded as the new gold standard of office BP measurement. Unattended BP measurement eliminates the white-coat effect and reduces external influences on the patient. On the other hand, it might underestimate real-life BP. The present study compares the prevalence of masked hypertension using attended versus unattended office BP measurements. We performed a cross-sectional study on 213 patients in a general practitioner's outpatient clinic and compared attended and unattended office BP with 24h-ambulatory BP monitoring (24h-ABPM). Masked hypertension was defined as pressure ≥135/85mmHg in daytime ABPM with office systolic BP<140/90mmHg. Median attended and unattended office BPs were 140/86 and 134/80mmHg with a median 24h-BP of 129/79mmHg and daytime ABP of 133/82mmHg. The number of patients with masked hypertension was 45/213 (21.2%) using unattended and 23/213 (10.8%) using attended office BP measurements (p<.0001). Bland-Altman analysis revealed a 7.4mmHg systolic and 6.2mmHg diastolic bias between the attended versus unattended office BP, and two systolic and -1.7mmHg diastolic biases between the unattended office BP and daytime ambulatory BP. In linear regression analysis, an unattended office BP of 134mmHg corresponded to 140mmHg in attended BP measurement. Using a cut-off of 135/85mmHg instead of 140/90mmHg in unattended office BP measurement, the rate of masked hypertension was 26/213 (12.2%). Thus, unattended office BP measurement results in a substantial increase in the prevalence of masked hypertension using the traditional definition of hypertension. The present findings suggest that it might be reasonable to use a definition of 135/85mmHg.

Sympathetic Neural Mechanisms in Hypertension: Recent Insights.

To examine published and unpublished data documenting the role of sympathetic neural factors in the pathogenesis of different hypertensive phenotypes. These phenotypes relate to attended or unattended blood pressure measurements, to nighttime blood pressure profile alterations, and to resistant, pseudoresistant, and refractory hypertension. Results of original clinical studies as well as of recent meta-analyses based on the behavior of different sympathetic biomarkers in various hypertensive forms will be also discussed. Studies performed in the past decade have shown that office blood pressure measurements, including in recent years those characterizing unattended or attended blood pressure assessment, are associated with profound changes in the behavior of different sympathetic biomarkers. This is the case for the clinical hypertensive phenotypes characterized by alterations in the nocturnal blood pressure profile and by sleep duration abnormalities. This is also the case for the clinical conditions defined as resistant, refractory, and pseudoresistant hypertension. Data reviewed in the present paper highlight the relevance of sympathetic neural factors in the development and progression of different clinical hypertensive phenotypes. This suggests that a common hallmark of the majority of the essential hypertensive states detectable in current clinical practice is represented by the alteration in the sympathetic blood pressure control.

PS-C28-5: ROLE OF SYMPATHETIC NERVOUS SYSTEM IN ATTENDED AND UNATTENDED BP LEVELS IN ESSENTIAL HYPERTENSION

Objective: It has been hypothesized that unattended blood pressure (BP) measurement may provide complementary clinical information to conventionally attended BP measurement. The role of sympathetic nervous system activation during attended and unattended BP measurements is largely undetermined. Design and method: We studied 161 untreated hypertensive patients undergoing attended and unattended office BP measurements. Patients were divided into two groups - group A, unattended systolic BP greater than the attended systolic BP (n = 79), and group B, unattended systolic BP equal or lower than the attended (n = 82). All participants underwent muscle sympathetic nerve activity (MSNA) estimation by microneurography. Unattended and attended BP measurements were performed with the same device in a random order for each patient on the day of MSNA recording. MSNA levels were compared between the two groups. Results: We examined 161 hypertensive patients [54% men, mean age 56 ± 12 years, BMI 29 ± 5 kg/m2, mean attended BP 140 ± 17 / 87 ± 13 mmHg, mean unattended BP 141 ± 20 / 85 ± 12 mmHg]. Group A and group B had statistically significant differences between attended systolic BP (136.7 ± 17.8 vs 143.7 ± 15.7 mmHg respectively, p = 0.009), attended diastolic BP (85.5 ± 14.7 vs 89.7 ± 11.4 mmHg respectively, p = 0.004), unattended systolic BP (145.5 ± 19 vs 135.7 ± 19.9 mmHg respectively, p = 0.002) and unattended diastolic BP (86.9 ± 13 vs 83.2 ± 11.2 mmHg respectively, p = 0.05). However, the two groups did not differ as regards MSNA levels (42.5 ± 10 vs. 41.6 ± 7.8 bursts per minute respectively, p = 0.5). MSNA levels did not correlate to attended and unattended systolic/diastolic BP in both groups. Conclusions: In conclusion, sympathetic nervous system activity may not contribute significantly to the differential BP levels during attended or unattended BP measurements.

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.

Sympathetic nervous system activity and unattended blood pressure measurement

Abstract Background/Introduction Sympathetic nervous system activation plays a crucial role in the pathophysiology and variability of hypertension. It has been hypothesized that measurement of unattended blood pressure (BP) may provide additional information to conventionally attended BP measurement, as it can lead to the limitation of the white coat effect. Purpose The aim of this study was to demonstrate the relationship of sympathetic nervous system activation and BP measurement variations with and without medical supervision. Methods We studied 103 untreated hypertensive patients, who underwent muscle sympathetic nerve activity (MSNA) estimation by microneurography. Both unattended (patient alone in the room, an oscillometric device programmed to perform 3 BP measurements at 1-minute intervals, after 5 minutes of rest) and attended BP measurements were conducted in all participants, with the same device, on the same day of MSNA recording in random order. Patients were divided into two groups based on the difference between attended and unattended BP. In group A, patients had unattended BP greater than attended BP (n=31) and in group B, patients had unattended BP lower than attended BP (n=72). The two groups were compared regarding the median value of MSNA recordings in our population (median MSNA = 63 bursts per 100 heartbeats). Results The two groups did not differ as regards both attended SBP levels (group A: 142.3±15.4 mmHg, group B: 145.6±13.7 mmHg, p=0.29) and attended DBP levels (group A: 89.2±9.8 mmHg, group B: 91.2±11.5 mmHg, p=0.25). A difference was observed concerning unattended SBP levels (group A: 152±16.3 mmHg, group B: 142.5±13.8 mmHg, p=0.03) and unattended DBP levels (group A: 94.4±10.3 mmHg, group B: 85.2±11.8 mmHg, p&amp;lt;0.01). Higher levels of MSNA were recorded in patients in group A when compared to group B, although this difference was not statistically significant (66.8±15.6 vs. 61.6±14.8 bursts per 100 heartbeats, p=0.11). Higher percentage of patients in group A had MSNA levels greater than the median value of MSNA compared to group B (68% vs 46% respectively). Conclusions In the present study, we found that the majority of patients who exhibit higher BP during the unattended measurement also record high MSNA values, suggesting a more stimulated sympathetic nervous system. On the contrary, most of the patients who can calm down during the unattended measurement exhibit lower levels of MSNA. More patients are needed to fully determine the clinical significance of this observation. Funding Acknowledgement Type of funding sources: None.

SYMPATHETIC NERVOUS SYSTEM ACTIVITY IN ATTENDED AND UNATTENDED BP MEASUREMENTS: NAVIGATING THE UNCHARTED

Objective: It has been hypothesized that unattended blood pressure (BP) measurement may provide complementary clinical information to conventionally attended BP measurement. The role of sympathetic nervous system activation during attended and unattended BP measurements is largely undetermined. Design and method: We studied 161 untreated hypertensive patients undergoing attended and unattended office BP measurements. Patients were divided into two groups - group A, unattended systolic BP greater than the attended systolic BP (n = 79), and group B, unattended systolic BP equal or lower than the attended (n = 82). All participants underwent muscle sympathetic nerve activity (MSNA) estimation by microneurography. Unattended and attended BP measurements were performed with the same device in a random order for each patient on the day of MSNA recording. MSNA levels were compared between the two groups Results: We examined 161 hypertensive patients [54% men, mean age 56 ± 12 years, BMI 29 ± 5 kg/m2, mean attended BP 140 ± 17 / 87 ± 13 mmHg, mean unattended BP 141 ± 20 / 85 ± 12 mmHg]. Group A and group B had statistically significant differences between attended systolic BP (136.7 ± 17.8 vs 143.7 ± 15.7 mmHg respectively, p = 0.009), attended diastolic BP (85.5 ± 14.7 vs 89.7 ± 11.4 mmHg respectively, p = 0.04), unattended systolic BP (145.5 ± 19 vs 135.7 ± 19.9 mmHg respectively, p = 0.002) and unattended diastolic BP (86.9 ± 13 vs 83.2 ± 11.2 mmHg respectively, p = 0.05). However, the two groups did not differ as regards MSNA levels (41.6 ± 8.9 vs. 42.1 ± 8.1 bursts per minute respectively, p = 0.7). MSNA levels did not correlate to attended and unattended systolic/diastolic BP in both groups. Conclusions: sympathetic nervous system activity may not contribute significantly to the differential BP levels during attended or unattended BP measurements.

SURGICAL MASKS AND UNATTENDED BLOOD PRESSURE CHANGES IN TREATED HYPERTENSIVE PATIENTS

Objective: Although the effect of face masks on preventing airborne transmission of SARS-CoV-2 is well studied, few data are available on their effects on physiological measures and no study has evaluated their effect 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’s disease, pregnancy, intolerance to the BP measurement method, or unwillingness to participate. Following 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, 69 ± 11 bpm; mask-off, 69 ± 11 bpm, P = 0.7). Conclusions: The results of our study indicate that common surgical masks do not affect systolic/diastolic BP levels during unattended BP measurements.

Sympathetic nervous system and hypertension: New evidences.

Evidences collected in the past few years have strengthened the concept that the sympathetic nervous system plays a primary role in the development and progression of the hypertensive state, starting from the early stage, and in the hypertension-related cardiovascular diseases. Several pathophysiological mechanisms are involved. Among them the genetic background, the immune system in conjunction with sympathetic activation. The present review will briefly discuss the importance of the above mentioned mechanisms in the development of hypertension. The paper will also examine the sympathetic mechanisms underlying attended vs unattended blood pressure measurements as well as their role in resistant vs pseudo-resistant hypertension. Finally evidence from recent meta-analysis on the relevance of sympathetic nerve traffic activation in the pathogenesis of hypertension will be briefly discussed.

Sympathetic Neural Mechanisms Underlying Attended and Unattended Blood Pressure Measurement.

[Figure: see text].

Attended vs unattended systolic blood pressure measurement: A randomized comparison in patients with cardiovascular disease.

Recent clinical guidelines recommend lower blood pressure (BP) goals for most patients, and recent trends have favored use of automated unattended BP measurements in the office setting to minimize observer error and white-coat effects. Patients attending a routinely scheduled CVD clinic visit were prospectively randomized to BP measured using an attended, followed by an unattended method, or vice versa, after a controlled rest period. All study BP measurements were obtained in triplicate using the automated Omron HEM-907XL BP monitor, and averaged. The outcome was difference in SBP. Routinely measured clinic BP from the same visit was extracted from the medical record, and compared with attended and unattended BP. A total of 102 patients were randomized, and mean age was 63years, 52% female and 75% Caucasian. Attended and unattended SBP was 125.4±20.4 and 122.6±21.0mm Hg, mean±SD, respectively. Routine clinic SBP was 130.6±23.6mm Hg. Attended SBP was 2.7mm Hg higher than the unattended measurement (95% CI 1.3-4.1; P=.0002). Routine clinic SBP was 5.2mm Hg higher than attended SBP (95% CI 2.4-8.0; P=.0003) and 8.0mm Hg higher than unattended SBP (95% CI 5.4-10.5; P<.0001). Attended measurement of BP is significantly higher than unattended measurement and the difference is physiologically meaningful, even in a CVD cohort with generally well-controlled hypertension. Furthermore, routine clinic SBP substantially overestimates both attended and unattended automated SBP, with important implications for treatment decisions like dose and/or drug escalation.

Evaluation of Unattended Automated Office, Conventional Office and Ambulatory Blood Pressure Measurements and Their Correlation with Target Organ Damage in an Outpatient Population of Hypertensives: Study Design and Methodological Aspects.

Accurate measurement of blood pressure (BP) has a pivotal role in the management of patients with arterial hypertension. Recently, introduction of unattended office BP measurement has been proposed as a method allowing more accurate management of hypertensive patients and prediction of hypertension-mediated target organ damage (HMOD). This approach to BP measurement has been in particular proposed to avoid the white coat effect (WCE), which can be easily assessed once both attended and unattended BP measurements are obtained. In spite of its interest, the role of WCE in predicting HMOD remains largely unexplored. To fill this gap the Young Investigator Group of the Italian Hypertension Society (SIIA) conceived the study "Evaluation of unattended automated office, conventional office and ambulatory blood pressure measurements and their correlation with target organ damage in an outpatient population of hypertensives". This is a no-profit multicenter observational study aiming to correlate attended and unattended BP measurements for quantification of WCE and to correlate WCE with markers of HMOD, such us left ventricular hypertrophy, left atrial dilatation, and peripheral atherosclerosis. The Ethical committee of the Federico II University hospital has approved the study.

Abstract P2073: Blood Pressure Measurement: Should Technique Define Targets?

Background: Advancements in technology over the last decades have brought a mini-revolution into the centuries old technique of blood pressure (BP) assessment. Automated oscillometric BP devices allow not only to eliminate human error in BP readings, but more importantly they standardize the length of resting period and allow for unattended resting and BP measurement. BP thresholds for definition of hypertension as well as BP treatment targets are however largely derived from studies using mercury sphygmomanometers or non-automated oscillometric BP devices. Comparative studies addressing the effect of standardized length of unattended resting and presence versus absence of medical personnel during BP measurement per se are however lacking. Methods and Population: In this prospective randomized, crossover trial we compared office casual BP readings to BP readings after 5 minutes unattended resting and unattended BP measurement. Additionally, we compared 5 minutes unattended resting and unattended BP measurement with medical personnel presence during BP measurement. BP readings were obtained from the same arm on 2 different visits using an automated oscillometric BP device (Omron HEM 907XL), one pre- and second one post 24-hour ABPM. All patients followed at our regional, tertiary care hospital-based Hypertension Centre were eligible for this trial. Results: 90 adult patients were consented and 79 (men 54% and women 46%) completed all the measurements. Mean casual BP was 137. 1 ± 16.7, mean resting unattended BP was 130.1 ± 13.7, indicating difference of 7.0 + 10.0 mm Hg (p &lt; 0.0001). Mean resting attended BP was 129.3 ± 13.2 (not statistically different from completely unattended resting BP, difference - 2.7 [95% CI 1.4 -6.8] p = 0.18). Summary: Our study conclusively confirms that resting decreases blood pressure as assess from the difference between casual BP and BP obtained after 5 minutes of rest. More importantly, our study indicates that presence of medical personnel during BP measurements after initial 5 minutes unattended rest does not have a significant impact on overall resting BP readings. Conclusion: These data no superiority of fully automated devices versus semi-automated devices for BP measurements

Abstract 026: Attended Versus Unattended Blood Pressure Measurement in Patients With Cardiovascular Disease: Does It Matter?

Introduction: Nearly one half of the subjects in SPRINT had their blood pressure (BP) measured absent an observer (unattended), whereas most prior trials have used attended measurement. This has created controversy in interpreting the relationship between achieved systolic BP (SBP) and outcomes in SPRINT. Accordingly, we prospectively examined the difference between attended and unattended office SBP measured using the same automated device used in SPRINT among patients with documented CV disease. Methods: We randomized patients attending a routinely scheduled cardiology clinic visit to have their BP measured using an attended, followed by an unattended method, or vice versa, after a controlled rest period. All study BP measurements were obtained in triplicate using the automated Omron HEM-907XL BP monitor, and averaged. The outcome of interest was the difference in SBP between the two measurement techniques. At the same visit, we obtained a routinely measured office BP from the medical record, and compared with attended and unattended measurements. Results: A total of 102 patients were enrolled, mean age was 63 years, 48% (49 of 102) men and 75% (76 of 102) were Caucasian. The mean attended and unattended SBP was 125.4 ± 20.4 and 122.6 ± 21.0 mm Hg, respectively. The mean SBP recorded by the clinic nursing staff was 130.6 ± 23.6 mm Hg. On average, the attended SBP was 2.7 mmHg higher than the unattended measurement (P=0.0002, 95% CI 1.3 to 4.1). The clinic staff SBP measurement was 5.2 mmHg higher than the attended SBP (P=0.0003, 95% CI 2.4 to 8.0) and 8.0 mmHg higher than the unattended SBP (P&lt;0.0001, 95% CI 5.4 to 10.5). Conclusion: Among CVD patients being evaluated in a cardiology clinic, there is only a small (~3 mmHg) but statistically significant difference between attended and unattended automated SBP. More importantly, the routine office measured SBP was significantly higher than either the attended or unattended SBP. Our findings suggest that observing the BP measurement in patients with established CVD affects the BP, but much less than previously suggested. Factors such as measurement timing and non-standardized measurement technique are likely to have a larger impact on BP measurement than observer attendance.

COMPARISON OF AUTOMATED OFFICE BLOOD PRESSURE WITH OFFICE AND OUT-OF-OFFICE MEASUREMENT TECHNIQUES

Objective:Automated office blood pressure (AOBP), a fully automated unattended BP measurement technique represents an attractive alternative or integrative option to assess patient's blood pressure (BP) status. However, the lack of strong evidences to establish a threshold value for hypertension dia

The role of clinic blood pressure for the diagnosis of hypertension.

Recent data from randomized clinical trials and updates to hypertension guidelines warrant a review of the literature for the diagnosis and management of hypertension in the clinic setting. Although there have been significant advances in ambulatory blood pressure (BP) monitoring and home BP monitoring, office BP (OBP) measurements remains the primary means of diagnosis and treatment. The current review focuses on updated guidelines, proper technique, device selection, and the recent controversy regarding unattended BP measurements. We review the data on cardiovascular outcomes, the comparison of OBP with ambulatory BP monitoring and home BP monitoring and some of the pitfalls of OBP measurements. The current review highlights the need for constant review of BP goals to minimize cardiovascular risk and some of the ongoing controversies regarding OBP measurements.

Clinical Implications

HomeHypertensionVol. 71, No. 2Clinical Implications Free AccessIn BriefPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessIn BriefPDF/EPUBClinical Implications Originally published1 Feb 2018https://doi.org/10.1161/HYPERTENSIONAHA.117.10771Hypertension. 2018;71:217Metabolic Predictors of Vascular Change (p 237)Download figureDownload PowerPointAortic stiffness increases with age and contributes to the pathogenesis of hypertension and cardiovascular disease. In previous cross-sectional studies, metabolic traits were associated with aortic stiffness and mean arterial pressure. We examined whether metabolic traits at baseline and their changes over time were associated with changes in vascular function longitudinally. Vascular and metabolic traits were examined in 5779 middle-aged participants attending sequential examinations of the Framingham Heart Study cohorts (mean follow-up, 5.9±0.6 years). Multivariable regression was used to relate changes in vascular measures to changes in body mass index, serum lipids, and blood glucose. Aortic stiffness measures and pressure pulsatility increased, whereas mean arterial pressure decreased, suggesting that factors other than distending pressure may have contributed to the increase in aortic stiffness. Interindividual variation in the longitudinal changes of arterial stiffness (carotid-femoral pulse wave velocity) and mean arterial pressure were explained more by changes in metabolic traits than by baseline metabolic trait levels, consistent with the concept that modification of metabolic factors may mitigate arterial stiffness over time.Unattended Blood Pressure Measurement (p 243)Download figureDownload PowerPointDo you remember your reaction when looking at your angry math teacher? Or your reaction meeting the most beautiful girl in class on the schoolyard? In both cases, your blood pressure (BP) probably increased. The person that measures someone’s BP—either frightening or attractive—affects BP as well. The technique of unattended BP measurement is intended to minimize this alert reaction. Although the protocol did not really call for it, several study centers in the SPRINT study (Systolic Blood Pressure Intervention Trial) measured BP in an unattended manner, leading to a controversial discussion on the generalizability of the trial’s findings. The discussion was heated by an article from Filipovský et al reporting a 16 mm Hg difference in measurement techniques in a hypertension center. It is noteworthy that there is convincing evidence from the 80s that BP substantially decreases from the first visit of a new doctor to the following ones. So, what about the disparity of unattended versus attended BP in a familiar medical environment? Our study shows that the difference between measurements is low in a general practitioner setting. These findings make it improbable that the BP values in SPRINT substantially underestimate office BP values in primary care. It is currently being discussed whether unattended BP measurement should serve as the new gold standard for the assessment of office BP. The differences of the present data and those of Filipovský et al suggest that it may indeed be wise to implement this approach in secondary or tertiary care institutions, whereas it is dispensible in a general practitioner setting.sFlt-1/PlGF Ratio in Prediction of Preeclampsia (p 306)Download figureDownload PowerPointA substantial body of evidence suggests that angiogenic factors (sFlt-1 [soluble FMS-like tyrosine kinase-1] and PlGF [placenta growth factor]) could be useful biomarkers for prediction, diagnosis, and prognosis of preeclampsia from 24 to 37 weeks gestation. In this group, the sFlt-1/PlGF ratio has a very high negative predictive value for ruling out preeclampsia and its positive predictive value, whereas lower than the negative predictive value, outperforms current clinical tools. We conducted a meta-analysis of studies using sFlt-1/PlGF ratio to predict development of preeclampsia. The pooled sensitivity was 80% (95% confidence interval [CI], 0.68–0.88); pooled specificity 92% (95% CI, 0.87–0.96); and area under the curve 0.94 (95% CI, 0.91–0.95). With positive and negative likelihood ratios of 10.5 (95% CI, 6.2–18.0) and 0.22 (95% CI, 0.13–0.35), respectively, the probability of developing preeclampsia increased to 78% with a positive test compared with 7% with a negative test. Importantly, all included studies showed a high negative predictive value (10/15 studies reporting negative predictive value >98.5%). These results have important clinical implications. A low sFlt-1/PlGF ratio is a strong negative predictor of disease <37 weeks, allowing safe discharge or decreased surveillance. Concomitantly, a high sFlt-1/PlGF ratio could help prioritize patient care (transfer to tertiary centers or increased surveillance). The use of angiogenic factors for ruling out preeclampsia is used throughout Europe and was recently approved for pregnancies <35 weeks in the United Kingdom. The effective segregation of patients in a disease with an unpredictable course, which has substantial maternal and fetal morbidity and mortality, could have important clinical benefits. Previous Back to top Next FiguresReferencesRelatedDetails February 2018Vol 71, Issue 2 Advertisement Article InformationMetrics © 2017 American Heart Association, Inc.https://doi.org/10.1161/HYPERTENSIONAHA.117.10771 Originally publishedFebruary 1, 2018 PDF download Advertisement

PP.16.03] COMPARISON OF UNATTENDED BLOOD PRESSURE MEASUREMENT (SPRINT METHOD) WITH OFFICE, 24H AMBULATORY AND CENTRAL BLOOD PRESSURE MEASUREMENTS IN HYPERTENSIVE PATIENTS

Objective: It has been discussed how unattended blood pressure (BP) measurement as done in SPRINT study correlates with other forms of BP evaluation which have been shown to be highly predictive of cardiovascular outcome.Design and method: Study was done in a single centre for 3 months in 2016 and involved 118 consecutive hypertensive patients (60 female, ageing 56+17years, BMI 27+4 Kg/m2) who were scheduled to carry out a 24 h ambulatory BP monitoring (ABPM) and who, in the interval of 48 hours that include ABPM, were also submitted to evaluation of casual BP (average 3 measurements), to an unattended 3 BP measurements separated by 2 minutes with a preprogrammed device (OMRON M10-IT), and to measurement of central BP from the aortic wave form (SphygmoCor). Results: As shown in table the difference casual-unattended SBP was remarkable. Also, it persisted (14–16 mmHg) along the tertiles of distribution of unattended SBP, whereas the differences of 24 h SBP, daytime BP and central SBP minus unattended of SBP significantly decreased from the lower to the upper tertiles. Conclusions: Along all the range of values, the unattended BP measurement significantly underestimate by 16/5 mmHg the BP values recorded in office thereby being more close to the 24 h and central (SBP) and to daytime (DBP) values. This must be considered when risk stratification is based on BP targets taken from unattended measurements.

How Low Should We Go With Blood Pressure?

Traditional blood pressure (BP) measurement has made its time. We should familiarize ourselves with automated unattended BP measurements. This method will virtually eliminate the BP rise associated with the presence of doctors or even nurses. Using such a protocol in patients who meet the SPRINT (Systolic Blood Pressure Intervention Trial) inclusion/exclusion criteria, a blood pressure target of ≤120 mm Hg will lead to an important reduction in the risk of stroke and heart attack. The SPRINT (Systolic Blood Pressure Intervention Trial), ClinicalTrials.gov number, NCT01206062, funded by the National Institutes of Health, is a landmark trial that, for the reasons outlined below, is expected to change our clinical approach to the management of hypertensive patient.1 The authors of this article believe that SPRINT significantly contributed to the progress of cardiovascular medicine although some implications of the study need to be assessed judiciously. To substantiate our opinion that BP goals should be reassessed lower after SPRINT, we will try to briefly summarize what SPRINT shows, what it confirms, and what it adds to existing knowledge. The SPRINT trial randomized 9361 treated or untreated hypertensive patients with systolic BP of 130 to 180 mm Hg at entry and high cardiovascular risk to a systolic BP goal of 15%, subclinical cardiovascular disease defined by left ventricular hypertrophy or abnormal ankle brachial index or coronary artery calcium score, glomerular filtration rate 20 to 59 mL/min per 1.73 m2, or age ≥75 years.1 The main exclusion criteria were diabetes mellitus, previous stroke, 1-minute standing systolic BP of <110 mm Hg, heart failure (HF), polycystic kidney disease, …