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Indication-specific 6-h systolic blood pressure thresholds can approximate 24-h determination of blood pressure control

Journal of Human Hypertension volume 25, pages 250–255 (2011)Cite this article

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Abstract

Ambulatory blood pressure monitoring (ABPM) is an accurate method for evaluating hypertension, yet its use in clinical practice may be limited by availability, cost and patient inconvenience. The objective of this study was to investigate the ability of a 6-h ABPM window to predict blood pressure control, judging by that of the full 24-h ABPM session across several clinical indications in a cohort of 486 patients referred for ABPM. Sensitivities and specificities of the 6-h systolic blood pressure mean to accurately classify patients as hypertensive were determined using a fixed reference point of 130 mm Hg for the 24-h mean. For four common indications, in which ABPM was ordered, prediction tables were constructed varying the thresholds for the 6-h mean to find the optimal value that best predicted the 24-h hypertensive status as determined from the full 24-h interval. Using a threshold of 137 mm Hg for the indications of borderline hypertension, evaluation of current antihypertensive regimen and suspected white-coat hypertension, sensitivity and specificity ranged from 0.83–0.88 to 0.80–0.88, respectively, for the ability of 6-h ABPM to correctly categorize hypertensive status. Using 133 mm Hg as the threshold for treatment resistance resulted in a sensitivity and specificity of 0.93 and 0.83, respectively. We conclude that a shortened ABPM session of 6 h can be used to accurately classify blood pressure as controlled or not, based on the results of a 24-h session. The optimal 6-h threshold for comparison depends upon indication for referral.

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References

  1. Pickering TG, Shimbo D, Haas D . Ambulatory blood-pressure monitoring. N Engl J Med 2006; 354: 2368–2374.

    Article  CAS  PubMed  Google Scholar 

  2. Pickering TG, Miller NH, Ogedegbe G, Krakoff LR, Artiniann NT, Goff D . Call to action on use and reimbursement for home blood pressure monitoring: a joint scientific statement from the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association. Hypertension 2008; 52: 10–29.

    Article  CAS  PubMed  Google Scholar 

  3. Staessen JA, Thijs L, Fagard R, O’Brien ET, Clement D, de Leeuw PW et al. Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension. Systolic Hypertension in Europe Trial Investigators. JAMA 1999; 282: 539–546.

    Article  CAS  PubMed  Google Scholar 

  4. Clement DL, De Buyzere ML, De Bacquer DA, de Leeuw PW, Duprez DA, Fagard RH et al. Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension. N Engl J Med 2003; 348: 2407–2415.

    Article  PubMed  Google Scholar 

  5. Stergiou GS, Argyraki KK, Moyssakis I, Mastorantonakis SE, Achimastos AD, Karamanos VG et al. Home blood pressure is as reliable as ambulatory blood pressure in predicting target-organ damage in hypertension. Am J Hypertens 2007; 20: 616–621.

    Article  PubMed  Google Scholar 

  6. Gaborieau V, Delarche N, Gosse P . Ambulatory blood pressure monitoring versus self-measurement of blood pressure at home: correlation with target organ damage. J Hypertens 2008; 26: 1919–1927.

    Article  CAS  PubMed  Google Scholar 

  7. Ernst ME . Nighttime blood pressure is the blood pressure. Pharmacotherapy 2009; 29: 3–6.

    Article  PubMed  Google Scholar 

  8. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo Jr JL . The Seventh Report of the Joint National Committee on Prevention, Dectection, Evaluation, and Treatment on High Blood Pressure: The JNC-7 Report. JAMA 2003; 289: 2560–2572.

    Article  CAS  PubMed  Google Scholar 

  9. Ernst ME, Bergus GR . Favorable patient acceptance of ambulatory blood pressure monitoring in a primary care setting in the United States: a cross-sectional survey. BMC Fam Pract 2003; 4: 15.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Degaute JP, van de Borne P, Kerkhofs M, Dramaix M, Linkowski P . Does non-invasive ambulatory blood pressure monitoring disturb sleep? J Hypertens 1992; 10: 879–885.

    CAS  PubMed  Google Scholar 

  11. Fravel MA, Ernst ME, Weber CA, Dawson JD, Carter BL, Bergus GR . Influence of patient characteristics on success of ambulatory blood pressure monitoring. Pharmacotherapy 2008; 28: 1341–1347.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Ernst ME, Bergus GR . Ambulatory blood pressure monitoring. South Med J 2003; 96: 563–568.

    Article  PubMed  Google Scholar 

  13. Ernst ME, Weber CA, Dawson JD, O’Connor MA, Lin W, Carter BL et al. How well does a shortened time interval characterize results of a full ambulatory blood pressure monitoring session? J Clin Hypertens (Greenwich) 2008; 10: 431–435.

    Article  Google Scholar 

  14. Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves JW, Hill MN et al. Recommendations for blood pressure measurement in human and experimental animals: Part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Hypertension 2005; 45: 142–161.

    Article  CAS  PubMed  Google Scholar 

  15. Baumgart P, Kamp J . Accuracy of the SpaceLabs Medical 90217 ambulatory blood pressure monitor. Blood Press Monit 1998; 3: 303–307.

    CAS  PubMed  Google Scholar 

  16. Williams B, Lindholm LH, Sever P . Systolic pressure is all that matters. Lancet 2008; 371: 2219–2221.

    Article  PubMed  Google Scholar 

  17. Wen SW, Kramer MS, Hoey J, Hanley JA, Usher RH . Terminal digit preference, random error, and bias in routine clinical measurement of blood pressure. J Clin Epidemiol 1993; 46: 1187–1193.

    Article  CAS  PubMed  Google Scholar 

  18. Yavuz BB, Yavuz B, Tayfur O, Cankurtaran M, Halil M, Ulger Z et al. White coat effect and its clinical implications in the elderly. Clin Exp Hypertens 2009; 31: 306–315.

    Article  PubMed  Google Scholar 

  19. Weber MA, Drayer JM, Wyle FA, Brewer DD . A representative value for whole-day BP monitoring. JAMA 1982; 248: 1626–1628.

    Article  CAS  PubMed  Google Scholar 

  20. Sheps SG, Bailey KR, Zachariah PK . Short-term (six hour), ambulatory blood pressure monitoring. J Hum Hypertens 1994; 8: 873–878.

    CAS  PubMed  Google Scholar 

  21. Chanudet X, Chau NP, Larroque P . Short-term representatives of daytime and night-time ambulatory blood pressures. J Hypertens 1992; 10: 595–600.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

This work was supported in part by the National Heart, Lung, and Blood Institute (1R01HL069801-01A1).

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Authors and Affiliations

  1. Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, IA, USA

    M E Ernst & B L Carter

  2. Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA

    M E Ernst, B L Carter & G R Bergus

  3. College of Pharmacy, The University of Iowa, Iowa City, IA, USA

    G S Sezate & C A Weber

  4. UCLA Center for Health Policy Research, Los Angeles, CA, USA

    W Lin

  5. Department of Biostatistics, College of Public Health, The University of Iowa, Iowa City, IA, USA

    J D Dawson

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  1. M E Ernst
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  2. G S Sezate
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  4. C A Weber
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  5. J D Dawson
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  6. B L Carter
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  7. G R Bergus
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Correspondence to M E Ernst.

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The authors declare no conflict of interest.

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Presented in part at the 21st annual meeting of the American Society of Hypertension, May 2008. New Orleans, LA.

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Ernst, M., Sezate, G., Lin, W. et al. Indication-specific 6-h systolic blood pressure thresholds can approximate 24-h determination of blood pressure control. J Hum Hypertens 25, 250–255 (2011). https://doi.org/10.1038/jhh.2010.66

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  • DOI: https://doi.org/10.1038/jhh.2010.66

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