Why it is Important to Measure Blood Pressure at Home Rather than Just at the Clinic?

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Abstract

Hypertension is a major cause of mortality worldwide. out-of-office/clinic blood pressure (BP) measurements (ambulatory BP monitoring [ABPM] and home BP monitoring [HBPM]) are superior to office/clinic measurements for the accurate diagnosis and risk-stratification of hypertensive patients. ABPM is able to provide additional information regarding prognostically important circadian rhythm abnormalities. HBPM is the preferred choice of patients. When used in conjunction with telemonitoring, it has the potential to improve treatment compliance and overcome treatment inertia resulting in better BP control. Challenges remain in implementation of universal HBPM monitoring.

Support: The publication of this article was funded by Omron Healthcare Singapore Pte Ltd.

Disclosure
The author has no conflicts of interest to declare.
Correspondence
Azani Mohamed Daud, Gleneagles Hospital, 282-286 Jalan Ampang, Kuala Lumpur 50450, Malaysia. E: docazani@yahoo.com
Received date
16 December 2010
Accepted date
18 January 2011
Citation
Asia-Pacific Cardiology - Volume 3 Issue 1;2011:3(1):41-44
Correspondence
Azani Mohamed Daud, Gleneagles Hospital, 282-286 Jalan Ampang, Kuala Lumpur 50450, Malaysia. E: docazani@yahoo.com

Pages

Hypertension has been shown to be a major cause of death worldwide.1 A clear relationship exists between hypertension (HTN) and cardiovascular (CV) events, with an increase in risk of total mortality, mortality due to heart disease, stroke, chronic kidney disease (CKD) and heart failure (HF) as well as morbidity associated with non-fatal CV disease.2 Despite there being clear demonstrable CV benefits from blood pressure (BP) reduction in large clinical trials,3-5 BP control remains poor worldwide6 and mortality due to hypertension rates are high.

BP exhibits a circadian pattern.7 BP tends to be lowest between 2 and 4am, with systolic and diastolic readings approximately 13 and 17% lower than daytime values. After 4am there is an 'early morning surgeÔÇÖ in BP readings, reaching a peak at about 6am. There is then a gradual decline towards the evening, followed by lower readings at night. The 'early morning surgeÔÇÖ is associated with an increase in CV events8,9 including acute myocardial infarction, ischaemic and haemorrhagic stroke and sudden cardiovascular death.10,11 An office/clinic BP reading only offers an instantaneous reading or snapshot of a patients BP in a day and cannot give a true reflection of BP readings throughout the day or abnormalities in the circadian rhythms.

However, in the past most clinical studies have used conventional cuff BP measurements at clinic/office visits to measure BP and still demonstrated CV outcome benefits. With better understanding of circadian BP changes, should we be looking at BP measurement away from the clinic/office in order to improve patient outcomes?

This article aims to outline the options available for clinicians in daily practice and the potential benefits of adopting out-of-office/clinic BP measurements in clinical practice with regards to accurate diagnosis of hypertension, risk stratification and how these techniques may be utilised to improve BP control and CV outcomes.

Pages

References
  1. Ezzati M, Lopez AD, Rodgers A, et al., Comparative Risk Assessment Collaborating Group. Selected major risk factors and global and regional burden of disease, Lancet, 2002;360:1347-60.
  2. Chobanian AV, Bakris GL, Black HR, et al., Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program Coordinating Committee. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, Hypertension, 2003;42:1206-52.
  3. Neal B, MacMahon S, Chapman N, Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. Blood Pressure Lowering Treatment Trialists' Collaboration, Lancet, 2000;356:1955-64.
  4. Dahlof B, Sever PS, Poulter NR, et al., Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial, Lancet, 2005;366:895-906.
  5. Floras JS, Ambulatory blood pressure: facilitating individualized assessment of cardiovascular risk, J Hypertens, 2007;25:1565-8.
  6. Kearney PM, Whelton M, Reynolds K, et al., Worldwide prevalence of hypertension: a systematic review, J Hypertens, 2004;22:11-9.
  7. Pickering TG, Shimbo D, Haas D, Ambulatory blood pressure monitoring, N Eng J Med, 2006;354:2368-74.
  8. Millar-Craig MW, CN Bishop, Raftery EB, Circadian variation of blood-pressure, Lancet, 1978;1:795-7.
  9. White WB, Cardiovascular risk and therapeutic intervention for the early morning surge in blood pressure and heart rate, Blood Press Monit, 2001;6:63-72.
  10. Muller JE, Tofler GH, Stone PH, Circadian variation and triggers of onset of acute cardiovascular disease, Circulation, 1989;79:733-43.
  11. White WB, Circadian variation of blood pressure: clinical relevance and implications for cardiovascular chronotherapeutics, Blood Press Monit, 1997;2:47-52.
  12. Kim-Gau Nga, Choon-Meng Tinga, Joon-Hock Yeob, et al., Progress on the development of the MediWatch ambulatory blood pressure monitor and related devices, Blood Press Monit, 2004;9:149-65.
  13. Pickering TG, Gerin W, Schwartz AR, What is the white-coat effect and how should it be measured?, Blood Press Monit, 2002;7:293-300.
  14. Stergiou GS, Skeva II, Baibas NM, Kalkana CB, et al., Diagnosis of hypertension using home or ambulatory blood pressure monitoring: comparison with the conventional strategy based on repeated clinic blood pressure measurements, J Hypertens, 2000;18:1745-51.
  15. Hansen TW, Kikuya M, Thijs L, et al., Prognostic superiority of daytime ambulatory over conventional blood pressure in four populations: a meta-analysis of 7,030 individuals, J Hypertens, 2007;25:1554-64.
  16. Sakuma M, Imai Y, Nagai K, et al., Reproducibility of home blood pressure measurements over a 1-year period, Am J Hypertens, 1997;10(Pt 1):798-803.
  17. Kleinert HD, Harshfield GA, Pickering TG, et al., What is the value of home blood pressure measurement in patients with mild hypertension?, Hypertension, 1984;6:574-8.
  18. Aylett MJ, Ambulatory or self blood pressure measurement? Improving the diagnosis of hypertension, Fam Pract, 1994;11:197-200.
  19. McGrath BP, Ambulatory blood pressure monitoring, Med J Aust, 2002;176:588-92.
  20. dable® Educational Trust, Available at: www.dableducational.org/ (accessed on 14 December 2010).
  21. Mancia G, Sega R, Bravi C, et al., Ambulatory blood pressure normality: results from the PAMELA study, J Hypertens, 1995;13:1377-90.
  22. Stergiou GS, Baibas NM, Gantzarou AP, et al., Reproducibility of home, ambulatory, and clinic blood pressure: implications for the design of trials for the assessment of antihypertensive drug efficacy, Am J Hypertens, 2002;15(Pt 1):101-4.
  23. Herpin D, Pickering T, Stergiou G, et al., Consensus conference on self-blood pressure measurement. Clinical applications and diagnosis, Blood Press Monit, 2000;5:131-5.
  24. Carney S, Gillies A, Garvey L, et al., Direct comparison of repeated same-day self and ambulatory blood pressure monitoring, Nephrology, 2005;10:151-6.
  25. The 2006 Gallup Study of the Hypertension Market. Princeton, NJ:Multi-Sponsor Surveys Inc; 2006.
  26. European Society of Hypertension Practice Guidelines for home blood pressure monitoring, J Human Hypertension, 2010;24:779-85.
  27. Hond ED, Celis H, Fagard R, et al., THOP Investigators. Selfmeasured versus ambulatory blood pressure in the diagnosis of hypertension, J Hypertens, 2003;21:717-22.
  28. Ohkubo T, Kikuya M, Metoki H, et al., Prognosis of 'masked' hypertension and 'white-coat' hypertension detected by 24-hour ambulatory blood pressure monitoring 10-year follow-up from the Ohasama study, J Am Coll Cardiol, 2005;46:508-15.
  29. Verdecchia P, O'Brien E, Pickering T, et al., European Society of Hypertension Working Group on Blood Pressure Monitoring. When can the practicing physician suspect white coat hypertension? Statement from the Working Group on Blood Pressure Monitoring of the European Society of Hypertension, Am J Hypertens, 2003;16:87-91.
  30. Pater C, Beyond the evidence of the new hypertension guidelines. Blood pressure measurementÔÇöis it good enough for accurate diagnosis of hypertension? Time might be in, for a paradigm shift (I), Curr Control Trials Cardiovasc Med, 2005;6:6.
  31. O'Brien E, Coats A, Owens P, et al., Use and interpretation of ambulatory blood pressure monitoring: recommendations of the British Hypertension Society, BMJ, 2000;320:1128-34.
  32. Ohkubo T, Imai Y, Tsuji I, et al., Home blood pressure measurement has a stronger predictive power for mortality than does screening blood pressure measurement: a population-based observation in Ohasama, J Hypertens, 1998;16:971-5.
  33. McKay DW, Myers MG, Bolli P, Chockalingam A, Masked hypertension: a common but insidious presentation of hypertension, Can J Cardiol, 2006;22:617-20.
  34. Helvaci MR, Seyhanli M, What a high prevalence of white coat hypertension in society!, Intern Med, 2006;45:671-4.
  35. Bobrie G, Gen├¿s N, Vaur L, et al., Is 'isolated home' hypertension as opposed to ÔÇ£isolated officeÔÇØ hypertension a sign of greater cardiovascular risk?, Arch Intern Med, 2001;161:2205-11.
  36. Oikawa T, Obara T, Ohkubo T, et al., J-HOME Study Group. Characteristics of resistant hypertension determined by self-measured blood pressure at home and office blood pressure measurements: the J-HOME study, J Hypertens, 2006;24:1737-43.
  37. Bobrie G, Genès N, Vaur L, et al., Is 'isolated home' hypertension as opposed to 'isolated office' hypertension a sign of greater cardiovascular risk?, Arch Intern Med, 2001;161:2205-11.
  38. Bj├Ârklund K, Lind L, Zethelius B, et al., Isolated ambulatory hypertension predicts cardiovascular morbidity in elderly men, Circulation, 2003;107:1297-302.
  39. Brown MA, Is resistant hypertension really resistant?, Am J Hypertens, 2001;14:1263-9.
  40. Denolle T, Waeber B, Kjeldsen S, et al., Self-measurement of blood pressure in clinical trials and therapeutic applications, Blood Press Monit, 2000;5:145-9.
  41. Weber MA, Drayer YM, Makamura DK, Wyle FA, The circadian blood pressure pattern in ambulatory normal subjects, Am J Cardiol, 994;45:115-9.
  42. Mancia G, Parati G, Ambulatory blood pressure monitoring and organ damage, Hypertension, 2000;36:894-900.
  43. Ohkubo T, Imai Y, Tsuji I, et al., Relation between nocturnal decline in blood pressure and mortality, Am J Hypertens, 997;10:1201-7.
  44. Mancia G, Bombelli M, Facchetti R, et al., Long-term prognostic value of blood pressure variability in the general population: results of the Pressioni Arteriose Monitorate e Loro Associazioni Study, Hypertension, 2007;49:1265-70.
  45. Boggia J, Li Y, Thijs L, et al., Prognostic accuracy of day versus night ambulatory blood pressure: a cohort study, Lancet, 2007;370:1219-29.
  46. Brunner HR Arakawa K, Antihypertensive Efficacy of Olmesartan Medoxomil and Candesartan Cilexetil in Achieving 24-Hour Blood Pressure Reductions and Ambulatory Blood Pressure, Goals Clin Drug Invest, 2006;26(4):185-13.
  47. White WB, Sica DA, et al., Preventing Increases in Early-Morning Blood Pressure, Heart Rate, and the Rate-Pressure Product With Controlled Onset Extended Release Verapamil at Bedtime, Am Heart J, 2002;144(4).
  48. Ohkubo T, Asayama K, Kikuya M, et al., Prediction of ischaemic and haemorrhagic stroke by self-measured blood pressure at home: the Ohasama study, Blood Press Monit, 2004;9:315-20.
  49. Mancia G, Facchetti R, Bombelli M, et al., Long-term risk of mortality associated with selective and combined elevation in office, home, and ambulatory blood pressure, Hypertension, 2006;47:846-53.
  50. Abe H, Yokouchi M, Saitoh F, et al., Hypertensive complications and home blood pressure: comparison with blood pressure measured in the doctor's office, J Clin Hypertens, 1987;3:661-9.
  51. Jula A, Puukka P, Karanko H, Multiple clinic and home blood pressure measurements versus ambulatory blood pressure monitoring, Hypertension, 1999;34:261-6.
  52. Cappuccio FP, Kerry SM, Forbes L, Donald A, Blood pressure control by home monitoring: meta-analysis of randomised trials (published correction appears in, BMJ, 2004;329:499), BMJ, 2004;329:145.
  53. Agarwal R, Bills JE, Hecht TJW, Light RP, Role of home blood pressure monitoring in overcoming therapeutic inertia and improving hypertension control: a systematic review and meta-analysis, Hypertension, 2011;57:29-38.
  54. Ogedegbe G, Schoenthaler A, A systematic review of the effects of home blood pressure monitoring on medication adherence, J Clin Hypertens, 2006;8:174-80.
  55. Parati G, Omboni S, Albini F, et al., Home blood pressure telemonitoring improves hypertension control in general practice. The TeleBPCare study, Hypertens, 2009;27:198-203.
  56. McManus RJ, Mant J, Bray EP, et al., Telemonitoring and selfmanagement in the control of hypertension (TASMINH2): a randomised controlled trial, Lancet, 2010;376:163-72.
  57. Okonofua EC, Simpson KN, Jesri A, et al., Therapeutic inertia is an impediment to achieving the Healthy People 2010 blood pressure control goals, Hypertension, 2006;47:345-51.
  58. Redo┬┤n J, Coca A, Lazaro P, et al., Factors associated with therapeutic inertia in hypertension: validation of a predictive model, J Hypertens, 2010;28:1770-7.
  59. Rodondi N, Peng T, Karter AJ, et al., Therapy modifications in response to poorly controlled hypertension, dyslipidemia, and diabetes mellitus, Ann Intern Med, 2006;144:475-84.
  60. Bobrie G, Postel-Vinay N, Delonca J, Corvol P, for the SETHI Investigators Self-Measurement and Self-Titration in Hypertension A Pilot Telemedicine Study, Am J Hypertension, 2007;20:1314-20.
  61. Port K, Palm K, Viigimaa M, Daily usage and efficiency of remote home monitoring in hypertensive patients over a oneyear period, J Telemed Telecare, 2005;11(Suppl. 1):343-6.
  62. Tan NC, Khin LW, Pagi R, Home blood-pressure monitoring among hypertensive patients in an Asian population, J Human Hypertension, 2005;19:559-64.
  63. Thomas G, Pickering NHM, Gbenga O, et al., Artinian and David Goff Call to Action on Use and Reimbursement for Home Blood Pressure Monitoring: A Joint Scientific Statement From the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association, Hypertension, 2008;52;10-29.