[PP.06.31] MISSED ARTERIAL HYPERTENSION BY OFFICE BLOOD PRESSURE MEASURED ACCORDING TO THE NICE 2013 GUIDELINES – RESULTS FROM THE IPARR TRIAL. (September 2017)

• Record Type: Journal Article
• Authors: Burkard, T.; Winterhalder, C.; Leonardi, L.; Maseli, A.; Schoen, T.; Eckstein, J.; Vischer, A.S.
• Is Part Of: Journal of hypertension. Volume 35(2017)Supplement 2
• Publication Date: 2017-09
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000523360.92669.39
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: Standard operating procedures (SOP) for office blood pressure measurement (OBPM) vary highly between different guidelines. The NICE 2013 guidelines for arterial hypertension (AH) SOP recommends a first blood pressure measurement (BPM) after 5 minutes rest and a second BPM if blood pressure (BP) is > 139 mmHg systolic (s139) or >89 mmHg diastolic (d89). We aimed to study how many probably hypertensive patients may be missed by this approach due to short term masked hypertension (STMH). Design and method: In this cross-sectional, single-centre trial, 1000 adult subjects were recruited. Seven sequential BPM were performed by an operator after five minutes rest in a quiet room and in sitting position. The BPM were taken using a standard device (Omron HBP-1300 professional BP monitor, appropriate cuff size), alternating with a tested smartphone app. Standard BPM were spaced 2 minutes apart. Overall, 4 standard and 3 smartphone BPM were taken, however, only standard BPM were used for this study. Additional information about cardiovascular risk factors, concomitant disease, and medication were collected. We compared the first BPM out of four to the three following BPM. STMH was defined as first BP s139 or >d89 mmHg. Results: Complete measurements were available in 802 subjects. We identified 528 (65.8%) subjects with a BP<s140 and <d90 mmHg in the first measurement. In 61/528 (11.6%) subjects at least one consecutive BPM was > s139 or >d89 mmHg and in 18/528 (3.4%) the mean of 2nd-4th measurement was >s139 or >d89 mmHg. 412/802 (51.4%) subjects had no history of AH and normal first BPM. In this group STMH was present in 45/412 (10.9%). Subjects with STMH showed no differences in clinical parameters in comparison to subjects with normal BPM over all measurements. Conclusions: By applying the SOP for OBPM suggested by NICE we found short term masked hypertension in more than 10% of all apparently normotensive subjects and especially in 11% of apparently normotensive subjects without known AH. Therefore by this SOP a significant proportion of patients may be missed for further evaluation.