BLOOD PRESSURE MANAGEMENT WITH THE ESH CARE APP – PRELIMINARY RESULTS
Eirini SiafiDimitrios KonstantinidisIoannis AndrikouDimitrios PolyzosSotirios DrogkarisEleni MantaFotis TatakisIoannis ZammanisKalliopi GrigoriouKyriakos DimitriadisIoannis LeontsinisKonstantinos Tsioufis
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Main issues in the treatment of hypertension are the low level of blood pressure (BP) control and the economic burden for health care systems. Mobile application with telemonitoring of BP could contribute to better control and lower costs by reducing office visits. This could be useful nowadays with difficult access to health system due to covid-19. The purpose of this study was to investigate if an innovative management strategy of hypertension, such as the use of ESH care application for smartphones combined with a dedicated platform, could improve hypertension control and replace frequent office visits.30 uncontrolled hypertensive patients, treated or untreated [mean age 53 ± 9 years, mean office BP (OBP) 146.3 ± 6.2 / 92.5 ± 9 mmHg, 53% men, 33% smokers, 23% with hypercholesterolemia] were randomized to the application assisted strategy (AAS) (17 patients), where a mobile phone application was offered to communicate home BP measurements (HBPm), or to regular office visits (13 patients). Patients' BP measurements (HBPm for AAS and OBP for standard care group) were evaluated in 1 and 3 months with treatment titration if uncontrolled. In all patients OBP and ambulatory BP measurement (ABPM) were evaluated in 6 months.In both groups the reduction in OBP and ABPM was significant in 6 months. In the AAS group the reduction in systolic/diastolic OBP and 24 h systolic/diastolic BP in 6 months was -26.5 ± 5.6 / -19.4 ± 8.2 mmHg (p < 0,001) and -19.6 ± 7.7 / -13.8 ± 4.8 mmHg (p < 0.001), respectively. In the standard care group, the reduction in systolic/diastolic OBP and 24 h systolic/diastolic BP in 6 months was -22.6 ± 9.7 / -9.6 ± 11 mmHg (p < 0.005) and-18.4 ± 6.0 / - 8.8 ± 4.4 mmHg (p < 0.001). In AAS group compared to standard care group there was a greater reduction in 24 h diastolic BP (-13.8 ± 4.8 mmHg vs -8.8 ± 4.4 mmHg, p = 0.016) and in diastolic OBP (-19.4 ± 8.2 mmHg vs -9.6 ± 11.0 mmHg, p = 0.04).The present results indicate that the monitoring of patients through a mobile health tool could be useful in hypertension management as it is correlated with better BP control compared to office visits. The trial is still enrolling patients.Casual
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1856 The purpose was to investigate the reproducibility of 24-hr ambulatory blood pressures (AmBP) following exercise in borderline hypertensive adults (141.9/91.9 pm 12.7/7.0 mmHg). Reproducibility was determined in 15 subjects by evaluating four 24-h AmBP monitoring sessions; two following a 50 min walk at 50/% VO2max (E), and two on a control day with no exercise (C). Dependent variables were average 24-hr, daytime, and nightime systolic (SBP) and diastolic blood pressure (DBP); systolic (SL) and diastolic blood pressure load (DL); and 24-hr area under the elevated systolic (SA) and diastolic blood pressure curve (DA). Simple main effects from a two way ANOVA (condition × day) showed that average 24-hr SBP (F=4.53, p=.043), daytime SBP (F=5.34, p=.029), 24-hr SL (F=5.96, p=.022) and daytime SL (F=5.54, p=.026) were significantly different between E days; the daytime SBP was significantly different between C days (F=4.32, p=.048). The result for C is consistent with the literature, showing a high reproducibility. However, it appears that ambulatory blood pressures may not be as reproducible following exercise. Supported by Indiana University Adult Fitness Program, School of HPER Student Research Grant-In-Aid
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The introduction of ambulatory blood pressure monitoring into clinical practice has defined a clinical condition called 'isolated office hypertension'.The aim of this study was to evaluate the long-term systolic and diastolic blood pressure changes in patients with isolated office hypertension and to identify the presence of markers capable of identifying which patients will develop sustained hypertension.All the 407 patients enrolled had a random office systolic or/and diastolic blood pressure of over 140/90mmHg and a mean daytime ambulatory blood pressure of 130/84mmHg or less. At enrollment, each patient underwent a 'baseline examination' made up of a physical evaluation, a 24h ambulatory blood pressure monitoring, and a mental arithmetic test performed at the end of the 24h ambulatory monitoring.Of the 173 patients finally studied, 102 (58.9%) developed sustained hypertension with an increase in both ambulatory systolic and diastolic blood pressure. At the time of the baseline examination, the patients were divided into two groups. Group A included patients with mean ambulatory systolic and diastolic blood pressures in the first hour of 130/84mmHg or less; group B included patients with mean ambulatory systolic and diastolic pressures in the first hour of greater than 130/84mmHg. During the mental arithmetic test, the systolic and heart rate values increased significantly only in group B patients. Of the 102 patients who had become hypertensive by the time of the follow-up examination, 84 (82%) belonged to group B.These data suggest that isolated office hypertension may indeed be a transitional state towards the development of sustained hypertension. Moreover, the mean ambulatory blood pressure value during the first hour can be considered to be a marker of a higher risk of developing sustained hypertension.
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Physicians are commonly uncertain whether a person with office blood pressure (BP) around 140/90 mm Hg actually has hypertension. This is primarily because of BP variability. One approach is to perform self-measured home BP and determine if home BP is elevated. There is a general agreement that if home BP is ≥135/85 mm Hg, then antihypertensive therapy may be commenced. However, some persons with home BP below this cut-off will have ambulatory hypertension. We therefore prospectively study the role of home BP in predicting ambulatory hypertension in persons with stage 1 and borderline hypertension. We studied in a cross-sectional way home and ambulatory BP in a group of 48 patients with at least two elevated office BP readings. The group was free of antihypertensive drug therapy for at least 4 weeks and performed 7 days of standardized self-BP measurements at home. We examined the relationships of the three BP methods and also defined a threshold (using receiver operating curves) for home BP that captures 80% of ambulatory hypertensives (awake BP ≥135/85 mm Hg). Office systolic BP (145 ± 13 mm Hg) was significantly higher than awake (139 ± 12 mm Hg, P = .013) and home (132 ± 11 mm Hg, P < .001) BP. Office diastolic BP (88 ± 4 mm Hg) was higher than home diastolic BP (80 ± 8 mm Hg, P < .001) but not different from awake diastolic BP (88 ± 8 mm Hg, P = .10). Home BP had a higher correlation (compared with office BP) with ambulatory BP. The home BP-based white coat effect correlated with ambulatory BP-based white coat effect (r = 0.83, P = .001 for systolic BP; r = 0.68, P = .001 for diastolic BP). The threshold for home BP of 80% sensitivity in capturing ambulatory hypertension was 125/76 mm Hg. Our preliminary data suggest that a lower self-monitored home BP threshold should be used (to exclude ambulatory hypertension) in patients with borderline office hypertension.
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Blood pressures measured casually by a doctor often differ considerably from those recorded during everyday activities away from the medical environment. In the present study, we compared office and ambulatory recorded pressures in 475 consecutive untreated patients diagnosed hypertensive by physicians. Blood pressure monitored non-invasively during the day was, on average 15/7 mmHg lower than the corresponding office pressures. The difference between office and ambulatory recorded pressure tended to be greatest in those patients with the highest office blood pressure levels, although the relationship between the two types of measurement was too weak (r = 0.50 and 0.38 for systolic and diastolic pressure, respectively) to have any predictive value in the individual patient. Office blood pressures were at least 10 mmHg higher than ambulatory pressures in 62% of patients for systolic and 42% for diastolic pressure. Blood pressure levels recorded during ambulatory monitoring were higher than in the doctor's office for 18% of patients for systolic and 22% for diastolic pressure. Among patients with systolic pressures of between 161 and 180 mmHg or diastolic pressures between 96 and 105 mmHg when facing a doctor, 27 and 37% respectively, showed markedly lower systolic (less than 140 mmHg) or diastolic (less than 90 mmHg) ambulatory recorded pressures. These data therefore indicate that ambulatory blood pressure monitoring may help to identify those truly hypertensive patients who are most likely to benefit from antihypertensive therapy.
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Objective To investigate the ch a racteristics of the 24 h ambulatory blood pressure and pulse pressure in the eld erly patients with isolated systolic hypertension. Methods A tota l of 121 patients (53 males and 68 females) with isolated systolic hypertension at age≥60 were recruited from outpatients and patients hospitalized in Fu Wai h ospital. The 24 h non-invasive ambulatory blood pressure and blood pressure at clinic were obtained on the same day for each patients. Results T he clinic, the 24 h and ambulatory systolic pressures both in daytime and ni ghttime increased with age while the diastolic pressures did not so. Pulse press ures of all patients were increased (65 mmHg), and the 24 h, daytime and nighttime pulse pressures were all significantly elevated with age (P0.05). The 24 h and daytime diastolic pressures in patients at age 70 were lower than those in patients at age ≤70 (P0.05). The 24 h systolic pressure, nighttime sys tolic and diastolic pressures in patients with body mass index ≥25 were signifi cantly higher than those in patients with body mass index 25(P0.05). In t he elderly patients with isolated systolic hypertension, the decline rates of th e ambulatory systolic and diastolic blood pressures in the night-time were 4. 6% and 7.0% respectively, while the daytime and nighttime systolic pressure lo ads were remarkably increased. Conclusion With the increase of age, blood pressure profile for isolated systolic hypertensive cases is characterized by t hat the clinic, the 24 h, both the daytime and the nighttime ambulatory systolic pressures, and the systolic pressure loads were significantly increased while t he diurnal rhythm was decreased.
Pulse pressure
Isolated systolic hypertension
Prehypertension
Systolic hypertension
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Objective To investigate the relationship between ambulatory diastolic blood pressure levels and cardiovascular risk in the elderly men after treated essential therapy. Methods 748 male patients with hypertension after antihypertensive drug therapy were followed-up by screening ambulatory diastolic blood from May 1995 to Sep 2001. First cardiovascular disease events (CVD events) were recorded. Results After treatment, the acute CVD events rates in the ambulatory diastolic blood pressure 70 mmHg and ≥90 mmHg groups were 11.9/100 patient-year and 13.6/100 patient-year, respectively, which were higher than that in the control group (70~79 mmHg, 7.0/100 patient-year). There was U-shaped curve relationship between ambulatory diastolic blood pressure after treatment and CVD events rates, namely, when diastolic blood pressure was less than 70 mmHg, CVD events significantly increased. This relationship still existed even after adjusted the other factors. Conclusions The ambulatory diastolic blood pressure 70 mmHg was related independently to increased CVD events rates in the elderly men with essential hypertension after treatment.
Prehypertension
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