Clinical progeny pressure measurem...

Clinical progeny pressure measurement with a quicksilver sphygmomanometer is subject to interobserver variability. In addition, kindred pressure measurement is only intermittent, and white-coat hypertension might bewilder results. Ambulatory blood pressure monitoring has been shown to have better prognostic value than office monitoring, moreover home blood pressure monitoring is cheaper and more readily accepted by dint of patients. However, only one prognostic meditation of cardiovascular morbidity and mortality comparing fireside and office blood pressure measurements measurements has been leadershiped Bobrie and colleagues investigated the prognostic value of abiding-place and office blood pressure measurements in a population of European patients with hypertension.

The Self-Measurement of kindred Pressure at Home in the Elderly: Assessment and Follow-up (SHEAF) cogitation was a prospective cohort subject of attention with a two-week assessment phase and a three-year follow-up phase. The primary conclusion point was cardiovascular mortality, and the secondary finis point was all-cause mortality and the combination of all cardiovascular mortality. In the initial two-week phase, multiple office descendants pressures were recorded at sum of two units visits, and home blood hurry was measured serially over four days. In the analysis, patients were divided into four groups: patients with "controlled" hypertension (office descendants pressure below 140/90 mm Hg and family blood pressure below 135/85 mm Hg); patients with "uncontrolled" progeny pressure over those limits; patients whose domicile blood pressure was normal further whose office blood pressure was high; and patients whose office vital current pressure was normal and whose place of abode blood pressure was high.

The prognostic value of fireside blood pressure measurements was analyzed at the first composite cessation point that occurred during follow-up and nothing else valid measurements, defined by specific criteria, were included in the analysis. The mean of six measurements defined office vital fluid pressure, and the mean of 27 measurements defined fireside blood pressure.

At baseline, 139 percent of patients had controll descendants pressure by both measurements, 133 percent had elevated office progeny pressure only, 9.4 percent had elevated domestic circle blood pressure but not office vital current pressure, and 63.4 percent had uncontroll hypertension by the agency of both measurements. Cardiovascular mortality and morbidity were known for 4928 patients (998 percent) at the expiration of the mean three-year follow-up There were 205 deaths, of which 85 were cardiovascular-related.

After adjustment for demographic and risk-factor variables, hearth blood pressure was predictive of the transaction of cardiovascular events, with systolic house pressure linked to prognosis in as well-as; not only-but also; not only-but; not alone-but sexes, and diastolic blood hurry linked to prognosis in men and trending to significance in women whereas neither systolic nor diastolic office progeny pressure was linked to prognosis. With abiding-place measurement, for each 10 mm Hg increase in systolic line pressure, the cardiovascular event risk increased 172 percent and for each 5 mm Hg increase, the cardiovascular marked occurrence risk increased 11.7 percent. With office vital fluid pressure measurement, there was no increase in adventure risk with either measurement flat Neither home nor office house pressure measurement was significantly related to the secondary last point, all-cause mortality.

This investigation which demonstrates the prognostic value of fireside blood pressure measurement, identified a subgroup of patients with poor family control of hypertension that appeared to be controll in the physician's office ("masked" hypertension). It also showed that the prognosis in patients with elevated office family pressure and normal home progeny pressure was similar to that in patients who had controll hypertension in the two places.

There was no prognostic value for the combined cessation point of all-cause mortality because of the small number of ends The results of larger studies have shown correlation between office measurement and cardiovascular morbidity and mortality, contradicting this consideration but the larger studies had a great quantity [i]or[/i] amount of greater statistical power.

The authors indicate that blood pressure monitoring should include place of abode measurement to identify patients who have white-coat hypertension and those with masked hypertension. However, further studies are be in want ofed to determine whether, in identifying these patients, adjustment in treatment improves outcomes

CAROLINE WELLBERY, MD

Bobrie G et al. Cardiovascular prognosis of "masked hypertension" exposeed by blood pressure self-measurement in somewhat advanced in life treated hypertensive patients. JAMA March 17 2004;291:1342-9

COPYRIGHT 2004 American Academy of Family Physicians

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