A couple of articles on the value (almost necessity) of home blood-pressure testing, versus accepting whatever shows up in the cardiologist's office. Research seems to show that what the doctors see is usually not very accurate to your real blood pressure...
Out-of-office blood pressure readings help predict CVD risk
Blood pressure readings taken at home with approved devices can be a useful addition to blood pressure management, and may even predict cardiovascular disease (CVD) risk better than readings from the doctor's office alone, according to a scientific statement issued today by the American Heart Association. While the new emphasis on out-of-office readings is the most significant change, the recommendations also emphasize using the proper cuff size when measuring blood pressure.
From American Heart Association:
Out-of-office blood pressure readings help predict CVD risk
American Heart Association scientific statement
Blood pressure readings taken at home with approved devices can be a useful addition to blood pressure management, and may even predict cardiovascular disease (CVD) risk better than readings from the doctor's office alone, according to a scientific statement issued today by the American Heart Association.
The Recommendations for Blood Pressure Measurement in Humans, published in Hypertension: Journal of the American Heart Association, is an update of 1993 guidelines on blood pressure measurement. While the new emphasis on out-of-office readings is the most significant change, the recommendations also emphasize using the proper cuff size when measuring blood pressure.
The most common error in measuring blood pressure in the outpatient setting is mis-cuffing, the statement says. Most mis-cuffing involves using a cuff too small for someone with large arms. Using small cuffs for children and small adults is also important.
''Since the last statement, there have been huge changes in the technology used to measure blood pressure and in our knowledge about the significance of different measurements,'' said lead author Thomas G. Pickering, M.D., D.Phil., director of the Behavioral Cardiovascular Health and Hypertension Program at Columbia University Medical Center in New York.
''We've found that blood pressure measurements taken by doctors in their offices may actually be unreliable in many patients. For that reason, there is wider acceptance of blood pressure readings taken by patients in their homes, and of 24-hour ambulatory blood pressure monitoring.''
If there is a discrepancy between an out-of-office measurement and the office measurement, ''physicians should consider the importance of the out-of-office readings if the measurement was taken in a reliable way,'' Pickering said.
Ambulatory blood pressure monitoring measures blood pressure at regular intervals around the clock, while the person does normal activities and keeps an activity diary that can be compared with the measurements.
Ambulatory monitoring can also identify people with hypertension whose blood pressure stays high throughout the night, when normal levels are about 15 millimeters of mercury (mmHg) lower than during the day. Increasing evidence shows that blood pressure that does not dip at night may be associated with higher cardiovascular risk, according to the statement.
''The 1993 document didn't say much about home and ambulatory monitoring, but now there is much more emphasis on out-of-office measurements and less exclusive reliance on traditional methods of measurement,'' Pickering said. Emphasizing out-of-office blood pressure measurement does not mean that your doctor will no longer check your blood pressure, he said.
The statement encourages patients to monitor their blood pressure at home, using validated devices and providing the readings to their physicians to use as supplemental information in monitoring treatment.
National data published last summer indicated that at least 65 million Americans -- or almost one-third of adults -- have high blood pressure. High blood pressure is defined as consistent systolic pressure of 140 mm Hg or higher, or diastolic pressure of 90 mm Hg or greater, taking hypertensive medicine, or being told at least twice by a healthcare provider that a person has high blood pressure. Systolic pressure is the top number and diastolic is the bottom number in a blood pressure reading. High blood pressure is a major risk factor for coronary heart disease, stroke and kidney failure. It is usually symptomless and is often called a ''silent killer.''
Millions of adults with blood pressure levels between 120 -- 139 mm Hg systolic and 80 -- 89 mm Hg diastolic are considered to have ''prehypertension.'' People with prehypertension may have a higher cardiovascular risk. They should institute lifestyle changes to lower their blood pressure and be followed closely by a healthcare provider to ensure proper treatment in case high blood pressure develops.
''This makes it extremely important to accurately detect small differences in blood pressure,'' Pickering said.
The preferred device for measuring blood pressure in the medical setting is still a mercury sphygmomanometer, but these devices are being phased out, partially because of environmental concerns about mercury contamination, he said.
''However, alternative devices can become inaccurate, so calibration with a mercury reading is critical to ensuring accuracy,'' he said.
Blood pressure can vary significantly depending on the conditions under which it is measured in the hospital or doctor's office. Ideally, blood pressure should be taken after several minutes' relaxation, when a person is seated comfortably in a chair, legs uncrossed, not talking, back and arm supported, and the cuff placed on bare skin.
Co-authors are John E. Hall, Ph.D.; Lawrence J. Appel, M.D.; Bonita E. Falkner, M.D.; John Graves, M.D.; Martha N. Hill, Ph.D.; Daniel W. Jones, M.D.; Theodore Kurtz, M.D.; Sheldon G. Sheps, M.D.; and Edward J. Roccella, Ph.D., M.P.H.
Editor's Note: For more information on high blood pressure and to access the American Heart Association's new on-line high blood pressure tracker, visit americanheart.org/hbp.
And this one:
Home Blood Pressure Tests Predict Risk Better
At-Home Blood Pressure Monitoring May Reveal Hidden Heart Risks
By Jennifer Warner
WebMD Medical News Reviewed By Brunilda Nazario, MD
on Tuesday, March 16, 2004
March 16, 2004 -- Home blood pressure tests may be a better predictor of heart disease or stroke risk than those performed at the doctor's office, a new study suggests.
French researchers found home blood pressure measurements taken among a group of elderly men and women with high blood pressure more accurately identified those patients at risk for future heart attack and stroke than tests taken in the office.
Researchers say the results suggest that blood pressure should be measured at home as well as at the doctor's office among people being treated for high blood pressure.
Home Blood Pressure Tests Reveal Risks
In the study, researchers compared the predictive value of home vs. office blood pressure measurements in a group of more than 4,900 elderly patients being treated for high blood pressure.
After about three years, the study showed that 324 patients had suffered a heart problem, such as having a heart attack or stroke or needing heart bypass surgery.
Researchers found that each 10-point increase in the patient's at-home systolic blood pressure (the top number) reading increased the risk of heart disease and stroke by 17%. Each five-point increase in at-home diastolic blood pressure (the bottom number) increased that risk by 12%.
But neither office systolic nor diastolic blood pressure had the same predictive value.
In this elderly population, office blood pressure measurements failed to identify 9% of those with elevated blood pressure at home but not in the office, write Guillaume Bobrie, MD, of the Hôpital Européen Georges Pomipdou, and colleagues. This is particularly concerning because the frequency of heart events or stroke in this group is similar to that of patients who don't have their blood pressure under control.
These findings suggest that the monitoring of patients being treated for high blood pressure must include home blood pressure self-measurement, which is the method most preferred by patients, they write.
But researchers say more study is needed to determine if changing treatment based on home blood pressure monitoring will help prevent heart disease or stroke. Until then, they say treatment and follow-up of patients with elevated blood pressure at home but not in the office need to be studied.
---
SOURCE: Borie, G. The Journal of the American Medical Association, March 17, 2004; vol 291: pp 1342-1349.
and this one...
Home Blood Pressure Monitoring Has Diagnostic Advantages
A DGReview of :"Home self-measurements of blood pressure and relationship with diagnosis of hypertension and target organ damage: comparative study with ambulatory monitoring" Medicina Clinica
01/04/2001
By James Adams
Blood-pressure (BP) measurements taken at the doctor's office may overestimate the prevalence of arterial hypertension, researchers suggest.
Self-measurements of BP taken at home correlate better with left ventricular mass index (LVMI) and with ambulatory blood pressure measurements than do blood pressure measurements at the doctor's office, according to a study by investigators at the Hospital General and the Grupo de Estudio de Enfermedades Vasculares in Albacete, Spain.
Also, self-measurement at home was found to be more closely related to target organ damage caused by arterial hypertension than were office measurements.
Investigators conducted three BP measurements in 64 consecutive patients using a mercury sphygmomanometer in the office. The patients also self-measured BP 20 times in the office in the morning, then another 20 times in the afternoon at home, using the Omron 705CP, an automatic validated device.
Ambulatory BP measurements were also collected throughout the day with Takeda TM-2420 device, and eye fundus studies, microalbuminauria analyses and echocardiograms were conducted.
Results showed that mean office BP was higher than home self-measurements and ambulatory BP measurement. Home self-measurements and ambulatory measurements correlated better with LVMI than did office measurements, independently of age, sex and body mass index.
"A minimum program of self-measurements of BP at home with automatic devices has a prognostic value and relationship with organ damage of arterial hypertension," the investigators concluded.
Med Clin (Barc) 2000; 115: 730-735. "Home self-measurements of blood pressure and relationship with diagnosis of hypertension and target organ damage: comparative study with ambulatory monitoring"
Out-of-office blood pressure readings help predict CVD risk
Blood pressure readings taken at home with approved devices can be a useful addition to blood pressure management, and may even predict cardiovascular disease (CVD) risk better than readings from the doctor's office alone, according to a scientific statement issued today by the American Heart Association. While the new emphasis on out-of-office readings is the most significant change, the recommendations also emphasize using the proper cuff size when measuring blood pressure.
From American Heart Association:
Out-of-office blood pressure readings help predict CVD risk
American Heart Association scientific statement
Blood pressure readings taken at home with approved devices can be a useful addition to blood pressure management, and may even predict cardiovascular disease (CVD) risk better than readings from the doctor's office alone, according to a scientific statement issued today by the American Heart Association.
The Recommendations for Blood Pressure Measurement in Humans, published in Hypertension: Journal of the American Heart Association, is an update of 1993 guidelines on blood pressure measurement. While the new emphasis on out-of-office readings is the most significant change, the recommendations also emphasize using the proper cuff size when measuring blood pressure.
The most common error in measuring blood pressure in the outpatient setting is mis-cuffing, the statement says. Most mis-cuffing involves using a cuff too small for someone with large arms. Using small cuffs for children and small adults is also important.
''Since the last statement, there have been huge changes in the technology used to measure blood pressure and in our knowledge about the significance of different measurements,'' said lead author Thomas G. Pickering, M.D., D.Phil., director of the Behavioral Cardiovascular Health and Hypertension Program at Columbia University Medical Center in New York.
''We've found that blood pressure measurements taken by doctors in their offices may actually be unreliable in many patients. For that reason, there is wider acceptance of blood pressure readings taken by patients in their homes, and of 24-hour ambulatory blood pressure monitoring.''
If there is a discrepancy between an out-of-office measurement and the office measurement, ''physicians should consider the importance of the out-of-office readings if the measurement was taken in a reliable way,'' Pickering said.
Ambulatory blood pressure monitoring measures blood pressure at regular intervals around the clock, while the person does normal activities and keeps an activity diary that can be compared with the measurements.
Ambulatory monitoring can also identify people with hypertension whose blood pressure stays high throughout the night, when normal levels are about 15 millimeters of mercury (mmHg) lower than during the day. Increasing evidence shows that blood pressure that does not dip at night may be associated with higher cardiovascular risk, according to the statement.
''The 1993 document didn't say much about home and ambulatory monitoring, but now there is much more emphasis on out-of-office measurements and less exclusive reliance on traditional methods of measurement,'' Pickering said. Emphasizing out-of-office blood pressure measurement does not mean that your doctor will no longer check your blood pressure, he said.
The statement encourages patients to monitor their blood pressure at home, using validated devices and providing the readings to their physicians to use as supplemental information in monitoring treatment.
National data published last summer indicated that at least 65 million Americans -- or almost one-third of adults -- have high blood pressure. High blood pressure is defined as consistent systolic pressure of 140 mm Hg or higher, or diastolic pressure of 90 mm Hg or greater, taking hypertensive medicine, or being told at least twice by a healthcare provider that a person has high blood pressure. Systolic pressure is the top number and diastolic is the bottom number in a blood pressure reading. High blood pressure is a major risk factor for coronary heart disease, stroke and kidney failure. It is usually symptomless and is often called a ''silent killer.''
Millions of adults with blood pressure levels between 120 -- 139 mm Hg systolic and 80 -- 89 mm Hg diastolic are considered to have ''prehypertension.'' People with prehypertension may have a higher cardiovascular risk. They should institute lifestyle changes to lower their blood pressure and be followed closely by a healthcare provider to ensure proper treatment in case high blood pressure develops.
''This makes it extremely important to accurately detect small differences in blood pressure,'' Pickering said.
The preferred device for measuring blood pressure in the medical setting is still a mercury sphygmomanometer, but these devices are being phased out, partially because of environmental concerns about mercury contamination, he said.
''However, alternative devices can become inaccurate, so calibration with a mercury reading is critical to ensuring accuracy,'' he said.
Blood pressure can vary significantly depending on the conditions under which it is measured in the hospital or doctor's office. Ideally, blood pressure should be taken after several minutes' relaxation, when a person is seated comfortably in a chair, legs uncrossed, not talking, back and arm supported, and the cuff placed on bare skin.
Co-authors are John E. Hall, Ph.D.; Lawrence J. Appel, M.D.; Bonita E. Falkner, M.D.; John Graves, M.D.; Martha N. Hill, Ph.D.; Daniel W. Jones, M.D.; Theodore Kurtz, M.D.; Sheldon G. Sheps, M.D.; and Edward J. Roccella, Ph.D., M.P.H.
Editor's Note: For more information on high blood pressure and to access the American Heart Association's new on-line high blood pressure tracker, visit americanheart.org/hbp.
And this one:
Home Blood Pressure Tests Predict Risk Better
At-Home Blood Pressure Monitoring May Reveal Hidden Heart Risks
By Jennifer Warner
WebMD Medical News Reviewed By Brunilda Nazario, MD
on Tuesday, March 16, 2004
March 16, 2004 -- Home blood pressure tests may be a better predictor of heart disease or stroke risk than those performed at the doctor's office, a new study suggests.
French researchers found home blood pressure measurements taken among a group of elderly men and women with high blood pressure more accurately identified those patients at risk for future heart attack and stroke than tests taken in the office.
Researchers say the results suggest that blood pressure should be measured at home as well as at the doctor's office among people being treated for high blood pressure.
Home Blood Pressure Tests Reveal Risks
In the study, researchers compared the predictive value of home vs. office blood pressure measurements in a group of more than 4,900 elderly patients being treated for high blood pressure.
After about three years, the study showed that 324 patients had suffered a heart problem, such as having a heart attack or stroke or needing heart bypass surgery.
Researchers found that each 10-point increase in the patient's at-home systolic blood pressure (the top number) reading increased the risk of heart disease and stroke by 17%. Each five-point increase in at-home diastolic blood pressure (the bottom number) increased that risk by 12%.
But neither office systolic nor diastolic blood pressure had the same predictive value.
In this elderly population, office blood pressure measurements failed to identify 9% of those with elevated blood pressure at home but not in the office, write Guillaume Bobrie, MD, of the Hôpital Européen Georges Pomipdou, and colleagues. This is particularly concerning because the frequency of heart events or stroke in this group is similar to that of patients who don't have their blood pressure under control.
These findings suggest that the monitoring of patients being treated for high blood pressure must include home blood pressure self-measurement, which is the method most preferred by patients, they write.
But researchers say more study is needed to determine if changing treatment based on home blood pressure monitoring will help prevent heart disease or stroke. Until then, they say treatment and follow-up of patients with elevated blood pressure at home but not in the office need to be studied.
---
SOURCE: Borie, G. The Journal of the American Medical Association, March 17, 2004; vol 291: pp 1342-1349.
and this one...
Home Blood Pressure Monitoring Has Diagnostic Advantages
A DGReview of :"Home self-measurements of blood pressure and relationship with diagnosis of hypertension and target organ damage: comparative study with ambulatory monitoring" Medicina Clinica
01/04/2001
By James Adams
Blood-pressure (BP) measurements taken at the doctor's office may overestimate the prevalence of arterial hypertension, researchers suggest.
Self-measurements of BP taken at home correlate better with left ventricular mass index (LVMI) and with ambulatory blood pressure measurements than do blood pressure measurements at the doctor's office, according to a study by investigators at the Hospital General and the Grupo de Estudio de Enfermedades Vasculares in Albacete, Spain.
Also, self-measurement at home was found to be more closely related to target organ damage caused by arterial hypertension than were office measurements.
Investigators conducted three BP measurements in 64 consecutive patients using a mercury sphygmomanometer in the office. The patients also self-measured BP 20 times in the office in the morning, then another 20 times in the afternoon at home, using the Omron 705CP, an automatic validated device.
Ambulatory BP measurements were also collected throughout the day with Takeda TM-2420 device, and eye fundus studies, microalbuminauria analyses and echocardiograms were conducted.
Results showed that mean office BP was higher than home self-measurements and ambulatory BP measurement. Home self-measurements and ambulatory measurements correlated better with LVMI than did office measurements, independently of age, sex and body mass index.
"A minimum program of self-measurements of BP at home with automatic devices has a prognostic value and relationship with organ damage of arterial hypertension," the investigators concluded.
Med Clin (Barc) 2000; 115: 730-735. "Home self-measurements of blood pressure and relationship with diagnosis of hypertension and target organ damage: comparative study with ambulatory monitoring"
