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BACKGROUND Self-measured blood pressure (SMBP) is an effective strategy for managing and controlling hypertension. However, uncertainty regarding patients' ability to accurately measure their blood pressure (BP) contributes to treatment inertia. Therefore, we compared BP measurements with the Omron HEM-9210T device obtained by nurses and community-dwelling adults after training. METHODS This cross-sectional study was conducted in a simulated home environment at an academic institution. After a 5-min rest, a trained nurse measured a participant's BP twice at a 1-min interval. The participants then ambulated at their usual pace for 2 min. Next, they were asked to rest for 5 min, during which each individual watched a 3-min video on SMBP. Following the rest, the participants obtained two readings at a 1-min interval. RESULTS We recruited 102 community-dwelling adults with a mean age of 54 (±14) years; 59% female, 88% Black race, and 63% with a hypertension diagnosis. Half (n  = 51) had a home BP monitor. Overall, there were no significant differences between nurse- and participant-obtained systolic BP (mean difference [MD]: −1.1; standard deviation [SD]: 8.0; P  = 0.178) or diastolic BP (MD: −0.9; SD: 5.5; P  = 0.111). Participants who used an extra-large cuff had higher self-measured diastolic BP (MD: −2.9; SD: 4.5; P  = 0.010). All participants demonstrated satisfactory SMBP skills after the training. CONCLUSIONS Community-dwelling adults can accurately measure BP after a 3-min video training. Integrating SMBP training into patient encounters may result in reliable home BP measurements, improving hypertension management and clinical decision making. [ABSTRACT FROM AUTHOR]

Background: The association between Interdialytic home blood pressure variability (BPV) and the prognosis of patients undergoing maintenance hemodialysis (MHD) largely unknown. Hypothesis: We proposed the hypothesis that interdialytic home BPV exert effect on cardiac and all‐cause mortality among individuals undergoing MHD. Methods: A total of 158 patients receiving MHD at the hemodialysis unit of Wuhan Fourth Hospital between December 2019 and August 2020 were included in this prospective cohort study. Patients were divided into tertiles according to the systolic BPV (SBPV), and the primary endpoints were cardiac and all‐cause death. Kaplan–Meier analysis was used to assess the relationship between long‐term survival and interdialytic home SBPV. In addition, Cox proportional hazards regression models were used to identify risk factors contributing to poor prognosis. Results: The risk of cardiac death and all‐cause death was gradually increased in patients according to tertiles of SBPV (3.5% vs. 14.8% vs. 19.2%, p for trend =.021; and 11.5% vs. 27.8% vs. 44.2%, p for trend <.001). The Cox regression analysis revealed that compared to Tertile 1, the hazard ratios for all‐cause mortality in Tertile 2 and Tertile 3 were 3.13 (p =.026) and 3.24 (p =.021), respectively, after adjustment for a series of covariates. Conclusions: The findings revealed a positive correlation between increased interdialytic home SBPV and elevated mortality risk in patients with MHD. [ABSTRACT FROM AUTHOR]

Home blood pressure monitoring (HBPM) has been shown to provide a more reliable assessment of blood pressure (BP) than in-office measurement and may lead to improved BP control. While many mHealth apps are available to help users track their blood pressure (BP), no apps incorporate the full set of evidence-based HBPM recommendations for ensuring accurate measurement at home. Through an agile development approach employing user stories, we translated an evidence-based standardized protocol for BP measurement and monitoring over a recommended 3–7 day monitoring period into a mHealth app and corresponding clinician portal. We then pilot tested this platform to assess its feasibility for guiding users to measure BP over multiple days according to this protocol. During this pilot testing, one hundred and twenty five users created an app account; 75 (60.0%) of these users recorded at least one BP reading and 47 (37.6%) completed at least one monitoring period. Through this work, we have demonstrated how a series of guidelines can be systematically translated into a mHealth platform for HBPM. Such platforms may be accessible resources to facilitate standardized HBPM and sharing of readings with providers. [ABSTRACT FROM AUTHOR]

Aims/Introduction: Isolated high home systolic blood pressure (IHHSBP) is a risk for cardiovascular disease (CVD). However, no study has shown an association between IHHSBP and CVD in diabetes. We examined the association between IHHSBP and CVD in type 2 diabetes. Materials and Methods: This retrospective cohort study included 1082 individuals with type 2 diabetes, aged 20 to 90 years, without a history of macrovascular complications. Home blood pressure (HBP) was measured three times every morning and evening for 14 days. Cox proportional hazards models were used to examine the relationship between IHHSBP and CVD incidence. Results: With the normal HBP group as the reference, the adjusted hazard ratio (HR) (95% confidence interval [CI]) for CVD was 1.58 (1.02–2.43) in the IHHSBP group. Correcting for antihypertensive medication use did not change HR. Based on sex, the adjusted HR (95% CI) for CVD was 1.25 (0.74–2.13) in males and 2.28 (1.01–5.15) in females. Conclusions: In individuals with type 2 diabetes, those with IHHSBP had a higher HR for cardiovascular disease than those with normal HBP. But, Isolated high home diastolic blood pressure and high HBP were not. The association between IHHSBP and CVD was stronger in females than in males. [ABSTRACT FROM AUTHOR]

Background There were many hypertensive patients at non-high risk of developing COVID-19 that needed to be medical observation at home, but the changes in their blood pressure and measurement frequency as well as heart rate during the period are still unclear. Objective To perform an analysis of the changes in blood pressure and measurement frequency as well as heart rate in hypertensive patients that needed to be medical observation at home. Methods Through the iHealth cloud platform, data〔including age, sex, systolic blood pressure (SBP) and diastolic blood pressure (DBP) measured by the iHealth Clear (BPM1) at home, and heart rate〕were collected from December 1st, 2019 to March 27th, 2020, involving all hypertensive patients in Wuhan who had an ID number for consecutively uploading blood pressure readings, and were desensitized for removing the confidential information. The features of blood pressure during the period were analyzed. ARIMAX model was used to assess the association of age, sex, number of confirmed COVID-19 cases per day, cumulative confirmed COVID-19 deaths, time granularity and the traffic control with participants' blood pressure and hear rates. Results In total, blood pressure readings of 36 472 measurements by the participants using 1 232 iHealth Clear (BPM1) were collected during the 118-day period. Men demonstrated higher mean SBP, DBP and heart rate than women (P

Serial blood pressure and heart rate measurements, particularly obtained by the patients at home, are currently recommended for the management of patients. Home blood pressure and heart rate measurements were obtained by an 81-year old husband and his 74-year old wife in the morning and evening, over the course of an entire month. Morning and evening systolic blood pressure (129.9 ± 5.5, 125.9 ± 10.2, respectively), and diastolic blood pressure (69.2 ± 4.0, 70.1 ± 5.3) were not different (P >.05), heart rate (61.2 ± 2.9, 69.0 ± 5.5) was higher in the evening (P =.00001) in the husband, while systolic blood pressure (134.7 ± 9.6, 119.0 ± 12.0) and diastolic blood pressure (78.6 ± 5.6, 72.1 ± 7.3) were higher in the morning (P =.00001, P =.00031), and heart rate (62.7 ± 4.7, 68.2 ± 4.6) was higher in the evening (P =.00017) in the wife. Patient-generated serial home blood pressure and heart rate logs provide essential data for the patients' management and could potentially be useful in research; circadian variation of blood pressure and heart rate calls for implementation of chronotherapeutic principles for the time of drug administration. [ABSTRACT FROM AUTHOR]

BACKGROUND Inconsistencies between the office and out-of-office blood pressure (BP) values (described as white-coat hypertension or masked hypertension) may be attributable in part to differences in the BP monitoring devices used. METHODS We studied consistency in the classification of BP control (wellcontrolled BP vs. uncontrolled BP) among office, home, and ambulatory BPs by using a validated “all-in-one” BP monitoring device. In the nationwide, general practitioner-based multicenter HI–JAMP study, 2,322 hypertensive patients treated with antihypertensive drugs underwent office BP measurements and 24-hour ambulatory BP monitoring (ABPM), consecutively followed by 5-day home BP monitoring (HBPM), for a total of seven BP measurement days. RESULTS Using the thresholds of the JSH2019 and ESC2018 guidelines, the patients with consistent classification of well-controlled status in the office (<140 mmHg) and home systolic BP (SBP) (<135 mmHg) (n = 970) also tended to have well-controlled 24-hour SBP (<130 mmHg) (n = 808, 83.3%). The patients with the consistent classification of uncontrolled status in office and home SBP (n = 579) also tended to have uncontrolled 24-hour SBP (n = 444, 80.9%). Among the patients with inconsistent classifications of office and home BP control (n = 803), 46.1% had inconsistent ABPM-vs.-HBPM out-of-office BP control status. When the 2017 ACC/AHA thresholds were applied as an alternative, the results were essentially the same. CONCLUSIONS The combined assessment of the office and home BP is useful in clinical practice. Especially for patients whose office BP classification and home BP classification conflict, the complementary clinical use of both HBPM and ABPM might be recommended. [ABSTRACT FROM AUTHOR]

Abstract Blood pressure monitoring (BPM) devices have to be validated according to strict international validation protocols. Each protocol requests a specific number of participants to be included. All protocols use vast amounts of resources, as three people have to be present for every measurement, making trials costly, especially when the manufacturer has no intention to execute a validation study, reflected in the low share of validated in the commercially available BPM devices. The aim of our study was to develop criteria, which could detect low accuracy devices that could not pass a validation protocol early in the course of the validation process. The 2010 European Society of Hypertension International Protocol (ESH‐IP) and the Universal Standard for Validation of BPM devices (AAMI/ESH/ISO) were scrutinized for criteria which can be used for preclusion of passing. Based on this, we developed a fail model. We found that a BPM device cannot pass the ESH‐IP protocol, if there are ≥27, 13, or 4 single measurements differing more than 5, 10, or 15 mmHg, respectively, from the reference. For the AAMI/ESH/ISO protocol, we developed a model, which calculates best‐case standard deviations (SDs) to detect SDs which would prevent the passing of the protocol before its completion, making a stepwise validation process possible. In conclusion, we found that our model is able to predict failure of low‐accuracy BPM devices early during a validation protocol if used in a stepwise‐approach. This can be useful to keep costs of validation studies low and to enable investigator‐initiated trials.

Background: Blood pressure (BP) control in haemodialysis (HD) patients is essential. Peri-dialytic BP levels do not accurately diagnose hypertension or predict the cardiovascular (CV) mortality., Methods: In this study, we recruited 43 adult patients who had been on chronic HD for ≥3 months. Seven-day home BP monitoring (HBPM) (values of Day1 discarded) and 44-h interdialytic ambulatory BP monitoring (iABPM) were performed. Pre- and post-dialysis BP levels were measured during the 6 dialysis sessions prior to iABPM. A 6-year follow-up was carried out to assess all-cause and CV mortality., Results: In patients considered as normotensive in pre-dialysis ( n  = 17), masked hypertension was found in 24% and 29% on the basis of iABPM and HBPM, respectively. Conversely, among hypertensive patients in pre-dialysis ( n  = 26), 'white-coat' hypertension was noted in 23% either by iABPM or HBPM. After a 6-year follow-up, 25 patients were deceased including 6 patients from CV causes. Day-time systolic BP measured by iABPM was associated with all-cause mortality in an adjusted model for age and gender ( p  = 0.045)., Conclusion: In chronic HD patients, 44-h iABPM and 6-day HBPM show a reliable concordance and help to re-classify ∼25% of cases miscategorised based on pre-dialysis measurements. Day-time systolic BP levels using iABPM were significantly associated with 6-year all-cause mortality.

Blood pressure monitoring (BPM) devices have to be validated according to strict international validation protocols. Each protocol requests a specific number of participants to be included. All protocols use vast amounts of resources, as three people have to be present for every measurement, making trials costly, especially when the manufacturer has no intention to execute a validation study, reflected in the low share of validated in the commercially available BPM devices. The aim of our study was to develop criteria, which could detect low accuracy devices that could not pass a validation protocol early in the course of the validation process. The 2010 European Society of Hypertension International Protocol (ESH‐IP) and the Universal Standard for Validation of BPM devices (AAMI/ESH/ISO) were scrutinized for criteria which can be used for preclusion of passing. Based on this, we developed a fail model. We found that a BPM device cannot pass the ESH‐IP protocol, if there are ≥27, 13, or 4 single measurements differing more than 5, 10, or 15 mmHg, respectively, from the reference. For the AAMI/ESH/ISO protocol, we developed a model, which calculates best‐case standard deviations (SDs) to detect SDs which would prevent the passing of the protocol before its completion, making a stepwise validation process possible. In conclusion, we found that our model is able to predict failure of low‐accuracy BPM devices early during a validation protocol if used in a stepwise‐approach. This can be useful to keep costs of validation studies low and to enable investigator‐initiated trials. [ABSTRACT FROM AUTHOR]

L' European Renal Association - European Dialysis and Transplant Association (ERA-EDTA)/ European Society of Hypertension (ESH) préconise les mesures hors centre de la pression artérielle, automesure tensionnelle ou mesure ambulatoire de la pression artérielle, chez les patients dialysés. La faisabilité des mesures hors centre de la pression artérielle en soins courants n'est toutefois pas connue. L'objectif de notre étude a été de la quantifier tant « a priori », c'est-à-dire le pourcentage d'hémodialysés à qui les mesures hors centre de la pression artérielle peuvent être proposées et qui l'acceptent, qu'« a posteriori », c'est-à-dire le pourcentage de mesures hors centre de la pression artérielle faites et valides. Un programme de mesures hors centre de la pression artérielle systématiques a été mis en place d'avril à octobre 2019 dans nos structures d'hémodialyse chronique. Il a été proposé à chaque hémodialysé de réaliser, après éducation, une automesure tensionnelle (Omron M3®), de 2 mesures, à 1 à 2 minutes d'intervalle, le matin et le soir de 6 jours sans dialyse (validité : ≥ 15 mesures). En dehors des patients arythmiques, il a été proposé une mesure ambulatoire de la pression artérielle (Microlife WatchBP 03®) à tous les patients « non éligibles » à l'automesure tensionnelle (malvoyants, hémiplégiques, troubles neuropsychologiques, barrière de langage), sur 44 heures séparant 2 séances d'hémodialyse. Ces mesures étaient réalisées toutes les 15 min de 7 à 22 heures et toutes les 30 mn de 22 à 7 heures (validité : > 40 mesures/jour et > 14/nuit). Il s'agit d'une étude d'évaluation de pratiques recommandées en soins courants chez des hémodialysés > 18 ans, ayant donné leur consentement au recueil et l'analyse des données. Cent-vingt-neuf patients ont été traités par hémodialyse chronique dans nos structures pendant la campagne de mesures hors centre de la pression artérielle. Ces mesures n'ont pu être faites chez 21 patients (4 décédés, 2 greffés et 4 absents avant évaluation ; 7 arythmiques ; 3 refus et 1 polyhandicapé). Parmi les 108 patients (sex ratio 1,25 ; 69,3 ± 13,5 ans), 23 étaient non éligibles pour l'automesure tensionnelle (mal- ou non-voyants, troubles neuro- et/ou psychologiques, barrière de langage). En raison de 4 échecs d'automesure tensionnelle, la faisabilité de l'automesure tensionnelle (n = 81/129) est de 62,8 % (IC 95 % : 54,2–70,7). Parmi les 24 mesures ambulatoires de pression artérielle réalisées (23 chez les non-éligibles pour l'automesure tensionnelle et 1 chez un patient ayant un échec d'automesure tensionnelle), 19 étaient valides. La faisabilité des mesures hors centre de la pression artérielle (n = 100/129) est de 77,5 % (IC 95 % : 69,6–83,4). La faisabilité des mesures hors centre de la pression artérielle chez les hémodialysés est bonne, rendant l'application des recommandations envisageable. The European Renal Association-European Dialysis and Transplant Association (ERA-EDTA)/European Society of Hypertension (ESH) recommends out-of-center blood pressure measurements, self-blood pressure measurement or ambulatory blood pressure measurement in dialysis patients. However, the feasibility of out-of-center blood pressure measurements in routine care is not known. The objective of our study was to quantify it as " a priori " i.e. the percentage of hemodialysis to whom out-of-center blood pressure measurements can be proposed and who accept it, as " a posteriori ", i.e. the percentage of out-of-center blood pressure measurements made and valid. A systematic out-of-center blood pressure measurements program was implemented from April to October 2019 in our chronic hemodialysis structures. It was proposed to each dialysis patient to carry out after education, an self-blood pressure measurement (Omron M3®), from 2 measurements, to 1 to 2 minutes interval, mornings and evenings of 6 days without dialysis (validity: 15 measures). Apart from arrhythmic patients, to all patients "not eligible" for self-blood pressure measurement (visually impaired, hemiplegic, neuropsychological disorders, language barrier), a 44-hour ambulatory blood pressure measurement (Microlife WatchBP 03®) was proposed separating 2 hemodialysis sessions; measures every 15 minutes from 7 a.m. to 10 p.m. and 30 minutes from 10 p.m. to 7 a.m. (validity: 40 measurements/day and 14/night). This is a study evaluating practices recommended for routine care in 18-year-old hemodialysis, having given their consent to the collection and analysis of the data. One hundred twenty nine patients were treated with chronic hemodialysis in our structures during the out-of-center blood pressure measurements campaign. Out-of-center blood pressure measurements could not be done in 21 patients (4 deceased, 2 transplanted and 4 absent before evaluation; 7 arrhythmics; 3 refusals and 1 multiple-disabled). Of these 108 patients (sex ratio 1.25; 69.3 ± 13.5 years), 23 were ineligible for self-blood pressure measurement (visually impaired, neuro- and/or psychological disorders, language barrier). Due to 4 self-blood pressure measurement failures, the feasibility of the self-blood pressure measurement (n = 81/129) is 62.8 % (CI95% 54.2–70.7). Of the 24 ambulatory blood pressure measurements performed (23 among those not eligible for self-blood pressure measurement and 1 failure of self-blood pressure measurement), 19 were valid. The " a posteriori " feasibility of out-of-center blood pressure measurements (n = 100/129) is 77.5 % (CI95% 69.6–83.4). The feasibility of out-of-center blood pressure measurements in hemodialysis patients is good, making the application of the recommendations possible. [ABSTRACT FROM AUTHOR]

Abstract Background Home blood-pressure measurement (HBPM) is recommended for the diagnosis of hypertension and monitoring of patients with hypertension. Since 2013, the French National Health Insurance Body (FNHIB) has promoted HBPM to general practitioners (GPs). The objective of the study was to evaluate the practice of HBPM by French GPs to diagnose and monitor hypertension, 3 years after the beginning of the FNHIB campaign. Methods We conducted a postal survey from 7 March to 31 May 2016. All of the 1040 GPs practising in the Auvergne region in France were invited to participate, using a self-reporting questionnaire. We obtained information on the characteristics of the GPs, and their practice regarding the use of HBPM. Use of HBPM was reported as “never, occasionally, regularly and systematically”. Frequency of HBMP use was analysed using multivariate ordered logistic regression model. Results A total of 569 (54.7%) GPs responded to the survey. They were 50.3 (± 11.5) years old, 241 (43.0%) were female, and 352 (62.7%) worked in urban areas. Among them, 530 (94.5%) reported the use of HBPM for diagnosis and 519 (92.5%) for monitoring hypertension. To diagnose hypertension, younger GPs (OR = 0.97; 95% CI: 0.95–0.98), GPs practising in a group (OR = 1.45; 95% CI: 1.00–2.10) and in an MHC (OR = 2.09; 95% CI: 1.15–3.78), as compared to GPs with individual practices, and Clinical Tutors, as compared to non-Clinical Tutors, (OR = 1.92; 95% CI: 1.33–2.79) reported more frequent use of HBPM. To manage hypertension, female GPs, as compared to male GPs, (OR=1.47; 95% CI: 1.04–2.06), younger GPs (OR = 0.98; 95% CI: 0.97–0.99), and Clinical Tutors (OR = 1.90; 95% CI: 1.31–2.75) reported more frequent use of HBPM. Conclusions Our survey reveals that 3 years after the introduction of the FNHIB incentives, the use of HBPM by participating GPs to diagnose and manage hypertension is well established. A larger survey of GPs from other regions would make it possible to verify whether our results can be extrapolated to France as a whole.

Abstract Background This study aimed to test the feasibility and titration methods used to achieve specific blood pressure (BP) control targets in hypertensive patients of rural China. Methods A randomized, controlled, open-label trial was conducted in Rongcheng, China. We enrolled 105 hypertensive participants aged over 60 years, and who had no history of stroke or cardiovascular disease. The patients were randomly assigned to one of three systolic-BP target groups: standard: 140 to

Objective: To clarify the present situation of home blood pressure (HBP) measurement among Japanese patients. Methods: A nationwide questionnaire survey regarding HBP measurement was conducted on patients aged 20 years or older who had visited 20 community pharmacies to have their prescriptions filled. Results: In total, 76.7% of 1,103 hypertensives and 40.9% of 1,106 normotensives had their own devices for HBP measurement. Compared with normotensives, a higher proportion of hypertensives recognized the guideline-based reference values for HBP and clinic BP. Compared with hypertensives who did not have a physician’s recommendation, those who did more often had their own devices, recognized the guideline-based reference values for HBP, and measured HBP every day (70.4%, 1.5%, and 31.6% vs. 91.1%, 6.9%, and 65.4%, respectively). Among 793 hypertensives who measured HBP, a higher proportion of those with a physician’s recommendation measured HBP according to optimal guideline-based procedures compared with those without. Among 560 hypertensives who recorded HBP readings, a higher proportion of those with a physician’s recommendation (74.6%) showed all HBP readings to their physicians compared with those without (35.3%). Conclusions: Our findings suggest that physicians should recommend measuring HBP in accordance with the Japanese Society of Hypertension guidelines more aggressively, and provide more detailed explanations to patients regarding how to measure HBP.

Aims and objectives: To evaluate the effectiveness of a Family Nurse Practitioner (FNP)‐led programme on the degree of adherence of current recommendations on home blood pressure self‐measurement (HBPM) as compared to routine care and management. Background: HBPM plays an important role for monitoring hypertensive patients; however, patients' adherence to current guidelines is unsatisfactory. A nurse‐led training programme in the community setting could be an effective strategy to achieve high level of patients' adherence to recommendations. Design: A multicentre randomised controlled trial was carried out from September 2016 to September 2017. Methods: In total, 170 patients were randomly allocated into the intervention group (n = 83) and the usual care (n = 87). All participants received usual care (written and verbal information on HBPM recommendations); subjects in the intervention group also received 1‐hour training session on how to correctly self‐measure BP. Clinical trial registration was done (ClinicalTrials.gov.: NCT04681703). The CONSORT checklist for randomised controlled trials was used in this study. Results: At baseline, the level of adherence to the recommendation was similar in the two groups (p <.05). After 1 month, the adherence significantly increased in the intervention group, where patients were more likely to measure BP at the same hour and from the same arm, in a quiet environment, with the back and uncovered arm supported and the legs uncrossed; recording BP more than once in each measurement session; keeping a diary of blood pressure measurements; use of the appropriate cuff and proper placement of the cuff; and resting for >5 min before performing the measurement (all p <.05). Conclusions: The FNP‐led programme is effective in improving patients' adherence to guidelines on the correct technique to self‐measure BP at home. Relevance to clinical practice: This programme may be added to the existing interventions in the community setting or considered into specifically nurse‐led hypertension management models. [ABSTRACT FROM AUTHOR]

Arterial hypertension is a leading preventable cardiovascular risk factor. The definition and thresholds for the diagnosis of hypertension vary between European and American guidelines. That is mainly due to the widely known SPRINT trial in which unattended automated blood pressure measurements were used. This technique of blood pressure estimation requires a patient to be left alone in an office and then a programmed device measures blood pressure automatically. The absence of a health professional during the measurement helps to reduce or eliminate the "white coat" effect; therefore, values of blood pressure may be lower than in conventional office blood pressure measurements. There are premises that this technique can be a solid substitution for 24-hour ambulatory blood pressure measurements and that it can predict hypertension-mediated organ damage more accurately than standard techniques. However, due to the many methods in which measurement can be carried out, no universal protocol exists. More research is needed to evaluate the usefulness of unattended automated office blood pressure measurements in clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to clarify the relationship between decreased sleep quality during the first trimester and a rise in blood pressure during an otherwise normal course of pregnancy in primipara women. Materials and methods: We recruited 128 pregnant women (primipara) who visited the obstetrics and gynecology clinic for medical examination, of which 89 were longitudinally investigated from the first to the third trimester after obtaining informed consent. A survey was conducted in the first, second, and third trimesters to evaluate sleep quality using the Japanese version of the Pittsburgh Sleep Quality Index (PSQI-J). Patients were assigned to either a good sleep quality group (PSQI-J ≤ 5) or a poor sleep quality group (PSQI-J ≥ 6). Blood pressure was measured using a home blood pressure measurement method. We analyzed the relationship between sleep quality in the first trimester and blood pressure during pregnancy. Results: The increase in morning systolic blood pressure from first to third trimester was larger in the poor sleep quality group than in the good sleep quality group (7.1 ± 7.0 vs. 3.0 ± 5.6 mmHg, p

BACKGROUND Little is known about seasonal variation in nighttime blood pressure (BP) measured by a home device. In this cross-sectional study, we sought to assess seasonal variation in nighttime home BP using data from the nationwide, practice-based Japan Morning Surge-Home BP (J-HOP) Nocturnal BP study. METHODS In this study, 2,544 outpatients (mean age 63 years; hypertensives 92%) with cardiovascular risks underwent morning, evening, and nighttime home BP measurements (measured at 2:00, 3:00, and 4:00 am) using validated, automatic, and oscillometric home BP devices. RESULTS Our analysis showed that nighttime home systolic BP (SBP) was higher in summer than in other seasons (summer, 123.3 ± 14.6 mmHg vs. spring, 120.7 ± 14.8 mmHg; autumn, 121.1 ± 14.8 mmHg; winter, 119.3 ± 14.0 mmHg; all P <0.05). Moreover, we assessed seasonal variation in the prevalence of elevated nighttime home SBP (≥120 mmHg) in patients with non-elevated daytime home SBP (average of morning and evening home SBP <135 mmHg; n = 1,565), i.e. masked nocturnal hypertension, which was highest in summer (summer, 45.6% vs. spring, 27.2%; autumn, 28.8%; winter, 24.9%; all P <0.05). Even in intensively controlled morning home SBP (<125 mmHg), the prevalence of masked nocturnal hypertension was higher in summer (summer, 27.4% vs. spring, 14.2%; autumn, 8.9%; winter, 9.0%; all P <0.05). The urine albumin–creatinine ratio in patients with masked nocturnal hypertension tended to be higher than that in patients with non-elevated both daytime and nighttime SBP throughout each season. CONCLUSIONS The prevalence of masked nocturnal hypertension was higher in summer than other seasons and the difference proved to be clinically meaningful. [ABSTRACT FROM AUTHOR]

Background: Home blood-pressure measurement (HBPM) is recommended for the diagnosis of hypertension and monitoring of patients with hypertension. Since 2013, the French National Health Insurance Body (FNHIB) has promoted HBPM to general practitioners (GPs). The objective of the study was to evaluate the practice of HBPM by French GPs to diagnose and monitor hypertension, 3 years after the beginning of the FNHIB campaign. Methods: We conducted a postal survey from 7 March to 31 May 2016. All of the 1040 GPs practising in the Auvergne region in France were invited to participate, using a self-reporting questionnaire. We obtained information on the characteristics of the GPs, and their practice regarding the use of HBPM. Use of HBPM was reported as "never, occasionally, regularly and systematically". Frequency of HBMP use was analysed using multivariate ordered logistic regression model. Results: A total of 569 (54.7%) GPs responded to the survey. They were 50.3 (± 11.5) years old, 241 (43.0%) were female, and 352 (62.7%) worked in urban areas. Among them, 530 (94.5%) reported the use of HBPM for diagnosis and 519 (92.5%) for monitoring hypertension. To diagnose hypertension, younger GPs (OR = 0.97; 95% CI: 0.95–0.98), GPs practising in a group (OR = 1.45; 95% CI: 1.00–2.10) and in an MHC (OR = 2.09; 95% CI: 1.15–3.78), as compared to GPs with individual practices, and Clinical Tutors, as compared to non-Clinical Tutors, (OR = 1.92; 95% CI: 1.33–2.79) reported more frequent use of HBPM. To manage hypertension, female GPs, as compared to male GPs, (OR=1.47; 95% CI: 1.04–2.06), younger GPs (OR = 0.98; 95% CI: 0.97–0.99), and Clinical Tutors (OR = 1.90; 95% CI: 1.31–2.75) reported more frequent use of HBPM. Conclusions: Our survey reveals that 3 years after the introduction of the FNHIB incentives, the use of HBPM by participating GPs to diagnose and manage hypertension is well established. A larger survey of GPs from other regions would make it possible to verify whether our results can be extrapolated to France as a whole. [ABSTRACT FROM AUTHOR]

Morning hypertension is an independent risk for cerebrovascular and cardiovascular events. Although the prevalence of morning hypertension increases with age, treatment of morning hypertension has not been established, particularly in Very-Elderly patients. We compared the safety and efficacy of a losartan/hydrochlorothiazide (HCTZ) combination in controlling morning hypertension between Very-Elderly (≥75 years) and Young/Elderly patients (

Background: This study aimed to test the feasibility and titration methods used to achieve specific blood pressure (BP) control targets in hypertensive patients of rural China.Methods: A randomized, controlled, open-label trial was conducted in Rongcheng, China. We enrolled 105 hypertensive participants aged over 60 years, and who had no history of stroke or cardiovascular disease. The patients were randomly assigned to one of three systolic-BP target groups: standard: 140 to < 150 mmHg; moderately intensive: 130 to < 140 mmHg; and intensive: < 130 mmHg. The patients were followed for 6 months.Discussion: The optimal target for systolic blood pressure (SBP) lowering is still uncertain worldwide and such information is critically needed, especially in China. However, in China the rates of awareness, treatment and control are only 46.9%, 40.7%, and 15.3%, respectively. It is challenging to achieve BP control in the real world and it is very important to develop population-specific BP-control protocols that fully consider the population's characteristics, such as age, sex, socio-economic status, compliance with medication, education level, and lifestyle. This randomized trial showed the feasibility and safety of the titration protocol to achieve desirable SBP targets (< 150, < 140, and < 130 mmHg) in a sample of rural, Chinese hypertensive patients. The three BP target groups had similar baseline characteristics. After 6 months of treatment, the mean SBP measured at an office visit was 137.2 mmHg, 131.1 mmHg, and 124.2 mmHg, respectively, in the three groups. Home BP and central aortic BP measurements were also obtained. At 6 months, home BP measurements (2 h after drug administration) showed a mean SBP of 130.9 mmHg in the standard group, 124.9 mmHg in the moderately intensive group, and 119.7 mmHg in the intensive group. No serious adverse events were recorded over the 6-month study period. Rates of adverse events, including dry cough, palpitations, and arthralgia, were low and showed no significant differences between the three groups. This trial provided real-world experience and laid the foundation for a future, large-scale, BP target study.Trial Registration: Feasibility Study of the Intensive Systolic Blood Pressure Control; ClinicalTrials.gov, ID: NCT02817503. Registered retrospectively on 29 June 2016. [ABSTRACT FROM AUTHOR]

Objective: To clarify the present situation of home blood pressure (HBP) measurement among Japanese patients. Methods: A nationwide questionnaire survey regarding HBP measurement was conducted on patients aged 20 years or older who had visited 20 community pharmacies to have their prescriptions filled. Results: In total, 76.7% of 1,103 hypertensives and 40.9% of 1,106 normotensives had their own devices for HBP measurement. Compared with normotensives, a higher proportion of hypertensives recognized the guideline-based reference values for HBP and clinic BP. Compared with hypertensives who did not have a physician's recommendation, those who did more often had their own devices, recognized the guideline-based reference values for HBP, and measured HBP every day (70.4%, 1.5%, and 31.6% vs. 91.1%, 6.9%, and 65.4%, respectively). Among 793 hypertensives who measured HBP, a higher proportion of those with a physician's recommendation measured HBP according to optimal guideline-based procedures compared with those without. Among 560 hypertensives who recorded HBP readings, a higher proportion of those with a physician's recommendation (74.6%) showed all HBP readings to their physicians compared with those without (35.3%). Conclusions: Our findings suggest that physicians should recommend measuring HBP in accordance with the Japanese Society of Hypertension guidelines more aggressively, and provide more detailed explanations to patients regarding how to measure HBP. [ABSTRACT FROM AUTHOR]

Alaa Azaki,1,* Reem Diab,1,* Aya Harb,1,* Roland Asmar,1,2 Mirna N Chahine1,2 1Faculty of Medical Sciences, Lebanese University, Hadath, 2Foundation‑Medical Research Institutes (F-MRI®), Beirut, Lebanon *These authors contributed equally to this work Objective: Two oscillometric devices, the Microlife WatchBP O3® and the Omron RS6®, designed for self-blood pressure measurement were evaluated according to the European Society of Hypertension (ESH)-International Protocol (IP) Revision 2010 in the obese population. Methods: The Microlife WatchBP O3 measures blood pressure (BP) at the brachial level and the Omron RS6 measures BP at the wrist level. The ESH-IP revision 2010 includes a total of 33 subjects. The difference between observers’ and device BP values was calculated for each measure. A total of 99 pairs of BP differences were classified into three categories (≤5, ≤10, and ≤15 mmHg). The protocol procedures were followed precisely in each of the two studies. Results: Microlife WatchBP O3 and Omron RS6 failed to fulfill the criteria of the ESH-IP. The mean differences between the device and the mercury readings were: 0.3±7.8 mmHg and −1.9±6.4 mmHg for systolic BP and diastolic BP, respectively, for Microlife WatchBP O3, and 2.7±9.9 mmHg for SBP and 3.5±11.1 mmHg for diastolic BP for Omron RS6. Conclusion: Microlife WatchBP O3 and Omron RS6 readings differing from the mercury standard by more than 5, 10, and 15 mmHg failed to fulfill the ESH-IP revision 2010 requirements in obese subjects. Therefore, the two devices cannot be recommended for use in obese subjects. Keywords: Microlife WatchBP O3, Omron RS6, validation, blood pressure measurement, home blood pressure measurement, obese population, European Society of Hypertension, International Protocol

Purpose: The purpose of this study was to clarify the relationship between decreased sleep quality during the first trimester and a rise in blood pressure during an otherwise normal course of pregnancy in primipara women. Materials and methods: We recruited 128 pregnant women (primipara) who visited the obstetrics and gynecology clinic for medical examination, of which 89 were longitudinally investigated from the first to the third trimester after obtaining informed consent. A survey was conducted in the first, second, and third trimesters to evaluate sleep quality using the Japanese version of the Pittsburgh Sleep Quality Index (PSQI-J). Patients were assigned to either a good sleep quality group (PSQI-J ≤ 5) or a poor sleep quality group (PSQI-J ≥ 6). Blood pressure was measured using a home blood pressure measurement method. We analyzed the relationship between sleep quality in the first trimester and blood pressure during pregnancy. Results: The increase in morning systolic blood pressure from first to third trimester was larger in the poor sleep quality group than in the good sleep quality group (7.1 ± 7.0 vs. 3.0 ± 5.6 mmHg, p <.01). Sleep latency (r = 0.38, β = 0.43, p =.02) and sleep disturbances (r = 0.24, β = 0.33, p =.04) in the first trimester affected the increase in systolic blood pressure during pregnancy. Conclusions: Understanding sleep quality at the beginning of pregnancy can help predict a rise in systolic blood pressure in the third trimester. This emphasizes the importance of sleep education during pregnancy. [ABSTRACT FROM AUTHOR]

Aim. To analyze correctness of office blood pressure (BP) measurement by physicians and home-based BP monitoring (HBPM) — by the patients, and to assess the efficacy of patients teaching for correct BP self-measurement and control.Material and methods. Totally, 46 physicians questioned (32 local internists and 14 general practitioners with experience 2-27 years) and 290 patients with arterial hypertension (AH).Results. It was revealed that the following parameters were not unified: choice of arm, size of a cuff, times BP measured, time interval for repeated measurement, recording of BP by patients and physicians. These parameters did not suffice totally the Russian guidelines on diagnostics and treatment of arterial hypertension. About a half of BP patients by themselves corrected antihypertension treatment and dealt with the “crises”.Conclusion. Education of patients for BP measurement rules must be performed in “AH schools” and in offices (prevention departments) under supervision of local internists and general practitioners. Such events, as regular update of sphygmomanometers and supply physicians by cuffs of various size, will help to achieve better BP measurement quality in office, as in screening.

Current guidelines make no recommendations on the optimal timing or number of measurements for assessing home blood pressure variability (HBPV). Our aim was to elucidate the optimal schedule for measuring HBPV in relation to cardiovascular risk. METHODS In total, 1,706 Finnish adults (56.5 ± 8.5 years; 54% women) self-measured their home blood pressure (HBP) twice in the morning and evening during 7 consecutive days. The participants were followed up for cardiovascular events. We examined the association between HBPV (coefficient of variation based on 2 through 7 measurement days) and cardiovascular events using Cox regression models adjusted for HBP and other cardiovascular risk factors. RESULTS During a follow-up of 11.8 ± 3.1 years, 216 cardiovascular events occurred. Systolic morning HBPV based on three (hazard ratio [HR], 1.039; 95% confidence interval, 1.006-1.074, model c statistic 0.737) through seven (HR, 1.057; 95% confidence interval, 1.012-1.104, model c statistic 0.737) measurement days was significantly associated with cardiovascular events. Agreement in classification to normal vs. increased morning day-to-day HBPV between consecutive measurement days became substantial (κ = 0.69 for systolic and κ = 0.68 for diastolic) after the fourth measurement day. The associations of diastolic HBPV, evening HBPV, all-day HBPV, and variability based on first measurements of each measurement occasion, with cardiovascular outcomes were nonsignificant or remained significant only after the sixth measurement day. CONCLUSIONS Our results suggest systolic HBP should be measured twice in the morning for at least 3 days when assessing HBPV. Increasing the number of measurement days from 3 to 7 results in marginal improvement in prognostic accuracy. [ABSTRACT FROM AUTHOR]

Morning hypertension is an independent risk for cerebrovascular and cardiovascular events. Although the prevalence of morning hypertension increases with age, treatment of morning hypertension has not been established, particularly in Very-Elderly patients. We compared the safety and efficacy of a losartan/hydrochlorothiazide (HCTZ) combination in controlling morning hypertension between Very-Elderly (≥75 years) and Young/Elderly patients (<75 years). This study was a subanalysis of the Morning Hypertension and Angiotensin Receptor Blocker/Hydrochlorothiazide Combination Therapy study, in which patients with morning hypertension (≥135/85 mmHg) received a 50-mg losartan/12.5-mg HCTZ combination tablet (combination therapy) or 100-mg losartan (high-dose therapy) for 3 months. High adherence rates and few adverse effects were observed in Very-Elderly patients receiving combination (n = 32) and high-dose (n = 34) therapies and in Young/Elderly patients receiving combination (n = 69) and high-dose (n = 66) therapies. Baseline morning systolic BP (SBP) was similar in both age groups receiving either therapy. Morning SBP was reduced by 20.2 and 18.1 mmHg with combination therapy and by 7.1 and 9.1 mmHg with high-dose therapy in the Very-Elderly and Young/Elderly patients, respectively. Morning BP target (<135/85 mmHg) was achieved in 40.6% and 55.1% by combination therapy and in 14.7% and 24.2% by high-dose therapy in the Very-Elderly and Young/Elderly patients, respectively. Neither therapy changed renal function and serum potassium in Very-Elderly patients. In conclusion, the losartan/HCTZ combination was safe and effective in controlling morning hypertension in Very-Elderly as well as Young/Elderly patients. In addition, combination therapy was also superior to high-dose therapy for lowering morning SBP in Very-Elderly patients. [ABSTRACT FROM AUTHOR]

The COMmunity Pharamcists ASSist for Blood Pressure (COMPASS-BP) study aimed to assess the effectiveness of lifestyle support programs administered in community pharmacies on hypertension control. This open-label, two-armed parallel group, cluster-randomized controlled trial included 73 pharmacies (clusters) in Japan randomized to a control or intervention group. Eligible hypertensive patients (n = 125), aged 20-75 years, received the intervention (n = 64) or the control treatment (n = 61), as dictated by their pharmacy randomization. Patients in the intervention group received brochures and healthy lifestyle advice from pharmacists using motivational interviewing methods during pharmacy visits over a 12-week period, with their usual pharmacy care. Conversely, the control group just received usual care. The main outcome measure was a change in morning systolic blood pressure (SBP) from baseline to week 12. The intervention group exhibited a decrease in morning SBP that was 6.0 mmHg greater than that of the control group (95% confidence interval [CI]: -11.0 to -0.9, p = 0.021). In a mixed-effect model for repeated measures analysis, the intergroup difference in morning SBP decrease was -4.5 mmHg (95% CI: -8.5 to -0.6, p = 0.024). Our findings indicate that implementation of a lifestyle advice program in pharmacies is feasible and may lead to reduced blood pressure. [ABSTRACT FROM AUTHOR]

BACKGROUND Differences between the recently suggested outcome-driven diagnostic threshold of home blood pressure (HBP) measurements and the currently recommended diagnostic threshold of HBP measurements may cause a disagreement between 24-hour ambulatory blood pressure (ABP) and HBP measurements in the diagnosis of hypertension. We evaluated the agreement of various HBP diagnostic thresholds (135/85, 130/85, and 130/80 mm Hg) to ABP measurements, as a reference method. METHODS Patients who were confirmed to have high BP (≥140/90 mm Hg) at the outpatient clinic were referred. HBP measurement was performed for 7 days in triplicates every morning and evening. The 24-hour ABP measurement was performed on the 8th day. Using 24-hour ABP measurement as a reference method, we analyzed HBP diagnostic thresholds at 135/85, 130/85, and 130/80 mm Hg. RESULTS Among 319 patients, 256 patients (mean age, 51.8 ± 9.7 years; 119 men) with valid HBP measurements and 24-hour ABP measurements were enrolled. The threshold of 130/80 mm Hg showed the highest diagnostic sensitivity (P = 0.001) with diagnostic agreement by Kappa statistics. Using 130/80 mm Hg as a diagnostic threshold of hypertension, the prevalence of masked hypertension was significantly lower than 130/85 and 135/85 mm Hg (7.8, 15.2, and 18.4%, respectively, P = 0.002). CONCLUSIONS The present study suggests that lowering the diagnostic thresholds of HBP measurement from 135/85 mm Hg to 130/80 mm Hg may improve diagnostic accuracy for hypertension. [ABSTRACT FROM AUTHOR]

Objective: Two oscillometric devices, the Microlife WatchBP O3® and the Omron RS6®, designed for self-blood pressure measurement were evaluated according to the European Society of Hypertension (ESH)-International Protocol (IP) Revision 2010 in the obese population.Methods: The Microlife WatchBP O3 measures blood pressure (BP) at the brachial level and the Omron RS6 measures BP at the wrist level. The ESH-IP revision 2010 includes a total of 33 subjects. The difference between observers' and device BP values was calculated for each measure. A total of 99 pairs of BP differences were classified into three categories (≤5, ≤10, and ≤15 mmHg). The protocol procedures were followed precisely in each of the two studies.Results: Microlife WatchBP O3 and Omron RS6 failed to fulfill the criteria of the ESH-IP. The mean differences between the device and the mercury readings were: 0.3±7.8 mmHg and -1.9±6.4 mmHg for systolic BP and diastolic BP, respectively, for Microlife WatchBP O3, and 2.7±9.9 mmHg for SBP and 3.5±11.1 mmHg for diastolic BP for Omron RS6.Conclusion: Microlife WatchBP O3 and Omron RS6 readings differing from the mercury standard by more than 5, 10, and 15 mmHg failed to fulfill the ESH-IP revision 2010 requirements in obese subjects. Therefore, the two devices cannot be recommended for use in obese subjects. [ABSTRACT FROM AUTHOR]

Hypertension in pregnancy has several forms that differ by their mechanisms and their consequences for mothers and fetus. Chronic hypertension is defined by systolic blood pressure (SBP) ≥ 140mm Hg or diastolic blood pressure (DBP) ≥ 90mm Hg before pregnancy or before the 20th week of amenorrhea. Gestational hypertension is defined by SBP≥140mmHg or DBP ≥ 90mm Hg during or after the 20th week of amenorrhea. Pre-eclampsia is the occurrence of hypertension and proteinuria after 20 weeks of amenorrhea. Severe pre-eclampsia is accompanied by clinical signs and symptoms indicating visceral pain. A pre-eclampsia develops in 1-2 % of pregnancies, but much more frequently (up 34 %) in the presence of risk factors. High blood pressure during pregnancy remains, by its complications, the leading cause of maternal morbidity and mortality. Although symptomatic management has improved, there is currently no specific curative treatment, and only childbirth and delivery of the placenta, usually prematurely, alleviate the mother's symptoms. In the first six months of pregnancy, the primary goal of treatment is to prevent the complications of severe hypertension. Initiation of antihypertensive drug treatment is recommended in pregnant women with severe hypertension. Initiation of antihypertensive drug treatment should also be considered in pregnant women at high cardiovascular risk with moderate hypertension. A SBP goal <160 and a DBP goal between 85 and 100mm Hg is recommended in pregnancy. During the long-term followup, American and European scientific societies, French society of hypertension and French national college of gynecologists-obstetricians have recognized hypertension in pregnancy and pre-eclampsia as specific emerging risk of women. Pre-eclampsia is a specific risk factor of chronic hypertension, of coronary events, of stroke, of chronic renal failure and a specific risk factor of cardiovascular mortality. Paradoxically, information of these women at risk is insufficient to ignorance and lack of awareness among health professionals. The education of women has become a major issue of prevention, developing specific consultation after delivery, encouraging them to optimize their lifestyle with a coordinated follow-up. In the end, the implementation of structured care pathway, further monitoring of these women, aims to improve the practices of health professionals. This is what drove the French Society of Hypertension, in partnership with the French National College of Gynecologists-Obstetricians, to develop a consensus proposing easy-to-use guidelines. [ABSTRACT FROM AUTHOR]

BACKGROUND: Adherence to medication and lifestyle interventions are essential keys for the management of hypertension. In this respect, a structured educational program for hypertensive patients has got remarkable merits (herz.leben). In order to determine the isolated effect of participation in the educational program, neglecting the possible impact of more intense care, this prospective multicenter randomized controlled study was designed (NCT00453037). METHODS: A total of 256 patients in 13 centers were enrolled and randomly assigned to 2 groups (G). G-I (n = 137) underwent the educational program immediately (T-0), G-II (n = 119) after 6 months (T-6). Follow-up visits were done after 6 (T-6) and 12 (T-12) months. Primary endpoint was a difference in office blood pressure (BP) at T-6, when only G-I had undergone the educational program. RESULTS: Patients' baseline characteristics were comparable. At T-6, systolic office and home BP were significantly lower in G-I compared to G-II: office BP systolic 139 (134-150) mm Hg vs. 150 (135-165) mm Hg (P < 0.01); diastolic 80 (76-85) mm Hg vs. 84 (75-90) mm Hg (ns); home BP systolic 133 (130-140) mm Hg vs. 142 (132-150) mm Hg (P < 0.01); diastolic 80 (75-85) mm Hg vs. 80 (76-89) mm Hg (ns)). At T-12, when all patients had undergone the educational program differences in BP disappeared. CONCLUSION: The results of this multicenter randomized controlled study provide significant evidence for benefit by participation in a structured educational program. Positive effects seem to be mediated by better adherence and life style changes due to higher levels of information and patient empowerment. Therefore, educational strategies should be considered as standard of care for hypertensive patients. [ABSTRACT FROM AUTHOR]

Résumé Alors que la pratique régulière d’une activité physique (AP) est recommandée en cas d’hypertension artérielle (HTA), le niveau d’AP des sujets hypertendus reste mal connu. Notre objectif était d’étudier l’association entre le niveau d’AP et le caractère contrôlé ou non de l’HTA de sujets vus en consultation dans 9 centres spécialisés en HTA. Quatre-vingt-cinq sujets hypertendus ont été inclus (59 ± 14 ans, 61 % d’hommes, 12 % fumeurs, 29 % diabétiques). Au décours de leur consultation, une automesure tensionnelle (AMT) sur 7 jours (2 mesures le matin + 2 le soir) était réalisée, ainsi qu’un compte rendu de leurs activités quotidiennes permettant d’estimer la dépense calorique additionnelle à l’aide d’une réglette Acti-MET extrapolée du questionnaire international d’activités physiques (IPAQ). Les sujets complétaient ensuite un auto-questionnaire « score de Dijon » sur 30 points (distinguant les sujets actifs, score > 20/30, des sédentaires < 10/30). Les hypertendus contrôlés en AMT (< 135/85 mm Hg) (55 % des sujets), en comparaison aux non contrôlés, étaient plus âgés, avaient une tendance non significative à une dépense calorique déclarée plus élevée (4959 ± 5045 kcal/semaine vs 4048 ± 4199 kcal/semaine, p = 0,3755) et leur score de Dijon (19,44 ± 5,81 vs 18,00 ± 4,32, p = 0,2094) montrait une proportion de sujets « actifs » plus importante (48,9 % vs 34,2 %, p = 0,1773). En conclusion, nos résultats ont objectivé une « tendance » à une AP déclarée plus importante pour les sujets dont l’HTA est contrôlée. Ceci nous encourage à poursuivre par une étude qui inclurait davantage de sujets et dont l’AP serait évaluée par le port pendant 7 jours d’un capteur de type accéléromètre (méthode objective). While physical activity (PA) is recommended for high blood pressure management, the level of PA practice of hypertensive patients remains unclear. We aimed to assess the association between the level of both PA and blood pressure of individuals consulting in 9 hypertension specialist centres. Eighty-five hypertensive patients were included (59 ± 14 years, 61% men, 12% smokers, 29% with diabetes). Following their consultation, they performed home blood pressure measurement (HBPM) over 7 days (2 in the morning + 2 in the evening), they wrote in a dedicated form their daily activities to estimate the additional caloric expenditure using Acti-MET device (built from International physical Activity Questionnaire [IPAQ]). Thus, patients completed a self-administered questionnaire “score of Dijon” (distinguishing active subjects with a score > 20/30, from sedentary < 10/30). Subjects with normal HBPM value (< 135/85 mm Hg) (55% of them) compared to those with high HBPM were older, had a non-significant trend towards higher weekly caloric expenditure (4959 ± 5045 kcal/week vs. 4048 ± 4199 kcal/week, P = 0.3755) and score of Dijon (19.44 ± 5.81 vs. 18.00 ± 4.32, P = 0.2094) with a higher proportion of “active” subjects (48.9% vs. 34.2%, P = 0.1773). In conclusion, our results demonstrate a “tendency” to a higher level of reported PA for subjects whose hypertension was controlled. This encourages us to continue with a study that would include more subjects, which would assess PA level using an objective method such as wearing an accelerometer sensor. [ABSTRACT FROM AUTHOR]

Although both clinic blood pressure (BP) variability and home BP variability are associated with the risk of cardiovascular disease, the relationship between both BP variabilities remain unclear. We evaluated the association between visit-to-visit variability of clinic BP (VVV) and day-by-day home BP variability (HBPV) in patients with chronic kidney disease (CKD). We recruited 143 CKD patients in whom we performed HBP measurements every morning and evening over seven consecutive days. We obtained clinic BP data during 9.6 ± 1.0 consecutive visits within 24 months. The associations between the variables of VVV and HPBV were examined. The CV values of clinic systolic BP (CSBP) was significantly correlated with the mean values of morning systolic BP (MSBP) and those of evening systolic BP (ESBP) ( r = 0.23, 0.20; p = 0.007, 0.02, respectively). The CV values of CSBP was significantly correlated with the CV values of MSBP and those of ESBP ( r = 0.19, 0.31; p = 0.02, <0.001, respectively). On the multivariate regression analysis, the CV values of CSBP was significantly correlated with the CV values of MSBP and those of ESBP [standardized regression coefficient ( β) = 0.19, 0.34; p = 0.03, <0.001, respectively]. In conclusion, VVV showed a weak but significant association with HBPV, especially the CV values of ESBP in CKD patients. Further studies are necessary to clarify whether these different BPV elements will be alternative marker of BPV. [ABSTRACT FROM AUTHOR]

Background: Inadequate blood pressure (BP) control is a frequent challenge in general practice. The objective of this study was to determine whether a color-coded BP booklet using a traffic light scheme (red, >180 mmHg systolic BP and/or >110 mmHg diastolic BP; yellow, >140-180 mmHg systolic BP or >90-110 mmHg diastolic BP; green, ≤140 mmHg systolic BP and ≤90 mmHg diastolic BP) improves BP control and adherence with home BP measurement. Methods: In this two-group, randomized controlled trial, general practitioners recruited adult patients with a BP >140 mmHg systolic and/or >90 mmHg diastolic. Patients in the control group received a standard BP booklet and the intervention group used a color-coded booklet for daily home BP measurement. The main outcomes were changes in BP, BP control (treatment goal >140/90 mmHg), and adherence with home BP measurement after 6 months. Results: One hundred and twenty-one of 137 included patients qualified for analysis. After 6 months, a significant decrease in systolic and diastolic BP was achieved in both groups, with no significant difference between the groups (16.1/7.9 mmHg in the intervention group versus 13.1/8.6 mmHg in the control group, P=0.3/0.7). BP control (treatment target <140/90 mmHg) was achieved significantly more often in the intervention group (43% versus 25%; P=0.037; number needed to treat of 5). Adherence with home BP measurement overall was high, with a trend in favor of the intervention group (98.6% versus 96.2%; P=0.1) Conclusion: Color-coded BP self-monitoring significantly improved BP control (number needed to treat of 5, meaning that every fifth patient utilizing color-coded self-monitoring achieved better BP control after 6 months), but no significant between-group difference was observed in BP change. A markedly higher percentage of patients achieved BP values in the normal range. This simple, inexpensive approach of color-coded BP self-monitoring is user-friendly and applicable in primary care, and should be implemented in the care of patients with arterial hypertension. [ABSTRACT FROM AUTHOR]