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ABSTRACT: Atrial fibrillation (AF) is a significant risk factor for stroke and early detection of AF may help to identify patients in need of treatment. Automated blood pressure (BP) monitors with implemented AF or arrhythmia detection systems may be a useful tool for early diagnosis of AF. A systematic review (Medline/PubMed, Embase, Cochrane) of studies was performed to assess the accuracy of modified BP monitors (for diagnosing AF). A total of five studies (four tests in the physician's office and one at home) were selected. For the most accurate AF detection, three sequential BP measurements should be performed. Direct comparison against a 12-lead ECG showed that the highest sensitivity, 97% (95% CI: 94-100%), for detecting AF was obtained when three readings were assessed with two or three AF-positive readings. The highest specificity (97%) was obtained when performing three measurements, of which all three must be AF positive. The modified BP monitor (Microlife Corporation, Taipei, Taiwan) has high potential in improving AF screening.
Expert Review of Medical Devices 11/2012; 9(6):635-40. · 2.63 Impact Factor
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ABSTRACT: Although it is generally acknowledged that electronic monitoring of adherence to treatment improves blood pressure (BP) control by increasing patients' awareness to their treatment, little information is available on the long-term effect of this intervention.
In this observational study among a total of 470 patients with mild-to-moderate hypertension, adherence was measured in 228 patients by means of both the Medication Event Monitoring System (MEMS) and pill count (intervention group), and in 242 patients by means of pill count alone (control group). During a follow-up period of 1 year consisting of seven visits to the physician's office, BP measurements were performed and medication adjusted based on the achieved BP. In addition, at each visit adherence to treatment was assessed.
On the basis of pill counts, median adherence to treatment did not differ between the intervention group and the control group (96.1% vs. 94.2%; P = 0.97). In both groups, systolic and diastolic BP decreased similarly: 23/13 vs. 22/12 mm Hg in the intervention and control group respectively. Drug changes and the number of drugs used were associated with BP at the start of study, but not with electronic monitoring.
In this study, electronic monitoring of adherence to treatment by means of MEMS did not lead to better long-term BP control nor did it result in less drug changes and drug use.
American Journal of Hypertension 01/2012; 25(1):54-9. · 3.18 Impact Factor
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ABSTRACT: Poor adherence to treatment is one of the major determinants of an uncontrolled blood pressure. Participation in a clinical trial may increase patient's adherence to treatment. This prompted us to investigate adherence and persistence profiles in patients with hypertension who had participated in a clinical trial, by collecting pharmacy refill data before, during, and after participation in the trial. Pharmacy refill data of 182 patients with hypertension who participated in the Home Versus Office Blood Pressure Measurements: Reduction of Unnecessary Treatment Study between 2001 and 2005 were obtained from 1999 until 2010. Refill adherence to treatment was compared for the periods before, during, and after this trial. Persistence to medication was investigated for the period after termination of the trial. Refill data were available for 22 600 prescriptions. Participation into the trial significantly increased refill adherence, from 90.6% to 95.6% (P<0.001). After the trial period, refill adherence decreased again to 91.8% (P<0.001), which did not differ from the adherence before the start of the trial (P=0.45). Except for adherence to trial medication, adherence to nontrial-related drugs also increased as a consequence of trial participation, from 77.6% to 89.6% (P<0.001). After termination of the trial, median persistence was 1424 days. Participants classified as adherent (adherence: >90%) were less likely to discontinue treatment compared with nonadherent participants (odds ratio: 0.66 [95% CI: 0.45 to 0.98]). Participation in a clinical trial significantly increases adherence to both trial-related and nontrial-related treatment, suggesting that participants in a trial are more involved with their conditions and treatments.
Hypertension 08/2011; 58(4):573-8. · 6.21 Impact Factor
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ABSTRACT: Screening for inter-arm difference (IAD) of blood pressure (BP) at each first visit is recommended by numerous guidelines whereas it is unclear whether the method by which IAD is measured has significant influence on the IAD value.
A systematic review is made of the studies reporting on double-arm measurements and the association of IAD with procedure characteristics (Medline/PubMed, Embase, and Cochrane Library).
The mean absolute IAD was 5.4 ± 1.7 and 3.6 ± 1.2 mm Hg for systolic and diastolic BP, respectively. Of all subjects 14% had a systolic IAD ≥10 mm Hg, 4% a systolic IAD ≥20 mm Hg, and 7% a diastolic IAD ≥10 mm Hg. The relative risk (RR) of obtaining a systolic IAD ≥10 and 20 mm Hg and a diastolic IAD ≥10 mm Hg is higher when measuring sequentially instead of simultaneously (2.2 (95% CI: 1.4-3.6), P < 0.01; 4.8 (95% CI: 1.1-21.9), P < 0.05 and 2.5 (95% CI: 1.0-6.3) P < 0.05, respectively), when using a manual instead of an automated device (2.1 (95% CI: 1.1-3.9), P < 0.05; 4.4 (95% CI: 1.8-10.8), P < 0.01 and 3.7 (95% CI: 1.6-8.6), P < 0.01, respectively) and when performing only one BP measurement instead of multiple (2.0 (95% CI: 1.1-3.8), P < 0.05; 4.3 (95% CI: 1.6-11.4), P < 0.01 and 4.4 (95% CI: 1.7-11.4), P < 0.01, respectively).
Screening for IAD of BP is important but the measurement methodology has a major influence on IAD results. To prevent overestimation and observer bias IAD should be assessed simultaneously at both arms, with one or two automatic devices and multiple readings should be taken.
American Journal of Hypertension 07/2011; 24(11):1201-8. · 3.18 Impact Factor
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ABSTRACT: There is an increasing interest for using telecare(TC) in the management of hypertension. A systematic review to the use of blood pressure (BP) measurement in TC has been performed (Medline/PubMed, Embase, and Cochrane Library), selecting randomized clinical trials that compared TC with usual care (UC) for hypertension management (treatment and/or coaching). Nine randomized clinical trials were selected (n=2501, 61.4±0.6 years, 42±2.7% males). Overall there was a significant larger decrease in the TC group than in the UC group for systolic (5.2±1.5 mmHg; P<0.001) and diastolic BP (2.1±0.8 mmHg; P<0.01). When studies were separated for antihypertensive treatment modification during the study (yes or no), systolic BP decrease difference between the TC and UC groups (ΔTC-ΔUC) tended to be significantly lower (5.1±2.9 mmHg lower) with treatment modification compared with nontreatment modification in which the ΔTC-ΔUC was 8.6±2.4 mmHg, P=0.07. TC led to a greater decrease in systolic and diastolic BP than UC. The differences between TC and UC for systolic BP tend to become larger when no treatment modification is applied. TC seems a valuable tool for hypertension management.
Blood pressure monitoring 06/2011; 16(3):149-55. · 1.62 Impact Factor
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ABSTRACT: Background Poor adherence to antihypertensive medication is one of the major problems in the treatment of hypertension. Electronic monitoring is currently considered to be the gold standard for assessing adherence, but it may trigger patients to open the pill bottle without taking medication or to take out more than prescribed. In adjunct to electronic monitoring, pill count could be a valuable tool for exploring adherence patterns, and their effects on blood pressure reduction.
American Journal of Hypertension 11/2009; 23(2):149-154. · 3.18 Impact Factor
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ABSTRACT: Poor adherence to antihypertensive medication is one of the major problems in the treatment of hypertension. Electronic monitoring is currently considered to be the gold standard for assessing adherence, but it may trigger patients to open the pill bottle without taking medication or to take out more than prescribed. In adjunct to electronic monitoring, pill count could be a valuable tool for exploring adherence patterns, and their effects on blood pressure reduction.
Among a total of 228 patients with mild-to-moderate hypertension, adherence to treatment was measured by means of both the Medication Event Monitoring System (MEMS) and pill count. Patients were followed-up for seven visits over a period of 1 year. At each visit to the physician's office, patient's adherence was assessed by both methods.
Adherence is defined as the percentage of days with correct dosing; median adherence according to MEMS was lower than median adherence according to pill count (91.6 vs. 96.1; P < 0.001). Both methods agreed in defining patients as adherent in 107 (47%) and nonadherent in 33 (14%) patients. Thirty-one (14%) patients were adherent only by MEMS and 59 (25%) patients only by pill count. At the end of the study, patients in the four categories reached comparable blood pressure values and reductions.
Pill count could be a useful adjunct to electronic monitoring in assessing adherence patterns. Although deviant intake behavior occurred frequently, the effect on achieved blood pressure and blood pressure reduction was not remarkable.
American Journal of Hypertension 11/2009; 23(2):149-54. · 3.18 Impact Factor
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ABSTRACT: Masked hypertension (MH) is a relatively newly detected condition of which little is known. More information about MH may help to improve overall antihypertensive health care. We aimed to investigate the prevalence, potential causes, and associated consequences of MH.
We searched published literature using MEDLINE, EMBASE, and the Cochrane database completed with references cited in reviews and original study articles. We restricted our research to articles written in the English, German, French, and Spanish language. Studies were included only when the prevalence of MH was reported, office blood pressure (BP) values were given, and methods of BP measurements were described in detail. All data were extracted independently by two readers with a standardized protocol and data-collection form.
The prevalence of MH averaged 16.8% (95% confidence interval 13.0-20.5%). The MH prevalence was 7% for children and 19% for adults. MH prevalences did not differ significantly when determined with self or ambulatory BP measurement (21.1% vs. 16.8%; P = 0.42). Subjects with MH had significantly higher left ventricular mass index (LVMI) values than normotensives (110 vs. 98 g/m2; P < 0.01) but similar values as sustained hypertensives (109 g/m2). In addition, patients with MH were more often smokers than normotensives (mean difference 18%; P < 0.03).
MH strikes about a quarter of the patients who were initially classified as normotensives (based on office BP measurements) and of treated hypertensives. Patients with MH seem to have a similar cardiovascular risk as sustained hypertensives but they may remain undetected. The presence of MH seems to be a matter of a coincidently low office BP value not related to certain subject characteristics although the chance of its presence may be increased by smoking and antihypertensive treatment.
American Journal of Hypertension 06/2008; 21(9):969-75. · 3.18 Impact Factor
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ABSTRACT: Masked hypertension (MH) is defined as a normal blood pressure in the physician's office and an elevated blood pressure when measured out-of-office. The cause of MH may be termed the masked hypertension effect (MHE), and is not restricted to blood-pressure (BP) values around the thresholds for normal BP. We investigated the prevalence and persistence of MH and MHE in patients who were being treated for high BP and who had been followed for a period of 1 year.
One hundred and sixty-one treated hypertensive patients underwent office blood-pressure measurements (OBPMs) at seven visits and self-performed blood-pressure measurements (SBPMs) for 1 week before each visit over a period of 1 year. All measurements were performed with the same type of automatic device. At each visit, MH was determined according to the European Society of Hypertension definition (OBPM, <140/90 mm Hg; SBPM, >/=135 mm Hg or 85 mm Hg). In addition, we determined prevalences of MHE at 5/3 mm Hg (SBPM exceeds OBPM by 5 mm Hg systolic and 3 mm Hg diastolic), and MHE at 10/6 mm Hg (SBPM exceeds OBPM by 10 mm Hg systolic and 6 mm Hg diastolic), respectively.
During the entire study, 50% of the patients had MH, and 40% had MHE at 5/3 mm Hg at least once. At four sequential OBPM visits, 2% consistently had MH, and 3% had MHE at 5/3 mm Hg or MHE at 10/6 mm Hg. The prevalence of MH increased with lower OBPM levels but remained rather constant for MHE at 5/3 mm Hg and MHE at 10/6 mm Hg. The persistence of MH and the MHE over time in individual patients was low.
We conclude that MH and MHE at 5/3 mm Hg and MHE at 10/6 mm Hg commonly occur in treated patients, but are not persistent phenomena and probably result from an accidentally low OBPM value on one particular occasion.
American Journal of Hypertension 01/2008; 20(12):1258-65. · 3.18 Impact Factor
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Willem J Verberk,
Abraham A Kroon,
Jacques W M Lenders,
Alfons G H Kessels,
Gert A van Montfrans,
Andries J Smit,
Paul-Hugo M van der Kuy,
Patricia J Nelemans,
Roger J M W Rennenberg,
Diederick E Grobbee,
Frank W Beltman,
Manuela A Joore,
Daniëlle E M Brunenberg,
Carmen Dirksen,
Theo Thien,
Peter W de Leeuw
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ABSTRACT: It is still uncertain whether one can safely base treatment decisions on self-measurement of blood pressure. In the present study, we investigated whether antihypertensive treatment based on self-measurement of blood pressure leads to the use of less medication without the loss of blood pressure control. We randomly assigned 430 hypertensive patients to receive treatment either on the basis of self-measured pressures (n=216) or office pressures (OPs; n=214). During 1-year follow-up, blood pressure was measured by office measurement (10 visits), ambulatory monitoring (start and end), and self-measurement (8 times, self-pressure group only). In addition, drug use, associated costs, and degree of target organ damage (echocardiography and microalbuminuria) were assessed. The self-pressure group used less medication than the OP group (1.47 versus 2.48 drug steps; P<0.001) with lower costs ($3222 versus $4420 per 100 patients per month; P<0.001) but without significant differences in systolic and diastolic OP values (1.6/1.0 mm Hg; P=0.25/0.20), in changes in left ventricular mass index (-6.5 g/m(2) versus -5.6 g/m(2); P=0.72), or in median urinary microalbumin concentration (-1.7 versus -1.5 mg per 24 hours; P=0.87). Nevertheless, 24-hour ambulatory blood pressure values at the end of the trial were higher in the self-pressure than in the OP group: 125.9 versus 123.8 mm Hg (P<0.05) for systolic and 77.2 versus 76.1 mm Hg (P<0.05) for diastolic blood pressure. These data show that self-measurement leads to less medication use than office blood pressure measurement without leading to significant differences in OP values or target organ damage. Ambulatory values, however, remain slightly elevated for the self-pressure group.
Hypertension 12/2007; 50(6):1019-25. · 6.21 Impact Factor
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ABSTRACT: Masked hypertension (blood pressure that is normal in the physicians' office but elevated elsewhere) is a common phenomenon as prevalence among studies varies from 8 to 45% and is seen at all ages. large discrepancies, however, exist between studies that have dealt with masked hypertension. It is of high clinical importance as it is associated with higher target organ damage as compared with sustained normotension. Therefore more research should be determined. This paper provides an overview of current literature to improve knowledge about masked hypertension and about the cause of this phenomenon. In addition it provides some questions, which need to be answered for performing appropriate research into this subject in future.
Blood Pressure Monitoring 09/2007; 12(4):267-73. · 1.52 Impact Factor
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Blood Pressure Monitoring 03/2007; 12(1):57; author reply 57-9. · 1.52 Impact Factor
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ABSTRACT: To review the literature on home blood pressure measurement (HBPM), to examine its validity and applicability for clinical practice and to provide recommendations regarding HBPM assessment.
HBPM can eliminate the white coat effect and offers the possibility to obtain multiple measurements under standardized conditions, which increases knowledge of overall blood pressure value. Although it is not entirely capable of replacing ambulatory blood pressure measurement (ABPM), HBPM correlates better with target organ damage and cardiovascular mortality than office blood pressure measurement (OBPM), it enables prediction of sustained hypertension in patients with borderline hypertension, and proves to be an appropriate tool for assessing drug efficacy. Additional advantages of HBPM are that it may increase drug compliance and patient's awareness of hypertension. Overall, OBPM yield higher blood pressure values than HBPM. Differences between OBPM and HBPM tend to increase with age and are generally higher in patients without antihypertensive treatment than in patients with antihypertensive treatment.
Measurements should be performed according to accepted guidelines and recordings should be performed with a memory equipped automatic validated device. From the data reviewed here, we recommend that HBPM be assessed monthly by taking two measurements in the morning within 1 hour after awakening and two in the evening for three consecutive days, the data from the first day should be dismissed. A subject should be labeled hypertensive if his/her HBPM value is equal to or greater than 137 mmHg systolic and/or 84 mmHg diastolic.
Vascular Health and Risk Management 02/2007; 3(6):959-66.
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ABSTRACT: To investigate the prevalence and persistence of the white-coat effect (WCE) and white-coat hypertension (WCH) on multiple blood pressure measurement occasions in hypertensive patients with and without treatment.
Essential hypertensive patients in whom we took office blood pressure measurements (OBPM) at eight visits (three readings per visit) performed self blood pressure measurements (SBPM) for 1 week prior to each visit (42 readings per week) over a period of 1 year. All measurements were performed with the same automatic device (Omron 705CP). In addition, 24-h ambulatory blood pressure monitoring (ABPM) was performed at the start and at the end of the study. At the start, patients did not use any medication but on subsequent visits they were treated on the basis of their SBPM values. WCH was defined as an OBPM-value > or = 140 and/or 90 mmHg and a SBPM or daytime ABPM value < 135/85 mmHg. This definition was used irrespective of treatment. We also determined the prevalence of a substantial WCE (OBPM 20 mmHg systolic or 10 mmHg diastolic higher than SBPM or daytime ABPM).
Patients were recruited at hospital or general practice.
A total of 163 mild-to-moderate essential hypertensive patients with a mean age of 56 years (56% males).
At eight blood pressure (BP) measurement occasions, 75% of all patients had a substantial WCE at least once, while 57% had WCH at least once. One-third of the patients consistently had a substantial WCE and 14% consistently had WCH on three or more occasions The magnitude of the WCE was significantly related to the height of blood pressure in treated but not in untreated patients.
In some patients, WCH or a substantial WCE occurs consistently on multiple OBPM visits. Especially in untreated patients, the magnitude of the WCE varies widely among individuals. These results support the incorporation of SBPM and/or ABPM into optimal management of hypertension, not only to prevent misdiagnosis in untreated patients but also to determine the need for adjusting antihypertensive therapy in treated subjects.
Journal of Hypertension 12/2006; 24(12):2357-63. · 4.02 Impact Factor
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ABSTRACT: To determine how many self-measurements of blood pressure (BP) should be taken at home in order to obtain a reliable estimate of a patient's BP.
Participants performed self blood pressure measurement (SBPM) for 7 days (triplicate morning and evening readings). In all of them, office blood pressure (three consecutive readings) and 24-h ambulatory blood pressure were obtained as well. Average SBPM values, obtained from several combinations of readings, were correlated with the results of ambulatory blood pressure measurement (ABPM). In addition, we assessed whether certain patient characteristics would influence such correlations.
Patients were recruited at hospital or general practice.
A total of 216 untreated hypertensive patients.
The average SBPM value calculated from day 3 to day 7, omitting the first measurement of each morning and evening session, gave the best correlation with 24-h ABPM (r = 0.70). However, similar results were obtained from a SBPM value averaged from day 3 until 5 without the first measurement of each triplicate session. Overall, younger patients had significantly better correlations than older ones. Women had significantly better correlations with ABPM than men for systolic morning and daytime SBPM, whereas men had significantly better correlations for daytime and evening diastolic SBPM (P < 0.001). In addition, all correlations increased with lower systolic office blood pressure measurement (OBPM) values.
A minimum number of 5 days of measurement is recommended to obtain a reliable estimate of a patient's usual BP. On each day, three consecutive morning and evening measurements should be performed. For calculating the average SBPM, the first 2 days and the first measurement of each triplicate measurements should be discarded. Moreover, patient characteristics may have an impact on the number of necessary self-measurements. However, because adhering to these recommendations will make SBPM a time-consuming procedure, this type of measurement should be performed only when a decision about starting or changing antihypertensive therapy is needed or in the case of special patient groups.
Journal of Hypertension 08/2006; 24(8):1541-8. · 4.02 Impact Factor
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ABSTRACT: The purpose of this research was to review the literature on home blood pressure measurement (HBPM) and to provide recommendations regarding HBPM assessment. Observational studies on HBPM, published after 1992, as identified by PubMed, EMBASE, and Cochrane literature searches were reviewed. Studies were selected if they met the following criteria: 1) self-measurements had been performed with validated devices; 2) measurement procedures were described in sufficient detail; and 3) papers clearly explained how final HBPM results were calculated upon which conclusions and/or treatment decisions were based. Office blood pressure measurement (OBPM) yields higher blood pressure values than HBPM. For systolic blood pressure, differences between OBPM and HBPM increase with age and the height of office pressure. Differences also tend to be greater in men than in women and greater in patients without than in those with antihypertensive treatment. Furthermore, HBPM can diagnose normotension with almost absolute certainty; it correlates better with target organ damage and cardiovascular mortality than OBPM, it enables prediction of sustained hypertension in patients with borderline hypertension, and it proves to be an appropriate tool for assessing drug efficacy. Despite some limitations and although more data are needed, HBPM is suitable for routine clinical practice.
Journal of the American College of Cardiology 10/2005; 46(5):743-51. · 14.16 Impact Factor
