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BACKGROUND Out-of-office blood pressure (BP) measurement using home BP (HBP) or ambulatory BP (ABP) monitoring is often necessary for the accurate evaluation of hypertension. These methods have several similarities but also have major differences. Therefore, they are regarded as complementary, and there is uncertainty on how they should be applied in clinical practice. This study compared hypertension management based on clinic and ABP measurements or on HBP measurements alone. METHODS Untreated subjects with elevated BP were randomized to treatment initiation and titration based on clinic and ABP measurements or on HBP measurements alone. Target organ damage was assessed at baseline and after 1 year of treatment with echocardiographic left ventricular mass index (primary endpoint), pulse wave velocity, and urinary albumin excretion. RESULTS A total of 145 subjects were randomized, and 116 completed the study (mean age = 50.7±10.5 years; 69 men (59%); mean follow-up = 13.4±1.4 months). There was no difference between the 2 arms in treatment-induced change in left ventricular mass index (mean difference = 0.50±1.11 g/m2; 95% confidence interval (CI) = −1.70 to 2.70). Moreover, there was no difference between the 2 arms in treatment-induced changes in pulse wave velocity (mean difference = −0.16±0.42 m/s; 95% CI = −0.99 to 0.66), urinary albumin excretion (mean difference = −0.85±4.28 mg/dl; 95% CI = −9.37 to 7.66), HBP and ABP levels, and hypertension control rates. CONCLUSIONS These data suggest that HBP monitoring alone is as reliable as combined clinic and ABP measurements in monitoring the effects of antihypertensive drug treatment on BP and preclinical target organ damage. [ABSTRACT FROM PUBLISHER]

BackgroundIt is recognized that for the reliable assessment of blood pressure (BP) and the accurate diagnosis of hypertension, out-of-office BP measurement with ambulatory (ABPM) or home BP monitoring (HBPM) is often required. The clinical usefulness of ABPM is well established. However, despite the wide use of HBPM, only in the last decade convincing evidence on its usefulness has accumulated.MethodsSystematic review of the evidence on applying HBPM in the diagnosis and treatment of hypertension (PubMed, Cochrane Library, 1970-2010).ResultsSixteen studies in untreated and treated subjects assessed the diagnostic ability of HBPM by taking ABPM as reference. Seven randomized studies compared HBPM vs. office measurements or ABPM for treatment adjustment, whereas many studies compared HBPM with office measurements in assessing the antihypertensive drug effects. Several studies with different design investigated the role of HBPM vs. office measurements in improving patients' compliance with treatment and hypertension control rates. The evidence on the cost-effectiveness of HBPM is limited. The studies reviewed consistently showed moderate diagnostic agreement between HBPM and ABPM, and superiority of HBPM compared to office measurements in diagnosing uncontrolled hypertension, assessing antihypertensive drug effects and improving patients' compliance and hypertension control. Preliminary evidence suggests that HBPM has the potential for cost savings.ConclusionsThere is conclusive evidence that HBPM is useful for the initial diagnosis and the long-term follow-up of treated hypertension. These data are useful for the optimal application of HBPM, which is widely used in clinical practice. More studies on the cost-effectiveness of HBPM are needed.American Journal of Hypertension (2011). doi:10.1038/ajh.2010.194 [ABSTRACT FROM AUTHOR]

BackgroundAmbulatory arterial stiffness index (AASI) has been proposed as a marker of arterial stiffness, which predicts cardiovascular mortality. This study compared the reproducibility of 24-h, daytime, night time, and symmetrical AASI.MethodsA total of 126 untreated hypertensives (mean age 48.2 ± 10.7 (s.d.) years, 70 men) underwent 24-h ambulatory blood pressure (ABP) monitoring twice 2–4 weeks apart. The reproducibility of AASI was assessed using the following criteria: (i) repeatability coefficient (RC = 2 × s.d. of differences); (ii) RC expressed as a percentage of close to maximal variation (pMV = RC/(4 × s.d. of the mean of paired recordings)); (iii) coefficient of variation (CV); (iv) concordance correlation coefficient (CCC); (v) agreement (κ) between the two AASI measurements to detect subjects at the top quartile of the respective AASI distributions.ResultsThere was no difference in average AASI values between the two assessments. For 24-h, daytime, night time, and symmetrical AASI, respectively, (i) RC values were 0.24, 0.38, 0.42, and 0.30; (ii) pMV 49.6, 68.8, 73.9, and 56; (iii) CV 40.3, 39.3, 62.9, and 116.3; (iv) CCC 0.60, 0.35, 0.28, and 0.52; (v) agreement 82.5% (κ 0.54), 72.2% (0.28), 73% (0.22), and 81.7% (0.50). Differences in 24-h mean arterial ambulatory pressure (MAP) and in nocturnal MAP decline between the two assessments were significant determinants of the differences in 24-h and symmetrical AASI values.ConclusionsAlthough no differences were found in average AASI values of the two ambulatory recordings, significant differences were observed in their reproducibility, with 24-h AASI being the most reproducible measure in terms of all the examined criteria.American Journal of Hypertension 2010; doi:10.1038/ajh.2009.217 [ABSTRACT FROM AUTHOR]

BackgroundStudies using ambulatory blood pressure (BP) monitoring have shown that in children and adolescents masked hypertension (MH) is not uncommon. This school-based study investigated the prevalence and the characteristics of MH diagnosed using home BP measurements.MethodsA total of 765 subjects aged 6–18 years were assessed with office (two visits, six readings) and home BP measurements (3 days, 12 readings). Office hypertension was diagnosed using the US Task Force normalcy tables and home hypertension using the Arsakeion normalcy tables (≥95th percentile for both). White-coat hypertension (WCH) was defined as office hypertension but low home BP (<95th percentile) and MH as home hypertension but low office BP (<95th percentile).ResultsOn the basis of office BP measurements of the first visit 3.3% of participants had MH, 5.9% WCH, and 2.7% hypertension compared to 4.2, 2.1, and 1.8%, respectively, when a two-visit-average BP was used (P < 0.001 vs. first visit). Subjects with MH or WCH did not differ from hypertensives or normotensives regarding age, gender, or height. However, weight, body mass index (BMI), waist and hip circumference, and office and home BP values fell in between those of normotensives and hypertensives. Prehypertension (office BP: 90–95th centile) and increased BMI were independent predictors of MH.ConclusionsIn children and adolescents MH detected by home BP monitoring is not uncommon and is associated with prehypertension and overweight. Repeated office measurements are essential for the precise diagnosis. MH and WCH in children appear to be intermediate phenotypes of hypertension.American Journal of Hypertension 2009; doi:10.1038/ajh.2009.34American Journal of Hypertension (2009); 22, 5, 520–524. doi:10.1038/ajh.2009.34 [ABSTRACT FROM AUTHOR]

BACKGROUND Electronic devices that measure blood pressure (BP) at the arm level are regarded as more accurate than wrist devices and are preferred for home BP (HBP) monitoring. Recently, wrist devices with position sensors have been successfully validated using established protocols. This study assessed whether HBP values measured with validated wrist devices are sufficiently reliable to be used for making patient-related decisions in clinical practice. METHODS This randomized crossover study compared HBP measurements taken using validated wrist devices (wrist-HBP, Omron R7 with position sensor) with those taken using arm devices (arm-HBP, Omron 705IT), and also with measurements of awake ambulatory BP (ABP, SpaceLabs), in 79 subjects (36 men and 43 women) with hypertension. The mean age of the study population was 56.7 ± 11.8 years, and 33 of the subjects were not under treatment for hypertension. RESULTS The average arm-HBP was higher than the average wrist-HBP (mean difference, systolic 5.2 ± 9.1 mm Hg, P < 0.001, and diastolic 2.2 ± 6.7, P < 0.01). Twenty-seven subjects (34%) had a =10 mm Hg difference between systolic wrist-HBP and arm-HBP and twelve subjects (15%) showed similar levels of disparity in diastolic HBP readings. Strong correlations were found between arm-HBP and wrist-HBP (r 0.74/0.74, systolic/diastolic, P < 0.0001). However, ABP was more strongly correlated with arm-HBP (r 0.73/0.76) than with wrist-HBP (0.55/0.69). The wrist-arm HBP difference was associated with systolic ABP (r 0.34) and pulse pressure (r 0.29), but not with diastolic ABP, sex, age, arm circumference, and wrist circumference. CONCLUSIONS There might be important differences in HBP measured using validated wrist devices with position sensor vs. arm devices, and these could impact decisions relating to the patient in clinical practice. Measurements taken using arm devices are more closely related to ABP values than those recorded by wrist devices. More research is needed before recommending the widespread use of wrist monitors in clinical practice. [ABSTRACT FROM AUTHOR]

OBJECTIVE To investigate the minimum schedule of blood pressure (BP) measurements necessary to provide a reliable assessment of home BP (HBP) in children and adolescents. METHODS Subjects aged 6-18 years referred for elevated BP were assessed with HBP monitoring (6 workdays, duplicate morning and evening measurements) and 24-h ambulatory BP monitoring (ABP). Criteria for HBP reliability were its reproducibility (test-retest correlations and SD of differences (SDDs) between repeated measurements), its stability (average home BP of an increasing number of readings and its SD), and its relationship with ABP. RESULTS Data from 100 subjects were analyzed (mean age 13 ± 2.8 (SD) years, 61 boys). The reproducibility of 3-day HBP (r 0.88/0.79, SDDs 5.1/4.9, systolic/diastolic) was superior to that of a single (r 0.79/0.65, SDDs 7.6/7.1) or 2-day HBP (r 0.85/0.72, SDDs 6.1/5.4). By averaging up to 12 readings (3 days), there was a progressive decline in average HBP, with no further decline thereafter. The SD of average HBP was also progressively reduced, with little change after day 3. The association of HBP with ABP was improved by averaging more readings up to 12, with no further improvement when more readings were averaged. The exclusion of first-day measurements slightly increased the SD of average HBP and weakened the correlation with ABP, probably due to reduced number of readings. CONCLUSIONS In children and adolescents, 3-day monitoring with duplicate morning and evening measurements appears to be the minimum schedule for the reliable assessment of HBP. [ABSTRACT FROM AUTHOR]

BACKGROUND Home blood pressure (HBP) monitoring is being used in children. However, there is no information on the relationship between HBP and office measurements (office BP (OBP)) in this population. METHODS This school-based study investigated the effect of age on the difference between HBP and OBP in 765 healthy subjects aged 6-18 years (mean age 12 ± 3 (SD years). HBP (3 days, 12 readings) and OBP (2 visits, 6 readings) were measured using electronic devices validated in children (Omron 705IT). RESULTS Average OBP was slightly lower than HBP by 0.6 ± 7.0 mm Hg (95% confidence intervals (CI) 0.1, 1.1, P = 0.01) systolic and 1 ± 6 mm Hg (95% CI 0.7, 1.6, P < 0.0001) diastolic, whereas pulse rate was higher in the office by 7 ± 10 beats/min (95% CI 6.2, 7.6, P < 0.0001). Age was significantly correlated with the OBP-HBP difference (r = 0.13/0.24 for systolic/diastolic, P < 0.001) and inversely correlated with the office-home difference in pulse rate (r = -0.31, P < 0.001). In the younger children (6-12 years), both systolic and diastolic HBP were higher than OBP whereas pulse rate was higher in the office. In older children and adolescents, the BP difference was eliminated whereas the pulse rate difference was reduced but remained significant. These changes with age were similar in boys and girls. CONCLUSIONS In the pediatric population OBP appears to be lower than HBP. This difference is reduced with increasing age and eliminated after the age of 12 years. These data should be taken into account in the assessment of HBP in children and adolescents. [ABSTRACT FROM AUTHOR]

: BackgroundAdjuvant treatment with the estrogen receptor modulator tamoxifen is a well established long-term therapy in breast cancer. This study investigated the effect of tamoxifen on blood pressure (BP) and on factors by which it might be influenced.: MethodsNormotensive postmenopausal women on >12 months adjuvant tamoxifen therapy were randomized to withdraw or continue tamoxifen for 6 weeks and then to crossover to the alternative regimen for a second 6-week period. Measurements of clinic and ambulatory BP, plasma renin activity (PRA), and fractional sodium excretion (FENa) were performed at baseline and at the end of each study period.: ResultsTwenty-three women completed the study (mean age 60.6 ± 8.3 years). There was no effect of tamoxifen on clinic BP (mean difference between withdrawal and continuation for systolic BP, 0.4 ± 8.4 mm Hg, 95% confidence interval [CI] −4.0 to 3.2, and diastolic 0.6 ± 4.7, 95%CI −1.4 to 2.7) or 24-hour ambulatory BP (systolic 0.7 ± 7.4 mmHg, 95%CI −2.6 to 3.9; diastolic BP, 1.9 ± 5.5, 95% CI −0.5 to 4.2). Furthermore, no effect of tamoxifen on PRA (mean difference between withdrawal and continuation 0.03 ± 0.5 ng/mL/h, 95% CI −0.3 to 0.2) or FENa (0.05 ± 0.5, 95% CI −0.2 to 0.2) was detected.: ConclusionsTamoxifen seems to have no effect on BP, PRA, or FENa in normotensive postmenopausal women. [Copyright &y& Elsevier]

: BackgroundThe aims of this study were to compare the reproducibility of blood pressure (BP) measured in the clinic (CBP), at home (HBP), and by ambulatory monitoring (ABP), and to assess its implications on the accuracy of antihypertensive drug trials.: MethodsA total of 133 untreated subjects with elevated CBP were assessed with repeated measurements of CBP (five visits within 3 months), HBP (6 workdays within 2 weeks), and ABP (twice, 2 weeks apart). The reproducibility of CBP (one visit), HBP (2 days), and ABP (24 h) was quantified using the SD of differences (SDD) between repeated measurements. The number of subjects required in a comparative trial of two drugs was calculated for each measurement method.: ResultsWe found that HBP provided the lowest SDD values (6.9/4.7 mm Hg, systolic/diastolic, compared with 8.3/5.6 for ABP and 11.0/6.6 for CBP). For a parallel trial aiming to detect a difference in the effect of two drugs of 10 mm Hg systolic BP, 51 subjects would be required when using CBP compared with 29 using ABP and 20 using HBP (73, 53 and 37 subjects, respectively, for the detection of a 5 mm Hg difference in diastolic BP).: ConclusionsThe study shows that HBP seems to have superior reproducibility compared with both CBP and ABP. In addition, HBP can improve the accuracy of antihypertensive drug trials, thereby reducing the sample size required. [Copyright &y& Elsevier]

The author comments on a study about the measurements of the automated office blood pressure (BP). He observes that the researchers failed to provide appropriate time in getting lower BP through BpTRU approach, an electronic device, which is very important to the future of office BP measurement. He also concludes that the goal of the study remains unresolved since out-of-office BP was not assessed.

Background: In a post-hoc analysis of a multinational, randomized trial, we investigated whether the efficacy and safety of nifedipine gastrointestinal therapeutic system (GITS) and ramipril differed between Chinese and European patients with hypertension., Methods: Previously treated (after 2-week washout) and untreated patients with clinic blood pressure (BP) ≥140/90 mmHg (systolic/diastolic), daytime ambulatory BP ≥135/85 mmHg and standard deviation of home systolic BP >7 mmHg and/or daytime BP >12 mmHg were randomly assigned to treatment based on nifedipine GITS 30 mg or ramipril 10 mg for 12 months. Clinic, ambulatory and home BP were measured at baseline, 10 weeks and 12 months after randomization., Results: A total of 67 Chinese and 101 European patients were analyzed and they differed in age (50.9 vs. 54.6 years, respectively), body mass index (24.5 vs. 27.0 kg/m2), clinic diastolic BP (87.9 vs. 92.5 mmHg), heart rate (75.0 vs. 70.8 beats/minute) and nighttime diastolic BP (79.3 vs. 75.9 mmHg) (all P<0.05). However, within each ethnicity, patients were comparable for clinical characteristics between the nifedipine GITS and ramipril groups (P>0.05). In both the Chinese and European patients, BP was similarly reduced with nifedipine GITS and ramipril, except that daytime systolic/diastolic BP reductions were 7.4/4.1 mmHg greater in the ramipril than nifedipine GITS group in Chinese (P=0.02). The safety profile differed between the Chinese and European patients (P for drug*ethnicity interaction ≤0.05) for all adverse events (lower incidence on nifedipine GITS in Chinese), ankle edema (higher on nifedipine GITS in Europeans) and dry cough (higher on ramipril in Chinese)., Conclusion: In the Chinese and European patients with hypertension, nifedipine GITS and ramipril had similar BP lowering efficacy, but different safety profile and tolerability., (© The Author(s) 2024. Published by Oxford University Press on behalf of American Journal of Hypertension, Ltd. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)