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Pragmatic method using blood pressure diaries to assess blood pressure control

Citation

Sharman, JE and Blizzard, L and Kosmala, W and Nelson, MR, Pragmatic method using blood pressure diaries to assess blood pressure control, Annals of Family Medicine, 14, (1) pp. 63-69. ISSN 1544-1709 (2016) [Refereed Article]

Copyright Statement

Copyright 2016 by the Annals of Family Medicine, Inc

DOI: doi:10.1370/afm.1883

Abstract

PURPOSE: Twenty-four-hour ambulatory blood pressure (ABP) is the reference standard of blood pressure control. Home blood pressure (HBP) is superior to clinic blood pressure for assessing control, but a barrier to its use is the need for physicians to calculate average blood pressure from patient diaries. We sought to develop a quick and pragmatic method to assess blood pressure control from patients' HBP diaries.

METHODS: Seven-day HBP and 24-hour ABP were measured in 286 patients with uncomplicated treated hypertension (aged 64 8 years; 53% female). We determined the optimal ratio of home systolic blood pressure readings above threshold (≥135 mm Hg) for the last 10 recorded that would best predict elevated 24-hour ABP. Uncontrolled blood pressure was defined as 24-hour ABP systolic blood pressure ≥130 mm Hg or 24-hour ABP daytime systolic blood pressure ≥135 mm Hg. Validation by corroborative evidence was tested by association with markers of end-organ disease.

RESULTS: The best predictor of 24-hour ABP systolic blood pressure above treatment/target threshold was having 3 or more (≥30%) of the last 10 home systolic blood pressure readings ≥135 mm Hg (area under the receiver operating characteristic curve = 0.71). Importantly, patients meeting this criterion had evidence of target organ disease, with significantly higher aortic stiffness, left ventricular relative wall thickness, and left atrial area, and lower left ventricular ejection fraction, compared with those who did not meet this criterion.

CONCLUSIONS: To facilitate uptake of HBP monitoring, we propose that physicians can determine the percentage of the last 10 home systolic blood pressure values ≥135 mm Hg for a patient and tailor management accordingly.

Item Details

Item Type:Refereed Article
Keywords:blood pressure determinations, blood pressure monitoring, ambulatory, classification, diagnosis, epidemiology, hypertension, methods, practice-based research, primary care
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Sharman, JE (Professor James Sharman)
Author:Blizzard, L (Associate Professor Leigh Blizzard)
Author:Kosmala, W (Professor Wojciech Kosmala)
Author:Nelson, MR (Professor Mark Nelson)
ID Code:107460
Year Published:2016
Web of Science® Times Cited:4
Deposited By:Menzies Institute for Medical Research
Deposited On:2016-03-16
Last Modified:2017-11-02
Downloads:0

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