| 1. |
- Al-Karkhi, Isam, et al.
(författare)
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Comparisons of automated blood pressures in a primary health care setting with self-measurements at the office and at home using the Omron i-C10 device
- 2015
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Ingår i: Blood Pressure Monitoring. - : Lippincott Williams & Wilkins. - 1359-5237 .- 1473-5725. ; 20:2, s. 98-103
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: We aimed to compare blood pressure (BP) levels recorded using the semiautomatic oscillometric Omron i-C10 BP device in patients with or without hypertension in three different settings: (a) when used by a doctor or a nurse at the office (OBP); (b) when used for self-measurement by the patient at the office (SMOBP); and (c) when used for 7 consecutive days at home (HBP).MATERIALS AND METHODS: A total of 247 individuals were invited to participate, but 78 of these individuals declined and a further seven were excluded, leaving a final cohort of 162 participants.RESULTS: The mean OBP was higher than HBP (difference 8.1±14/3.1±8.8 mmHg, P<0.0001) and so was SMOBP compared with HBP (difference 7.0±13/4.2±7.3 mmHg, P<0.0001). Sixteen participants (9.9%) had at least 10 mmHg higher systolic SMOBP than OBP and 28 (17%) participants had at least 10 mmHg lower systolic SMOBP than OBP. Participants who were current smokers had a larger mean difference between systolic OBP and SMOBP than nonsmokers (OBP-SMOBP in smokers: 6.6±9.4 mmHg, OBP-SMOBP in nonsmokers: 0.5±9.2 mmHg, P=0.011 between groups).CONCLUSION: Self-measurement of BP in the office does not preclude an increase in BP when levels in the individual patients are compared with HBP using the same equipment. Thus, SMOBP with a semiautomatic device does not lead to a reduction in the white-coat effect in the same manner as fully automatic devices.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/3.0.
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| 2. |
- Carlsson, Axel C., et al.
(författare)
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Blood pressure measures and their predictive ability of cardiovascular mortality : a 26-year follow-up
- 2013
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Ingår i: Blood Pressure Monitoring. - 1359-5237 .- 1473-5725. ; 18:2, s. 72-77
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Tidskriftsartikel (refereegranskat)abstract
- Objective(s) Our aim was to calculate the predictability of different blood pressure measures for cardiovascular mortality in a cohort of both men and women. We also aimed to determine whether clinically applicable cut-off levels for cardiovascular mortality risk of these measures work well. Materials and methods A healthcare need investigation from the 1970s was used. Participants aged 46-65 were included, n=788 (390 men and 398 women). The following blood pressure measures were studied: systolic, diastolic, mean, mid, and pulse pressure. The participants were followed for 26 years with respect to cardiovascular mortality through the Swedish Cause-of-Death Register. Isolated diastolic hypertension failed to show significant associations with cardiovascular mortality. Results Combined systolic and diastolic hypertension showed twice as high cardiovascular mortality in men and women compared with those with normal blood pressure. Mid arterial blood pressure showed increased significant hazard ratios for all three grades of hypertension in men and for grades 2 and 3 in women with good predictability (area under the curve=0.72 and 0.80, respectively). Conclusions Mid arterial blood pressure is strongly associated with cardiovascular mortality. Additional studies in larger populations and with a wider age range comparing mid arterial blood pressure with clinically useful cut-offs of other blood pressure measures are required to corroborate our findings.
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| 3. |
- Eriksson, Marie, et al.
(författare)
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Comparison of blood pressure measurements between an automated oscillometric device and a Hawksley random-zero sphygmomanometer in the northern Sweden MONICA study.
- 2012
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Ingår i: Blood Pressure Monitoring. - 1359-5237 .- 1473-5725. ; 17:4, s. 164-170
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The Hawksley random-zero sphygmomanometer (random-zero) has been used widely in epidemiological observation studies. This study compares blood pressure measurements using the random-zero with measurements using an automated oscillometric device and suggests a correction of the automated oscillometric measurements to enable comparisons of blood pressure levels over time.METHODS: The northern Sweden MONICA population survey 2009 included 1729 participants, 853 men and 876 women, 25-74 years old. Blood pressure was measured using both random-zero and an automated oscillometric device in all participants. The Omron M7 digital blood pressure monitor was used for automated oscillometric measurements. A linear mixed model was used to derive a formula to adjust the automated oscillometric readings.RESULTS: Automated oscillometric measurements of systolic blood pressure were generally lower than random-zero measurements in women [oscillometric mean 122.1 mmHg (95% confidence interval: 121.0-123.2) versus random-zero mean 124.4 mmHg (123.5-125.5)], whereas automated oscillometric measurements of systolic blood pressure were generally higher than random-zero measurements in men [oscillometric 131.1 mmHg (130.0-132.2) versus random-zero 129.0 mmHg (127.9-130.1)]. For diastolic blood pressure, automated oscillometric measurements were higher in both women [oscillometric 79.9 mmHg (79.2-80.5) versus random-zero 76.7 mmHg (76.0-77.4)] and men [oscillometric 83.1 mmHg (82.4-83.8) vs. random-zero 81.2 mmHg (80.6-81.9)]. The difference also varied with age and order of measurement. Adjustment of the automated oscillometric measurements using mixed model regression coefficients produced estimates of blood pressure that were close to the random-zero measurements.CONCLUSION: Blood pressure measurements using an automated oscillometric device differ from those with random-zero, but the oscillometric measurements can be adjusted, on the basis of sex, age and measurement order, to be similar to the random-zero measurements.
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| 4. |
- Kikuya, Masahiro, et al.
(författare)
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Diagnostic thresholds for ambulatory blood pressure monitoring based on 10-year cardiovascular risk
- 2007
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Ingår i: Circulation. - 0009-7322 .- 1524-4539. ; 12:6, s. 393-395
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Tidskriftsartikel (refereegranskat)abstract
- Background - Current diagnostic thresholds for ambulatory blood pressure ( ABP) mainly rely on statistical parameters derived from reference populations. We determined an outcome-driven reference frame for ABP measurement. Methods and Results - We performed 24-hour ABP monitoring in 5682 participants ( mean age 59.0 years; 43.3% women) enrolled in prospective population studies in Copenhagen, Denmark; Noorderkempen, Belgium; Ohasama, Japan; and Uppsala, Sweden. In multivariate analyses, we determined ABP thresholds, which yielded 10-year cardiovascular risks similar to those associated with optimal ( 120/80 mm Hg), normal ( 130/85 mm Hg), and high ( 140/90 mm Hg) blood pressure on office measurement. Over 9.7 years ( median), 814 cardiovascular end points occurred, including 377 strokes and 435 cardiac events. Systolic/diastolic thresholds for optimal ABP were 116.8/74.2 mm Hg for 24 hours, 121.6/78.9 mm Hg for daytime, and 100.9/65.3 mm Hg for nighttime. Corresponding thresholds for normal ABP were 123.9/76.8, 129.9/82.6, and 110.2/68.1 mm Hg, respectively, and those for ambulatory hypertension were 131.0/79.4, 138.2/86.4, and 119.5/70.8 mm Hg. After rounding, approximate thresholds for optimal ABP amounted to 115/75 mm Hg for 24 hours, 120/80 mm Hg for daytime, and 100/65 mm Hg for nighttime. Rounded thresholds for normal ABP were 125/75, 130/85, and 110/70 mm Hg, respectively, and those for ambulatory hypertension were 130/80, 140/85, and 120/70 mm Hg. Conclusions - Population-based outcome-driven thresholds for optimal and normal ABP are lower than those currently proposed by hypertension guidelines.
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| 5. |
- Li, Yan, et al.
(författare)
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Is blood pressure during the night more predictive of cardiovascular outcome than during the day?
- 2008
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Ingår i: Blood Pressure Monitoring. - 1359-5237 .- 1473-5725. ; 13:3, s. 145-147
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was to investigate the prognostic significance of the ambulatory blood pressure (BP) during night and day and of the night-to-day BP ratio (NDR). We studied 7458 participants (mean age 56.8 years; 45.8% women) enrolled in the International Database on Ambulatory BP in relation to Cardiovascular Outcome. Using Cox models, we calculated hazard ratios (HR) adjusted for cohort and cardiovascular risk factors. Over 9.6 years (median), 983 deaths and 943 cardiovascular events occurred. Nighttime BP predicted mortality outcomes (HR, 1.18-1.24; P<0.01) independent of daytime BP. Conversely, daytime systolic (HR, 0.84; P<0.01) and diastolic BP (HR, 0.88; P<0.05) predicted only noncardiovascular mortality after adjustment for nighttime BR Both daytime BP and nighttime BP consistently predicted all cardiovascular events (HR, 1.11-1.33, P<0.05) and stroke (HR, 1.21-1.47; P<0.01). Daytime BP lost its prognostic significance for cardiovascular events in patients on antihypertensive treatment. Adjusted for the 24-h BP, NDR predicted mortality (P<0.05), but not fatal combined with nonfatal events. Participants with systolic NDR of at least 1 compared with participants with normal NDR (>= 0.80 to < 0.90) were older, at higher risk of death, but died at higher age. The predictive accuracy of the daytime and nighttime BP and the NDR depended on the disease outcome under study. The increased mortality in patients with higher NDR probably indicates reverse causality. Our findings support recording the ambulatory BP during the whole day.
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| 6. |
- Lind, Lars
(författare)
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Endothelium-dependent vasodilation in relation to different measurements of blood pressure in the elderly : the prospective investigation of the vasculature in Uppsala Seniors study
- 2008
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Ingår i: Blood Pressure Monitoring. - 1359-5237 .- 1473-5725. ; 13:5, s. 245-50
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: We have earlier showed endothelium-dependent vasodilation (EDV) in forearm resistance arteries to be mainly related to diastolic blood pressure (DBP), whereas flow-mediated vasodilation (FMD) was mainly related to systolic blood pressure (SBP) when measured with a mercury sphygmomanometer in the brachial artery. Here, we investigated whether these relationships were more powerful if blood pressure was measured invasively or by transformation to central aortic blood pressure. METHODS: In the prospective study of the Vasculature in Uppsala Seniors, 1016 patients aged 70 years were evaluated by the invasive forearm technique with acetylcholine (EDV), and brachial artery ultrasound to assess FMD. Blood pressure was measured with a mercury sphygmomanometer, invasively in the brachial artery and transformed to aortic blood pressure by pulse wave analysis. RESULTS: EDV was related to DBP with a similar strength regardless of whether DBP was measured traditionally, invasively or as calculated aortic pressure. Similarly, FMD was related to SBP with similar strength regardless of whether SBP was measured traditionally, invasively or as calculated aortic pressure. Only FMD was significantly related to pulse pressure. CONCLUSION: Measurements of blood pressure invasively or by calculation of aortic blood pressure did not increase the power of the associations between blood pressure and EDV in the elderly, when compared with traditional blood pressure measurements.
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| 7. |
- Thijs, Lutgarde, et al.
(författare)
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The International Database of Ambulatory Blood Pressure in relation to Cardiovascular Outcome (IDACO) : protocol and research perspectives
- 2007
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Ingår i: Blood Pressure Monitoring. - 1359-5237 .- 1473-5725. ; 12:4, s. 255-262
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The International Database on Ambulatory Blood Pressure Monitoring (1993-1994) lacked a prospective dimension. We are constructing a new resource of longitudinal population studies to investigate with great precision to what extent the ambulatory blood pressure improves risk stratification. Methods: The acronym IDACO refers to the new International Database of Ambulatory blood pressure in relation to Cardiovascular Outcome. Eligible studies are population based, have fatal as well as nonfatal outcomes available for analysis, comply with ethical standards, and have been previously published in peer-reviewed journals. In a meta-analysis based on individual patient data, composite and cause-specific cardiovascular events will be related to various indexes derived by ambulatory blood pressure monitoring. The analyses will be stratified by cohort and adjusted for the conventional blood pressure and other cardiovascular risk factors. Results: To date, the international database includes 7609 patients from four cohorts recruited in Copenhagen, Denmark (n=2311), Noorderkempen, Belgium (n=2542), Ohasama, Japan (n=1535), and Uppsala, Sweden (n=1221). In these four cohorts, during a total of 69 295 person-years of follow-up (median 9.3 years), 1026 patients died and 929 participants experienced a fatal or nonfatal cardiovascular event. Follow-up in five other eligible cohorts, involving a total of 4027 participants, is still in progress. We expect that this follow-up will be completed by the end of 2007. Conclusion: The international database of ambulatory blood pressure in relation to cardiovascular outcome will provide a shared resource to investigate risk stratification by ambulatory blood pressure monitoring to an extent not possible in any earlier individual study.
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| 8. |
- Wijkman, Magnus, et al.
(författare)
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A pilot study of hypertension management using a telemedicine treatment approach
- 2020
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Ingår i: Blood Pressure Monitoring. - : Lippincott Williams & Wilkins. - 1359-5237 .- 1473-5725. ; 25:1, s. 18-21
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Tidskriftsartikel (refereegranskat)abstract
- We recruited 78 men and 94 women to investigate if the proportion of subjects with well-controlled home blood pressure levels could be increased when treatment was guided by smartphone-based telemonitoring. All patients were prescribed one to three antihypertensive drugs. The Accumbo smartphone telemonitoring application was downloaded to the Iphones of the participants and home blood pressure information was gathered from semi-automatic oscillometric blood pressure-recorders by Bluetooth. The study physician adjusted the medications based on home blood pressure for 3 months. home blood pressure was controlled (<135/<85 mmHg) in 55 participants at baseline and in 56 subjects after 3 months (Chi-square P = 0.91). The 117 patients with initially uncontrolled home blood pressure had a drop in home blood pressure (from 138.0 +/- 9.0/91.3 +/- 6.5 mmHg to 133.4 +/- 8.0/88.6 +/- 6.1 mmHg, P < 0.001) and prescribed antihypertensive drugs increased from 1.71 +/- 0.94/day to 2.00 +/- 0.92/day, P < 0.0001. Thus, while the proportion of participants with controlled home blood pressure remained unchanged, the home blood pressure levels were lowered in participants who had uncontrolled home blood pressure at study start.
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| 9. |
- Wijkman, Magnus, et al.
(författare)
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Ambulatory systolic blood pressure predicts left ventricular mass in type 2 diabetes, independently of central systolic blood pressure
- 2012
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Ingår i: Blood Pressure Monitoring. - : Lippincott Williams & Wilkins. - 1359-5237 .- 1473-5725. ; 17:4, s. 139-144
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Both ambulatory and central blood pressures have been reported to correlate more closely than office blood pressure with left ventricular mass index (LVMI). The aim of this study was to test whether ambulatory systolic blood pressure (SBP) predicts LVMI independently of central SBP in patients with type 2 diabetes.Methods: We determined office, ambulatory and central blood pressures and performed echocardiography in 460 patients with type 2 diabetes, who participated in the CARDIPP (Cardiovascular Risk factors in Patients with Diabetes – a Prospective study in Primary care) study (ClinicalTrials.gov number NCT 01049737).Results: In separate multivariable regression models, both 24-hour ambulatory SBP, ambulatory day-time SBP, and ambulatory night-time SBP were significantly associated with LVMI, independently of central SBP, age, sex, BMI, ambulatory 24-hour heart rate, duration of known diabetes and presence or absence of any antihypertensive medications (r = 0.19, 0.17 and 0.18, respectively, P <0.01). All ambulatory SBP parameters, but not central SBP, were significantly associated with LVMI independently of office SBP.Conclusions: Ambulatory SBP predicted LVMI independently of central SBP in patients with type 2 diabetes. The use of ambulatory blood pressure measurements may be encouraged as a tool for refined risk stratification of patients with type 2 diabetes.
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| 10. |
- Willis, Michael, et al.
(författare)
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Real-world long-term effects on blood pressure and other cardiovascular risk factors for patients in digital therapeutics
- 2023
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Ingår i: Blood Pressure Monitoring. - : Lippincott Williams & Wilkins. - 1359-5237 .- 1473-5725. ; 28:2, s. 86-95
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Tidskriftsartikel (refereegranskat)abstract
- PurposeHypertension is a leading causeof premature death worldwide and a major public health problem. This study investigated the long-term effects (>1 year) of digital hypertension monitoring by home blood pressure (HBP) measurements in combination with individualized remote treatment via a Swedish Digital Therapeutics platform in a large patient population. MethodsThe primary endpoint, HBP, and exploratory endpoints, BMI, alcohol consumption, stress level, physical activity, and smoking, were assessed every 3 months for 540 and 360 days, respectively, in 7752 Swedish primary hypertension patients. Patients received individualized medical treatments and lifestyle advice via asynchronous text-based communication in an app. Changes from baseline in endpoints were calculated for the whole population and for subgroups defined by baseline SBP >= 135 (high SBP), 125-135 (suboptimal SBP), 115-125 (optimal SBP), and <115 mmHg (low SBP). ResultsAfter 360 days of treatment, the whole population showed a significant increase of 57% (from 37 to 58%) in the proportion of patients with controlled SBP (i.e. SBP of 115-135 mmHg). The largest reduction in SBP of 13.8 mmHg was observed for the high SBP subgroup, whereas for the low SBP subgroup, SBP increased by 13.4 mmHg. BP improved most in the first three months, and for both the high and low BP subgroups, the improvement continued during the 540-day study period. Significant beneficial changes were also observed for some exploratory endpoints including BMI and smoking. ConclusionsIn conclusion, the digital therapeutics platform was associated with significant improvement in BP control and associated risk factors, which were maintained over a longer period.
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