Unattended Office Blood Pressure Research Articles

DIAGNOSTIC PERFORMANCE OF COMMUNITY HEALTH WORKER-LED ATTENDED AND UNATTENDED OFFICE BLOOD PRESSURE MEASUREMENTS IN RURAL SUB-SAHARAN AFRICA

Objective: The burden of hypertension in rural sub-Saharan Africa (SSA) has been on the rise. In rural SSA, screening, diagnosis and treatment monitoring for hypertension is typically through attended office blood pressure (OBP) conducted by a trained health worker. A community-centered approach where community health workers (CHWs) conduct out-of-office blood pressure (BP) measurements at the homes of community members may increase the proportion of patients diagnosed early and improve monitoring during treatment. However, the diagnostic performance of these BP measurements when conducted by CHWs remains unclear. Design and method: We are conducting a cross-sectional study to determine the diagnostic performance of OBP performed by CHWs in identifying individuals with hypertension in rural Kenya and The Gambia. A random age-stratified random sample of 1250 participants aged 30 years and above from the Kilifi Health and Demographic Surveillance System and the Kiang West Demographic Surveillance System are being enrolled into the study. Participants undergo randomly assigned attended and unattended OBP measurement and 24-hour ambulatory BP monitoring (reference standard) conducted by trained CHWs at their homes. Results: Recruitment is ongoing. We have enrolled and completed BP measurements for 166 participants, all from the Kenya study site (13% of the total sample). Of these, 114 (69%) are female with an average age of 57 years (standard deviation 15 years). Based on ambulatory BP, 71 (43%) of included participants are hypertensive. The preliminary sensitivity of attended and unattended OBP is 0.50 (0.38, 0.62) and 0.47 (0.35, 0.59) respectively with both measurement methods having a high specificity of 0.93 (0.85, 0.97). The diagnostic odds ratio (DOR) for attended OBP (DOR 13.6; likelihood ratio (LR) positive 7.33 (3.26, 16.47)) is higher than that of unattended OBP (DOR 12.1; LR positive 6.89 (3.05, 15.54)). Diagnostic performance does not appear to differ by age or sex. Further analyses will be conducted when recruitment is complete. Conclusions: Attended OBP appears to have better diagnostic performance than unattended OBP when conducted at participants’ homes by CHWs, but the sensitivity of both methods for detecting hypertension is low.

A NOVEL ELECTRO-HYDRAULIC ACOUSTIC THERAPY REDUCES BLOOD PRESSURE IN HYPERTENSIVE PATIENTS WITH CHRONIC KIDNEY DISEASE: 12-MONTH FOLLOW-UP

Objective: Arterial hypertension (HTN) coexisting with chronic kidney disease (CKD) presents a significant global healthcare challenge, with limited effective clinical interventions. Electro-Hydraulic Acoustic Therapy (eHAT), a lower-energy modality vs. lithotripsy, emerges as a promising technique for relieving ischemia and promoting tissue regeneration. We hypothesized that eHAT would reduce blood pressure (BP) and preserve renal function in patients with hypertension and CKD. Design and method: Twenty medically treated patients with HTN and Stage IIIa/b CKD enrolled in this prospective, single-arm study were treated over 3-weeks with six eHAT sessions (2400 shockwaves/kidney; 0.09 mJ/mm2 at 2.66Hz; NephrospecTM, Curespec, Yehud, Israel). Follow-up (FU) visits at 1, 3, 6, and 12 months involved measurements of attended and unattended office BP, ambulatory BP and estimated glomerular filtration rate (eGFR). Results: The treatment was well tolerated. All BP measurements strongly tended to decline over 12 months and showed a similar pattern.(Table 1, Figs. 1-3), whereas eGFR was well preserved (Table 1, Fig. 4). Conclusions: Conclusion. eHAT is a tolerable and safe procedure and, moreover, a 3-week regimen tends to reduce BP and preserve eGFR in patients with HTN and CKD. Therefore, eHAT may constitute a novel, safe, and non-invasive alternative therapeutic approach in the management of HTN in the context of CKD.

UNATTENDED VERSUS ATTENDED AUTOMATED OFFICE BLOOD PRESSURE USING THE SAME DEVICE AND PROTOCOL

Objective: There is increasing interest in unattended automated office blood pressure (OBP) measurement, which gives lower blood pressure values than the conventional auscultatory OBP. Whether unattended automated OBP differs from standardized attended automated OBP performed using the same device and measurement protocol remains uncertain. Design and method: A systematic PubMed and EMBASE search and meta-analysis of studies (aggregate data) comparing unattended vs. attended automated OBP using the same device and measurement protocol (conditions, number of measurements, visits) were performed. Results: Ten eligible studies (n = 1,004, weighted age 60.8 ± 4.2 [SD] years, 55% males) were analyzed. Unattended OBP (pooled systolic/diastolic 133.9 [95% CI: 129.7, 138]/80.6 [95% CI: 77, 84.2] mmHg) did not differ from attended OBP (135.3 [95% CI: 130.9, 139.6]/81 [95% CI: 77.6, 84.3] mmHg); pooled systolic OBP difference −1.3, 95% CI: −4.3, 1.7 mm Hg and diastolic −0.4, 95% CI: −1.2, 0.3 mm Hg. Nine of ten studies achieved high quality score and no publication bias was identified. Meta-regression analysis did not reveal any effect of age, gender, or attended systolic OBP on the unattended-attended systolic OBP difference (P = NS for all), although there was a trend towards higher attended than unattended OBP at higher OBP levels. Conclusions: These data suggest that when the same device and measurement protocol is used, attended automated OBP provides similar blood pressure values as unattended automated OBP. Although unattended automated OBP is theoretically advantageous as it ensures that standardized conditions and measurement protocol are used, carefully standardized attended automated OBP appears to be a reasonable and practical alternative for wide use in clinical practice.

Abstract P488: Antihypertensive Effects of Lactotripeptides on Unattended Office and Abulatory Blood Pressure. A Randomized, Double-blind, Placebo-controlled Study

Milk fermentation by Lactobacillus helveticus produces some tripeptides (VPP and IVP) with sustained ACE-inhibitor activity that have shown to lower blood pressure (BP) in experimental animals and in humans. Grana Padano DOP, an Italian cheese, has shown a potent in vitro ACE-inhibitory effect due to its high concentration of such tripeptides. Present data refer to a randomized, double-blind, placebo controlled, study in which 30 mild-moderate hypertensive patients received a dietary integration with Grana Padano DOP. At base-line all patients had BP not on target (>140 and/or 90 mmHg) after their usual treatment and received a dietary integration with Grana Padano (1 ounce per day) and placebo, in cross over fashion.BP was evaluated at baseline and at the end of the active and placebo treatment (2 months each) by Office and unattended Office BP (using the BpTRU, average of 5 consecutive BP readings) and by ambulatory BP monitoring (ABPM). Results: dietary integration with Grana Padano resulted in a significant decreased in systolic and diastolic office and unattended office BP (-6 mmHg for systolic and - 5 mmHg for diastolic BP). ABPM confirmed a sustained antihypertensive effect of such integration (see table). In conclusion, the diaily integration with 1 ounce of Grana Padano DOP cheese caused a significant decrease in systolic and diastolic BP pressure in hypertensive patients. No changes in BMI, total and HDL cholesterol, triglycerides, glucose, serum sodium and potassium levels were observed. The statistically significant drop in BP may be considered also clinically significant since the majority (67%) of the patients reached normal BP levels at the end of active treatment.