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Randomized Trial of Guiding Hypertension Management Using Central Aortic Blood Pressure Compared With Best-Practice Care: Principal Findings of the BP GUIDE Study

Citation

Sharman, JE and Marwick, TH and Gilroy, D and Otahal, P and Abhayaratna, WP and Stowasser, M, on behalf of the BP GUIDE (value of central Blood Pressure for GUIDing managEment of hypertension) study investigators, Randomized Trial of Guiding Hypertension Management Using Central Aortic Blood Pressure Compared With Best-Practice Care: Principal Findings of the BP GUIDE Study, Hypertension, 62, (6) pp. 1138-1145. ISSN 0194-911X (2013) [Refereed Article]

Copyright Statement

Copyright 2013 American Heart Association

DOI: doi:10.1161/HYPERTENSIONAHA.113.02001

Abstract

Arm cuff blood pressure (BP) may overestimate cardiovascular risk. Central aortic BP predicts mortality and could be a better method for patient management. We sought to determine the usefulness of central BP to guide hypertension management. This was a prospective, open-label, blinded-end point study in 286 patients with hypertension randomized to treatment decisions guided by best-practice usual care (n=142; using office, home, and 24-hour ambulatory BP) or, in addition, by central BP intervention (n=144; using SphygmoCor). Therapy was reviewed every 3 months for 12 months, and recommendations were provided to each patient and his/her doctor on antihypertensive medication titration. Outcome measures were as follows: medication quantity (daily defined dose), quality of life, and left ventricular mass (3-dimensional echocardiography). There was 92% compliance with recommendations on medication titration, and quality of life improved in both groups (post hoc P<0.05). For usual care, there was no change in daily defined dose (all P>0.10), but with intervention there was a significant stepwise decrease in daily defined dose from baseline to 3 months (P=0.008) and each subsequent visit (all P<0.001). Intervention was associated with cessation of medication in 23 (16%) patients versus 3 (2%) in usual care (P<0.001). Despite this, there were no differences between groups in left ventricular mass index, 24-hour ambulatory BP, home systolic BP, or aortic stiffness (all P>0.05). We conclude that guidance of hypertension management with central BP results in a significantly different therapeutic pathway than conventional cuff BP, with less use of medication to achieve BP control and no adverse effects on left ventricular mass, aortic stiffness, or quality of life.

Item Details

Item Type:Refereed Article
Keywords:aorta, clinical trial, heart ventricles, hemodynamics
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:Marwick, TH (Professor Tom Marwick)
Author:Otahal, P (Mr Petr Otahal)
ID Code:87343
Year Published:2013
Web of Science® Times Cited:61
Deposited By:Menzies Institute for Medical Research
Deposited On:2013-11-13
Last Modified:2014-06-05
Downloads:1 View Download Statistics

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