Tag: hypertension

Categories : Cardiovascular DiseaseTags :

Blood Pressure Rise on Standing up Linked to Cardiovascular Risk

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Blood pressure cuff
BP cuff for home monitoring, Source: Pixabay

Among young and middle-aged adults with high blood pressure, a substantial rise in blood pressure upon standing may identify those with a higher risk of serious cardiovascular events, such as heart attack and stroke, according to new research published in the journal Hypertension.

“This finding may warrant starting blood-pressure-lowering treatment including medicines earlier in patients with exaggerated blood pressure response to standing,” said Professor Paolo Palatini, MD, lead author of the study.

Blood pressure usually falls slightly upon standing up. In this study, researchers assessed whether the opposite response – a significant rise in systolic blood pressure upon standing – is a risk factor for heart attack and other serious cardiovascular events.

Researchers recruited 1207 people aged 18-45 years old with untreated stage 1 hypertension, from the ongoing HARVEST study which started in 1990. Stage 1 hypertension was defined as systolic blood pressure of 140–159 mm Hg and/or diastolic BP 90–100 mm Hg. None had taken blood pressure-lowering medication prior to the study, and all were initially classed as low risk for major cardiovascular events based on lifestyle and medical history.

The researchers took six blood pressure measurements in various physical positions, including when lying down and after standing up. The 120 participants with the highest rise (top 10%) in blood pressure upon standing averaged an 11.4mmHg increase; all increases in this group were greater than 6.5mmHg. Remaining participants averaged a 3.8mmHg fall in systolic blood pressure upon standing.

The researchers compared heart disease risk factors, laboratory measures and the occurrence of major cardiovascular events (heart attack, heart-related chest pain, stroke, aneurysm of the aortic artery, clogged peripheral arteries) and chronic kidney disease among participants in the two groups. In some analyses, the development of atrial fibrillation, an arrhythmia that is a major risk factor for stroke, was also noted. Results were adjusted for age, gender, parental history of heart disease, and several lifestyle factors and measurements taken during study enrolment.

During an average 17-year follow-up, there were 105 major cardiovascular events among the participants. The most common were heart attack, heart-related chest pain and stroke.

People in the top 10% for rise in blood pressure:

  • had nearly twice the risk for a major cardiovascular event compared to the others;
  • did not generally have a higher risk profile for cardiovascular events during their initial evaluation (outside of the exaggerated blood pressure response to standing);
  • were more likely to be smokers (32.1% vs 19.9% in the non-rising group), yet physical activity levels were comparable, and they were not more likely to be overweight or obese, and no more likely to have a family history of cardiovascular events;
  • had more favourable cholesterol levels (lower total cholesterol and higher high-density-lipoprotein cholesterol);
  • had lower systolic blood pressure when lying down than the other group (140.5 mm Hg vs. 146.0 mm Hg, respectively), yet blood pressure measures were higher when taken over 24 hours.

After adjusting for average blood pressure taken over 24 hours, an exaggerated blood pressure response to standing remained an independent predictor of adverse heart events or stroke.

“The results of the study confirmed our initial hypothesis – a pronounced increase in blood pressure from lying to standing could be prognostically important in young people with high blood pressure. We were rather surprised that even a relatively small increase in standing blood pressure (6-7 mm Hg) was predictive of major cardiac events in the long run,” said Prof Palatini.

In a subset who had stress hormones measured from 24-hour urine samples, the epinephrine/creatinine ratio was higher in the people with rising BP compared to non-risers (118.4 nmol/mol vs 77.0 nmol/mol, respectively).

“Epinephrine levels are an estimate of the global effect of stressful stimuli over the 24 hours. This suggests that those with the highest blood pressure when standing may have an increased sympathetic response to stressors,” said Prof Palatini. “Overall, this causes an increase in average blood pressure.”

“The findings suggest that blood pressure upon standing should be measured in order to tailor treatment for patients with high blood pressure, and potentially, a more aggressive approach to lifestyle changes and blood-pressure-lowering therapy may be considered for people with an elevated blood pressure response to standing,” he said.

Source: American Heart Association

Categories : Cardiovascular DiseaseTags :

Taking Healthcare to SASSA Queues: Pensioners Screened for Hypertension

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Hundreds of pensioners queuing for their old age grants are being screened and tested for hypertension at paypoints in Mpumalanga. In this way, care is provided where and to whom it’s needed most.

In total, more than 4.2 million people in South Africa aged 60 and older currently receive the Older Persons Grant. For many of them, particularly in rural areas, grant collection days often involve standing in queues for hours.

In a pilot project in Bushbuckridge, Mpumalanga, the South African Medical Research Council (SAMRC) and SAMRC/WITS’s Rural Public Health and Health Transitions Research Unit. are using these queues as an opportunity to take screening for hypertension to some of the most vulnerable and often neglected people in the country.

The study is being conducted in collaboration with local communities, the South African Social Security Agency (SASSA), the South African Post Office (SAPO) in Ximhungwe and Boxer Superstores in Thulamahashe.

The project called “Know Your Numbers” was launched in April 2021 with 20 fieldworkers from local communities at six sites where hundreds of pensioners gather each month to collect their grants. The teams take people’s blood pressure using mobile Omron machines.

“Screening about 100 people per queue, we are picking up high blood pressure in about 60% of the participants. These people are all referred to their closest local clinic for further assessment, treatment and care as required. About 30% of the participants are male and about 70% female and that’s because there are sadly less men alive to collect social grants,” said Jane Simmonds, Know Your Numbers project manager at SAMRC/WITS’s Rural Public Health and Health Transitions Research Unit.

Silent killer
Hypertension is known as the ‘silent killer’ because there are no exclusive symptoms that point directly to the disease. A 2021 study by the SAMRC found that the prevalence of hypertension rose between 1998 and 2016, from 27% to 45% in men and 31% to 48% in women. This has a significant impact on the health of older persons. “Older adults contribute critical support to local households, fostering orphans, enabling schooling and countering food insecurity. We can ill afford a rising toll of deaths from stroke and heart failure, or greater vulnerability to Covid-19,” said Steve Tollman, Unit Director.

“Many people don’t have money to travel to the doctor or clinic before they’re already very sick,” said Simmonds. Measuring blood pressure in people standing in the queue could help them manage and improve their health and save them the costs and time involved in visiting a clinic for a simple monthly health check.

“People will not go to town or clinics for treatment or vaccines if they have to choose between spending their R1800 grant on food or for transport,” said Simmonds, who lobbied for what became a successful project to offer the Covid vaccine directly to pensioners while they were queuing.

She explained how transport costs and problems accessing the Electronic Vaccination Data System (EVDS) had become barriers to vaccination for older people when the vaccine was first rolled out.

“When the Covid vaccines became available to people 60 and older in July last year, I thought that if we could meet people in queues for hypertension screening, then why not reach them for vaccines? I spent a lot of time talking to the Minister Of Health, Deputy-Director General or anyone that would listen to me about this concept. Eventually the Solidarity Fund came on board to fund vaccine outreach sites through the national health department. These sites have done over 500 000 vaccines since July 2021,” she said.

SASSA’s Dianne Dunkerley told GroundUp that SASSA had agreed to a pilot project with strict conditions to protect the security of beneficiaries and to avoid prolonging their already lengthy wait in line.

Dunkerley said the project is being welcomed by older people. “Older people who didn’t realise they had hypertension were identified, and could then go to local clinics for treatment and further monitoring,” she said.

“In cases where people did not want to make decisions immediately, they were sent home with information to discuss with family and friends which is great.”

Fieldworkers from the community speaking to pensioners about the health screening outside the SA Post Office where they collect their social grant.

Dunkerly said SASSA “would not be averse to expanding this project to other provinces” and discussions were underway.

“We really have started seeing the benefits and the reduction of costs, both of transport and of time, for older people. We think that because they’re old, they don’t have anything else to do. Well, many pensioners look after entire families and do all kinds of things. Where we can minimise the time they spend looking for services, it really is a good thing,” she said.

Professor Andre Kengne, Director of the Non-Communicable Diseases Research Unit at SAMRC, told GroundUp, “Early lessons from the ‘Know Your Number’ project are strongly suggesting that the reach of prevention and control services for common health conditions including chronic diseases such as hypertension, can be substantially improved by taking some of the essential services such as health screening and health promotion to the most vulnerable people in the community.”

He said older persons are the most affected by chronic non-communicable diseases and that improving the detection, linkage to care and control of those conditions through appropriate community-based approaches, significantly reduces the related harmful health effects.

The researchers hope that lessons from the ongoing and thorough pilot evaluation can be used to lobby the government to include screening and tests for diabetes, HIV, TB, cancers and other health issues which affect older persons.

By Barbara October

Source: GroundUp

Categories : Cardiovascular DiseaseTags :

Intensive Hypertension Treatment may Prevent Strokes in Older Adults

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Photo by Kindel Media on Pexels

More intensive hypertension treatment could help prevent or delay strokes in older adults, according to an analysis of results from randomised clinical trials published in the Journal of the American Geriatrics Society.

The researchers initially screened 22 trials for inclusion. Nine trials involving 38 779 adults with an average age ranging from 66 to 84 years were included in the analysis, with follow-up times ranging from 2.0 to 5.8 years.

On average, the researchers found that it took 1.7 years to prevent 1 stroke for 200 older persons treated with more intensive hypertension treatment.

For older adults with baseline systolic blood pressures below 150 mmHg, the time to benefit from more intensive hypertension treatment was longer than 1.7 years; for older adults with baseline systolic blood pressure above 190 mmHg, the time to benefit was shorter than 1.7 years.

In their discussion, the researchers noted the risks of aggressive hypertension treatment, including hypotension, syncope and falls. However, they noted that emerging evidence shows that the increase in fall risk is transient.

“While the 2017 American College of Cardiology/American Heart Association guidelines recommend individual risk discussions about hypertension treatment for primary prevention in older adults, there is a critical gap in data about how long a patient needs to receive blood pressure treatment before they will benefit – or the blood pressure treatment’s time to benefit,” said lead author Vanessa S. Ho, MS, of California Northstate University College of Medicine. “A treatment’s time to benefit is an especially important consideration for patients with a limited life expectancy who may experience immediate burdens or harms from any additional medication.”

Source: Wiley

Categories : Cardiovascular DiseaseTags :

Hypertension Warning for Long-term Paracetamol Use

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BP cuff for home monitoring, Source: Pixabay

Long-term paracetamol use could increase the risk of heart disease and strokes in people with high blood pressure, according to a randomised clinical trial by the University of Edinburgh.

Researchers recommend that patients with a long term prescription, usually for chronic pain, should rather choose the lowest effective dose for the shortest possible time.

The study, which appears in Circulation, is the first large randomised clinical trial to address the question of paracetamol’s effect on cardiovascular disease, and complements earlier work in observational studies.

Paracetamol was often suggested as a safer alternative to non-steroidal anti-inflammatory drugs (NSAIDs), which are known to increase blood pressure and risk of heart disease.

In the latest study, 110 patients with a history of high blood pressure were prescribed one gram of paracetamol four times a day – a routinely prescribed dose in patients with chronic pain – or a matched placebo for two weeks. All patients received both treatments, with the order randomised and blinded. The paracetamol group saw a significant increase in blood pressure, compared to the placebo group.

This rise was similar to that seen with NSAIDs, and could be expected to increase the risk of heart disease or stroke by around 20%. The findings should lead to a review of long-term paracetamol prescriptions to patients, said the researchers, especially to those with hypertension and an increased risk of heart disease or stroke.

Lead Investigator Dr. Iain MacIntyre said: “This is not about short-term use of paracetamol for headaches or fever, which is, of course, fine—but it does indicate a newly discovered risk for people who take it regularly over the longer term, usually for chronic pain.”

Principal Investigator Professor David Webb said: “We would recommend that clinicians start with a low dose of paracetamol, and increase the dose in stages, going no higher than needed to control pain. Given the substantial rises in blood pressure seen in some of our patients, there may be a benefit for clinicians to keep a closer eye on blood pressure in people with high blood pressure who newly start paracetamol for chronic pain.”

Professor Sir Nilesh Samani, Medical Director at the British Heart Foundation, who funded the study, said: “This research shows how quickly regular use of paracetamol can increase blood pressure in people with hypertension who are already at increased risk of heart attacks and strokes. It emphasises why doctors and patients should regularly review whether there is an ongoing need to take any medication, even something that may seem relatively harmless like paracetamol, and always weigh up the benefits and risks. However, if you take paracetamol occasionally to manage an isolated headache or very short bouts of pain, these research findings should not cause unnecessary concern.”

Source: University of Edinburgh

Categories : Cardiovascular Disease Metabolic DisordersTags :

GLP-1: The Missing Link of Diabetes and Hypertension

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Image by Nataliya Vaitkevich on Pexels

An international team of researchers has finally cracked the puzzle of why so many patients with hypertension also have diabetes. Their discovery has shown that glucagon-like peptide-1 (GLP-1) couples the body’s control of blood glucose and blood pressure.

Senior Author Professor Julian Paton at the University of Auckland, said: “We’ve known for a long time that hypertension and diabetes are inextricably linked and have finally discovered the reason, which will now inform new treatment strategies.”

The study is published online in Circulation Research.

It has long been known that GLP-1 is released from the wall of the gut after eating and acts to stimulate insulin from the pancreas to control blood sugar levels.  However, the researchers found that GLP-1 also stimulates the carotid body, a chemoreceptor located in the neck.

Researchers used RNA sequencing to read all the messages of the expressed genes in the carotid body in rats with and without high blood pressure. This led to the finding that the receptor that senses GLP-1 is located in the carotid body, but less so in hypertensive rats.

David Murphy, Professor of Experimental Medicine from Bristol Medical School: Translational Health Sciences (THS) and senior author, explained: “Locating the link required genetic profiling and multiple steps of validation.  We never expected to see GLP-1 come up on the radar, so this is very exciting and opens many new opportunities.”

Professor Paton added: “The carotid body is the convergent point where GLP-1 acts to control both blood sugar and blood pressure simultaneously; this is coordinated by the nervous system which is instructed by the carotid body.”

Even when on medication, many patients with hypertension and/or diabetes are at high risk of life-threatening cardiovascular disease. This is because most medications only treat symptoms and not causes of high blood pressure and high sugar.

Professor Rod Jackson, an epidemiologist from the University of Auckland, said: “We’ve known that blood pressure is notoriously difficult to control in patients with high blood sugar, so these findings are really important because by giving GLP-1 we might be able to reduce both sugar and pressure together, and these two factors are major contributors to cardiovascular risk.”

Lead author Audrys Pauža, PhD student in the Bristol Medical School, added: “The prevalence of diabetes and hypertension is increasing throughout the world, and there is an urgent need to address this.

“Drugs targeting the GLP-1 receptor are already approved for use in humans and widely used to treat diabetes. Besides helping to lower blood sugar these drugs also reduce blood pressure, however, the mechanism of this effect wasn’t well understood.

“This research revealed that these drugs may actually work on the carotid bodies to enact their anti-hypertensive effect. Leading from this work, we are already planning translational studies in humans to bring this discovery into practice so that patients most at risk can receive the best treatment available.”

The research has also revealed many novel targets for ongoing functional studies that the team hope will lead to studies in human hypertensive and diabetic patients.

Source: University of Bristol

Categories : Cardiovascular DiseaseTags :

Air Pollution Linked to Hypertension

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Photo by Lizgrin F on Unsplash

Chronic exposure to air pollution in the form of particulate matter contributes to the risk of cardiovascular and respiratory diseases, and in particular has been linked to hypertension, according to a study published in Scientific Reports.

Air pollution, accounting for more than 4.2 million deaths annually, is a significant health risk. The study assessed the impact of particulate pollution on the long-term incidence of hypertension in Spain, supporting the need to improve air quality to the extent possible in order to reduce the risk of cardiometabolic diseases among the population.

To this end, researchers have carried out a study, di@bet.es, which recruited 1103 participants aged 18–83. None of the participants presented with hypertension at the start of the study (2008–2010), and they were monitored until 2016–17. Participants were assigned air pollution concentrations for particulate matter, obtained through modeling and air quality readings. During this period, 282 cases of incident hypertension were recorded.

The study was carried out in collaboration with the air pollution department of the Research Centre for Energy, Environment and Technology (CIEMAT).

As explained by endocrinologist Sergio Valdés, “Several previous studies have described the short- and long-term association of ambient air pollutants with hypertension and blood pressure levels, but few studies have addressed the association between long-term exposure to these particles and the incidence of hypertension in a prospective manner. Therefore, the di@bet.es study has offered us the opportunity to do so in the Spanish population.”

Participants underwent a medical examination and had blood samples taken. They also answered questionnaires to obtain demographic information and variables such as smoking, exercise and diet.

Gemma Rojo, last study author, stated that “our data is consistent with a large body of evidence suggesting that air pollution may contribute to the pathogenesis of hypertension. It also supports the idea that the particulate component of air pollution is the greatest threat to the cardiovascular system.”

In this regard, she noted, “Although previous associations between exposure to gaseous pollutants and hypertension have shown some discrepancies, most studies reporting long-term exposure to particulate matter and incident high blood pressure have reported positive associations consistent with our findings.”

As Sergio Valdés explained, “our results support the need to improve air quality to the extent possible in order to reduce the risk of high blood pressure among our population, as even moderate levels such as those we report here increase the risk significantly.”

Source: Consorcio Centro de Investigación Biomédica en Red MP

Categories : Cardiovascular Disease NeurologyTags :

Hypertension Doubles Epilepsy Risk

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A new study has found that hypertension may double an adult’s risk of developing epilepsy, according to a new study published in Epilepsia.

The study recruited 2986 US participants with an average age of 58 years, 55 new cases of epilepsy were identified during an average follow-up of 19 years. Hypertension, defined as presence of elevated blood pressure or use of antihypertensive medications, was linked to a nearly 2-fold higher risk of epilepsy. After excluding participants with normal blood pressure who were taking antihypertensive medications, hypertension was linked to a 2.44-times higher risk of epilepsy.

“Our study shows that hypertension, a common, modifiable, vascular risk factor, is an independent predictor of epilepsy in older age,” said co–lead author Maria Stefanidou, MD, MSc, of Boston University School of Medicine. “Even though epidemiological studies can only show association and not causation, this observation may help identify subgroups of patients who will benefit from targeted, aggressive hypertension management and encourage performance of dedicated clinical studies that will focus on early interventions to reduce the burden of epilepsy in older age.”

Source: Wiley

Categories : Cardiovascular DiseaseTags :

Firefighters’ Blood Pressure Soars in an Emergency

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Source: Pixabay CC0

When the emergency alarm sounds, blood pressure (BP) among firefighters often soars, according to preliminary research presented at the American Heart Association’s Scientific Sessions 2021.

“All emergency and first responders should be aware of their health. They should know what their typical blood pressure level is and be aware of how it fluctuates. Most important, if they have high blood pressure, they should make sure it is well-controlled,” said senio author Deborah Feairheller, PhD.

The study recruited 37 male and 4 female volunteer and municipal firefighters who wore ambulatory BP monitors during an on-call work shift lasting at least 12 consecutive hours. In addition to the automatic BP readings from the monitor, study participants were instructed to prompt the monitor to take a BP reading whenever a pager or emergency call sounded and whenever they felt they entered a stressful situation. Participants also logged activities and call types for each measurement. The firefighters’ average age was 41.2 years. Average body mass index (BMI) of all participants was 30.3, with BMI ≥ 25 defined as overweight, while BMI ≥ 30 is defined as obesity. The firefighters all had high blood pressure, defined as systolic BP as 130 mm Hg or higher, or a diastolic BP of 80 mm Hg or higher, as defined by the American Heart Association’s most recent guideline.

The findings were that:

  • Average BP and heart rate (HR) were 131/79.3 mmHg and 75.7 beats per minute (bpm) respectively.
  • Compared with the reading immediately preceding the call, systolic BPsurged an average of 19.2 mm Hg with fire calls and 18.7 mm Hg with medical calls.
  • Meanwhile, diastolic BP surged 10.5 mm Hg with fire calls and 16.5 mm Hg with medical calls.
  • Compared with the average BP during the entire 12-hour shift, systolic BP was 9% higher during fire calls, and diastolic BP was 9% higher during medical calls.
  • Average HR also increased during both types of calls: 10bpm with fire calls, and 15bpm for medical calls.
  • There were no significant differences in BP, HR or BP surge levels when comparing responses among fire calls, medical calls, riding an emergency vehicle or false alarms.

Surprising findings
“The public knows the value that emergency responders provide to communities. We hope to increase awareness that many firefighters have hypertension and that their blood pressure can increase to very dangerous levels when responding to emergency calls,” said Dr Feairheller.

“The current data show that almost 75% of firefighters have hypertension, and less than 25% have their blood pressure under control. I hope that our research can help identify occupational factors that affect blood pressure and increase awareness among this population,” Dr Feairheller added.

They were also surprised at the findings on diastolic BP increases. “We anticipated systolic blood pressure surges because that reading is usually more responsive to stimuli; however, the extent of the diastolic blood pressure surge was unexpected,” said Dr Feairheller.

The investigators are currently exploring whether diet and exercise regimens could help to lower the BP surge that firefighters experience during emergency calls.

Source: EurekAlert!

Categories : Cardiovascular DiseaseTags :

An Extra Drug or More of the Same for Uncontrolled Hypertension?

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Source: Unsplash

A new study may help people with uncontrolled hypertension and their doctors decide whether to increase the dose of one of their existing drugs, or add a new one, to bring down their blood pressure.

Reviewing data from veterans over age 65 receiving treatment over two years, researchers found that patients have a better chance of adhering to their medication regimen if their doctor maximises the dosage of one of the drugs they’re already taking. While both strategies decrease blood pressure, they found adding a new medication has a very slim advantage over increasing the dose of an existing medication, despite some of the patients being unable to stay on the new medication.

In the end, the researchers say, the new findings could add to discussions between physicians and patients whose blood pressure remains elevated despite starting medication treatment.

The findings, reported in the Annals of Internal Medicine, focus on patients whose initial systolic blood pressure was above 130mmHg.

By looking back at VA and Medicare data, the researchers were able to see patterns in treatment and blood pressure readings over time, in a kind of natural experiment. All the patients were taking at least one blood pressure medication at less than the maximum dose and had a treatment intensification at the start of the study period, indicating that their physicians thought they needed more intense treatment.

Intensifying treatment must be carefully considered, as there are many concerns — whether a drug interaction if a new drug is added, or an electrolyte imbalance with high doses, or fainting and falling if a person’s pressure gets too low .

This is the first time the two approaches have been compared, said first author Dr Carole E. Aubert.

“There’s increasing guidance on approaches to starting treatment in older adults, but less on to the next steps to intensify treatment, especially in an older and medically complex population that isn’t usually included in clinical trials of blood pressure medication,” she said. “How can we increase medications safely in a population already taking many medications for hypertension and other conditions.”

“Treatment guidelines do suggest starting treatment with multiple medications, and clinicians are comfortable with an approach of ‘starting low and going slow’ in older patients,” said senior author Dr Lillian Min. “But these results show that in older patients, we have further opportunity to tailor choices in intensifying drug therapy for hypertension, depending on the individual patient’s characteristics.”

She continued, “Is the patient more likely to stick to a simpler regimen? Then increase an existing medication. Or is the blood pressure very high and the clinician is more concerned about reducing it? Then consider starting a new medication now.”

For older adults already on various medications, overcomplicating it with another pill may be excessive. The risks of polypharmacy are already well known, Dr Min said.

Source: University of Michigan

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Home BP Monitoring Gets the Thumbs-up From Patients

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BP cuff for home monitoring, Source: Pixabay

Adults needing to track their blood pressure regularly for a hypertension diagnosis preferred home monitoring blood pressure versus at a clinic, kiosk or with a 24-hour wearable device, according to preliminary research presented at the American Heart Association’s Hypertension Scientific Sessions 2021.

According to the American Heart Association, about half of US adults have hypertension, and of those with high blood pressure (BP) over a third are unaware they have it. H

“Most hypertension is diagnosed and treated based on blood pressure measurements taken in a doctor’s office, even though the U.S. Preventive Services Task Force and the American Heart Association recommend that blood pressure measurements be taken outside of the clinical setting to confirm the diagnosis before starting treatment,” said lead study author Beverly Green, MD, MPH, senior investigator and family physician at Kaiser Permanente Washington Health Research Institute. “It is the standard that blood pressure monitoring should be done either using home blood pressure monitoring or 24-hour ambulatory blood pressure monitoring prior to diagnosing hypertension.”

The “gold standard” for out-of-office measurement to determine a diagnosis of high blood pressure is 24-hour ambulatory blood pressure monitoring devices, worn day and night to take continuous blood pressure readings. Measuring BP on a home device with a normal BP cuff, can be more convenient.

The researchers studied adherence and acceptability of different blood pressure measuring methods among 510 adults with elevated BP but without a hypertension diagnosis. Participants in the study were an average age of 59 years old; half were male; the average BP was 150/88 mm Hg and were taking blood pressure-lowering medications.

Participants were randomised to either clinic measurements, home monitoring or kiosk blood pressure monitoring.

Those in the group for clinic measurements were asked to return to the clinic for at least one additional blood pressure check, as is routine in diagnosing hypertension in clinical practice. The home group received home blood pressure machines and the training to use them, and were asked to measure their blood pressure twice in a row, two times daily, for five days, for a total of 20 measurements. The kiosk group was asked to take their blood pressure at a kiosk in their clinic or at a nearby pharmacy three times each on three separate days, for a total of nine measurements. All participants were asked to complete their group-assigned diagnostic regimens within three weeks, and then to complete 24-hour ambulatory blood pressure monitoring. Researchers compared adherence to and the acceptability among each diagnostic method.

They measured adherence to monitoring by noting the percent of individuals in each group who completed their assigned measurement method as instructed. They measured acceptability with questionnaires.

Researchers found that overall acceptability was highest for the at-home group, followed by the clinic and kiosk groups, while 24-hour ambulatory blood pressure monitoring was the least popular. Adherence to the monitoring regimen was lowest in the kiosk group, but more than 90% in the home testing group; more than 87% in the clinic group; nearly 68% in the kiosk group; and 91% for 24-hour ambulatory monitoring among all participants.

“Home blood pressure monitoring was the most preferred option because it was convenient, easy to do, did not disturb their daily personal or work routine as much, and was perceived as accurate,” said Dr Green. “Participants reported that ambulatory blood pressure monitoring disturbed daily and work activities, disrupted sleep and was uncomfortable.”

When asked which diagnostic testing regimen they would prefer, more than half chose home blood pressure monitoring, especially if they were assigned to the home group, where almost 80% preferred home monitoring.

Dr Green suggests that clinicians routinely offer home blood pressure monitoring to their patients with elevated blood pressure.
“Health care professionals should work toward relying less on in-clinic visits to diagnose hypertension and supporting their patients in taking their blood pressure measurements at home,” Dr Green said. “Home blood pressure monitoring is empowering and improves our ability to identify and treat hypertension, and to prevent strokes, heart attacks, heart failure and cardiovascular death.”

Source: American Heart Association