Abstracts
Background:
The importance of measuring blood pressure before morning micturition and in the afternoon, while working, is yet to be established in relation to the accuracy of home blood pressure monitoring (HBPM). Objective: To compare two HBPM protocols, considering 24-hour ambulatory blood pressure monitoring (wakefulness ABPM) as gold-standard and measurements taken before morning micturition (BM) and in the afternoon (AM), for the best diagnosis of systemic arterial hypertension (SAH), and their association with prognostic markers.
Methods:
After undergoing 24-hour wakefulness ABPM, 158 participants (84 women) were randomized for 3- or 5-day HBPM. Two variations of the 3-day protocol were considered: with measurements taken before morning micturition and in the afternoon (BM+AM); and with post-morning-micturition and evening measurements (PM+EM). All patients underwent echocardiography (for left ventricular hypertrophy - LVH) and urinary albumin measurement (for microalbuminuria - MAU).
Result:
Kappa statistic for the diagnosis of SAH between wakefulness-ABPM and standard 3-day HBPM, 3-day HBPM (BM+AM) and (PM+EM), and 5-day HBPM were 0.660, 0.638, 0.348 and 0.387, respectively. The values of sensitivity of (BM+AM) versus (PM+EM) were 82.6% × 71%, respectively, and of specificity, 84.8% × 74%, respectively. The positive and negative predictive values were 69.1% × 40% and 92.2% × 91.2%, respectively. The comparisons of intraclass correlations for the diagnosis of LVH and MAU between (BM+AM) and (PM+EM) were 0.782 × 0.474 and 0.511 × 0.276, respectively.
Conclusions:
The 3 day-HBPM protocol including measurements taken before morning micturition and during work in the afternoon showed the best agreement with SAH diagnosis and the best association with prognostic markers.
Arterial Pressure; Mass Screening; Predictive Value of Tests; Ambulatory Blood Pressure Monitoring; Cardiovascular Diseases/urine; Hypertension
Fundamentos:
A importância das medidas da pressão arterial antes do ato miccional matinal e no período da tarde, durante atividades laborativas, na acurácia da monitoração residencial da pressão arterial (MRPA) não foi estabelecida.
Objetivo:
Comparar dois protocolos de MRPA, tendo como padrão-ouro a monitoração ambulatorial da pressão arterial de 24 horas (MAPA-vigília) e avaliando-se as medidas antes do ato miccional e à tarde, para o melhor diagnóstico de hipertensão arterial (HAS), e sua associação com marcadores prognósticos.
Métodos:
Após realizarem MAPA de 24 horas, os 158 participantes (84 mulheres) foram randomizados para realizar MRPA de três ou cinco dias com posterior crossover. Analisou-se o protocolo de três dias nas seguintes situações: aferições antes do ato miccional matinal e à tarde (AM+MT); e aferições após o ato miccional matinal e à noite (PM+MN). Todos os pacientes foram submetidos a ecocardiografia (hipertrofia ventricular esquerda - HVE) e a dosagem de albumina urinária (microalbuminúria - MAU).
Resultados:
A estatística kappa para diagnóstico de HAS entre MAPA-vigília e MRPA de três dias padrão, MRPA de três dias (AM + MT) e (PM + MN), e MRPA de cinco dias foi de 0,660, 0,638, 0,348 e 0,387, respectivamente. Os valores de sensibilidade de AM+MT versus PM+MN foram 82,6% × 71%, respectivamente, e os de especificidade foram 84,8% × 74%, respectivamente. Os valores preditivos positivos e negativos foram 69,1% × 40% e 92,2% × 91,2%, respectivamente. As comparações das correlações intraclasse para diagnósticos de HVE e MAU, entre AM+MT e PM+MN, foram 0,782 × 0,474 e 0,511 × 0,276, respectivamente.
Conclusões:
O protocolo de MRPA de três dias que inclui medidas antes do ato miccional matinal e à tarde apresentou melhor concordância com o diagnóstico de HAS e melhor associação com marcadores prognósticos.
Pressão Arterial; Programas de Rastreamento; Valor Preditivo dos Testes; Monitoração Ambulatorial da Pressão Arterial; Doenças Cardiovasculares/urina; Hipertensão
Introduction
Ambulatory blood pressure monitoring (ABPM) has been recognized as the reference method
to predict the cardiovascular risk associated with increased blood pressure (BP).
Longitudinal studies with population samples11 Mancia G, Sega R, Bravi C, De Vito G, Valagussa F, Cesana G, et al.
Ambulatory blood pressure normality: results from the PAMELA study. J Hypertens.
1995;13(12 Pt 1):1377-90.
2 Ohkubo T, Imai Y, Tsuji I, Nagai K, Ito S, Satoh H, et al. Reference
values for 24-hour ambulatory blood pressure monitoring based on a prognostic
criterion: the Ohasama Study. Hypertension. 1998;32(2):255-9.-33 Bombelli M, Sega R, Facchetti R, Corrao G, Polo Friz H, Vertemati AM, et
al. Prevalence and clinical significance of a greater ambulatory versus office blood
pressure ('reversed white coat' condition) in a general population. J Hypertens.
2005;23(3):513-20. and hypertensive
individuals44 Clement DL, De Buyzere ML, De Bacquer DA, de Leeuw PW, Duprez DA, Fagard
RH, et al; Office versus Ambulatory Pressure Study Investigators. Prognostic value of
ambulatory blood-pressure recordings in patients with treated hypertension. N Engl J
Med. 2003;348(24):2407-15.,55 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(6):539-46. have reported the better ability of ABPM to stratify risk as compared with
measurements taken at the office. More recently, home blood pressure monitoring (HBPM)
has been accepted in different guidelines as an effective method to measure usual BP and
as a useful tool to stratify cardiovascular risk66 Imai Y, Otsuka K, Kawano Y, Shimada K, Hayashi H, Tochikubo O, et al;
Japanese Society of. Hypertension Japanese Society of Hypertension (JSH) guidelines
for self-monitoring of blood pressure at home. Hypertens Res.
2003;26(10):771-82.
7 Sociedade Brasileira de Cardiologia, Sociedade Brasileira de
Hipertensão, Sociedade Brasileira de Nefrologia. V Diretrizes Brasileiras de
Monitoração Ambulatorial da Pressão Arterial (MAPA V) e III Diretrizes de Monitoração
Residencial da Pressão Arterial (MRPA III). Arq Bras Cardiol. 2011;97(3
supl.3):1-24.
8 Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, et al;
Task Force Members. 2013 ESH/ESC Guidelines for the management of arterial
hypertension: the Task Force for the management of arterial hypertension of the
European Society of Hypertension (ESH) and of the European Society of Cardiology
(ESC). J Hypertens. 2013;31(7):1281-357.
9 Pickering TG, Miller NH, Ogedegbe G, Krakoff LR, Artinian NT, Goff D;
American Heart Association, American Society of, Hypertension Preventive
Cardiovascular Nurses Association. 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(1):1-9.
10 0. Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN, et
al; Subcommittee of Professional and Public Education of the American Heart
Association Council on High Blood Pressure Research. Recommendations for blood
pressure measurement in humans 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(1):142-61.-1111 1. Ogihara T, Kikuchi K, Matsuoka H, Fujita T, Higaki J, Horiuchi M, et
al; Japanese Society of Hypertension Committee. The Japanese Society of Hypertension.
Guidelines for the Management of Hypertension (JSH 2009). Hypertens Res.
2009;32:3-107. Erratum in: Hypertens Res 2009;32(4):318.. This low-cost method
has potential clinical use in different scenarios, such as in establishing the diagnosis
and prognosis of systemic arterial hypertension (SAH), in 'white coat hypertension' and
'masked hypertension', in assessing BP levels of the elderly and hypertensive
individuals with diabetes, in resistant hypertension, and in assessing adherence to
anti-hypertensive treatment, as a guide for pharmacological interventions66 Imai Y, Otsuka K, Kawano Y, Shimada K, Hayashi H, Tochikubo O, et al;
Japanese Society of. Hypertension Japanese Society of Hypertension (JSH) guidelines
for self-monitoring of blood pressure at home. Hypertens Res.
2003;26(10):771-82.
7 Sociedade Brasileira de Cardiologia, Sociedade Brasileira de
Hipertensão, Sociedade Brasileira de Nefrologia. V Diretrizes Brasileiras de
Monitoração Ambulatorial da Pressão Arterial (MAPA V) e III Diretrizes de Monitoração
Residencial da Pressão Arterial (MRPA III). Arq Bras Cardiol. 2011;97(3
supl.3):1-24.
8 Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, et al;
Task Force Members. 2013 ESH/ESC Guidelines for the management of arterial
hypertension: the Task Force for the management of arterial hypertension of the
European Society of Hypertension (ESH) and of the European Society of Cardiology
(ESC). J Hypertens. 2013;31(7):1281-357. -99 Pickering TG, Miller NH, Ogedegbe G, Krakoff LR, Artinian NT, Goff D;
American Heart Association, American Society of, Hypertension Preventive
Cardiovascular Nurses Association. 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(1):1-9. ,1212 Verberk WJ, Kroon AA, Jongen-Vancraybex HA, de Leeuw PW. The
applicability of home blood pressure measurement in clinical practice: a review of
literature. Vasc Health Risk Manag. 2007;3(6):959-66.
13 Celis H, Den Hond E, Staessen JA. Self-measurement of blood pressure at
home in the management of hypertension. Clin Med Res.
2005;3(1):19-26.-1414 Staesson JA, Den Hond E, Celis H, Fagard R, Keary L, Vandenhoven G, et
al; Treatment of HypertensionBased on Home or Office Blood Pressure (THOP) Trial
Investigators. Antihypertensive treatment based on blood pressure measurement at home
or in the physician's office: a randomized controlled trial. JAMA.
2004;291(8):955-64..
Home blood pressure monitoring is defined as the systematized out-of-office BP
measurement by the patient or any skilled person, during wakefulness, following a
specific and standardized protocol, which is different from self-blood pressure
measurement (SBPM), which is the non-systematized reading performed according to
doctor's guidance or patient's decision77 Sociedade Brasileira de Cardiologia, Sociedade Brasileira de
Hipertensão, Sociedade Brasileira de Nefrologia. V Diretrizes Brasileiras de
Monitoração Ambulatorial da Pressão Arterial (MAPA V) e III Diretrizes de Monitoração
Residencial da Pressão Arterial (MRPA III). Arq Bras Cardiol. 2011;97(3
supl.3):1-24..
European and North-American guidelines lack accuracy regarding protocol systematization
and control, which can be mistaken for SBPM88 Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, et al;
Task Force Members. 2013 ESH/ESC Guidelines for the management of arterial
hypertension: the Task Force for the management of arterial hypertension of the
European Society of Hypertension (ESH) and of the European Society of Cardiology
(ESC). J Hypertens. 2013;31(7):1281-357. ,99 Pickering TG, Miller NH, Ogedegbe G, Krakoff LR, Artinian NT, Goff D;
American Heart Association, American Society of, Hypertension Preventive
Cardiovascular Nurses Association. 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(1):1-9. ,1515 O'Brien E, Parati G, Stergiou G, Asmar R, Beilin L, Bilo G, et al;
European Society of HypertensionWorking Group on Blood Pressure Monitoring. European
society of hypertension position paper on ambulatory blood pressure monitoring. J
Hypertens. 2013;31(9):1731-68. Erratum in J Hypertens.
2013;31(12):2467.,1616 Parati G, Stergiou GS, Asmar R, Bilo G, Leeuw P, Imai Y, et al; ESH
Working Group on Blood Pressure Monitoring. European Society of Hypertensionpractice
guideline for home blood pressure monitoring. J Hum Hypertens.
2010;24(12):779-85.. However, inconsistencies in protocol recommendations regarding hours,
number of days and measurements taken during HBPM are still observed1717 Verberk WJ, Kroon AA, Kessels AG, Lenders JW, Thien T, van Montfrans GA,
et al. The optimal scheme of self blood pressure measurement as determined from
ambulatory blood pressure recordings. J Hypertens.
2006;24(8):1541-8.
18 Celis H, Cort P De, Fagard R, Thijs L, Staessen JA. For how many days
should blood pressure be measured at home in older patients before steady levels are
obtained? J Hum Hypertens. 1997;11(10):673-7.
19 Ohkubo T, Asayama K, Kikuya M, Metoki H, Hoshi H, Hashimoto J, et al.
How many times should blood pressure be measured at home for better prediction of
stroke risk? Ten-year follow-up results from the Ohasama study. J Hypertens.
2004;22(6):1099-104.-2020 Brook RD. Home blood pressure: accuracy is independent of monitoring
schedules. Am J Hypertens. 2000;13(6 Pt 1):625-31.. The HBPM protocols of the Brazilian Society of Cardiology (SBC)77 Sociedade Brasileira de Cardiologia, Sociedade Brasileira de
Hipertensão, Sociedade Brasileira de Nefrologia. V Diretrizes Brasileiras de
Monitoração Ambulatorial da Pressão Arterial (MAPA V) e III Diretrizes de Monitoração
Residencial da Pressão Arterial (MRPA III). Arq Bras Cardiol. 2011;97(3
supl.3):1-24. and of the Japanese Society of Hypertension66 Imai Y, Otsuka K, Kawano Y, Shimada K, Hayashi H, Tochikubo O, et al;
Japanese Society of. Hypertension Japanese Society of Hypertension (JSH) guidelines
for self-monitoring of blood pressure at home. Hypertens Res.
2003;26(10):771-82. recommend BP measuring in the morning after
micturition, avoiding urinary bladder distension and consequent BP elevation. The
influence of BP measurements taken in the afternoon during work on the estimation of
usual BP is still arguable2121 Garcia-Vera MP, Sanz J. How many self-measured blood pressure readings
are needed to estimate hypertensive patients "true" blood pressure? J Behav Med.
1999;22(1):93-113.. The European
Society of Hypertension1515 O'Brien E, Parati G, Stergiou G, Asmar R, Beilin L, Bilo G, et al;
European Society of HypertensionWorking Group on Blood Pressure Monitoring. European
society of hypertension position paper on ambulatory blood pressure monitoring. J
Hypertens. 2013;31(9):1731-68. Erratum in J Hypertens.
2013;31(12):2467.,1616 Parati G, Stergiou GS, Asmar R, Bilo G, Leeuw P, Imai Y, et al; ESH
Working Group on Blood Pressure Monitoring. European Society of Hypertensionpractice
guideline for home blood pressure monitoring. J Hum Hypertens.
2010;24(12):779-85. recommends BP measurement for seven days, two
taken in the morning and two in the evening, the means of the first day being discarded
for the purpose of diagnosis and therapeutic decisions. It is worth noting the lack of
major recommendations on the influence of micturition or other conditions on the
accuracy of HBPM.
The objective of the present study was to assess the influence on the SAH diagnosis of BP measurements taken immediately after waking up (before micturition) and in the afternoon, considering ABPM during wakefulness as gold-standard. In addition, the secondary objective was to assess the association of prognostic markers, such as microalbuminuaria (MAU) and left ventricular hypertrophy (LVH), with HBPM protocols that differ about the inclusion or exclusion of measurements taken before and after morning micturition or in the afternoon.
Methods
Population
Individuals referred for assessment of ABPM at a private clinic specialized in cardiology in the city of João Pessoa, Paraíba state, were eligible for this study. They were consecutively assessed at medical office, and, after anamnesis and physical examination, the individuals meeting the inclusion criteria were invited to participate in the study and to sign the written informed consent previously approved by the ethics committee of the institution. Patients with the following characteristics were excluded from the study: cardiac arrhythmia; cognitive deficit; and visual deficit hindering the measurements. In addition, exams that did not reach the required number of measurements were excluded from the analysis: < 16 validated measurements during wakefulness and/or < 8 measurements during sleep on ABPM or < 14 validated measurements on HBPM77 Sociedade Brasileira de Cardiologia, Sociedade Brasileira de Hipertensão, Sociedade Brasileira de Nefrologia. V Diretrizes Brasileiras de Monitoração Ambulatorial da Pressão Arterial (MAPA V) e III Diretrizes de Monitoração Residencial da Pressão Arterial (MRPA III). Arq Bras Cardiol. 2011;97(3 supl.3):1-24..
Study design
This is a diagnostic cross-sectional study to compare different HBPM protocols, considering 24-hour ABPM as gold-standard, for the diagnosis of SAH. All diagnostic tests were performed between February 2009 and April 2010.
Study protocol
The analyses of this investigation complement previously published data. The recruiting flowchart (Figure 1) and the assessment protocols have been previously described (Figure 2)2222 Almeida AE, Stein R, Gus M, Nascimento JA, Arévalo JR, Fuchs FD, et al. Improved diagnostic accuracy of a three-day protocol of home blood pressure monitoring for the diagnosis of arterial hypertension. Blood Press Monit. 2013;18(2):119-26.. Briefly, after personal data collection, patients underwent 24-hour ABPM, after which, all were randomized to one of the HBPM protocols (three or five days) and later crossover with a five-day interval between protocols. All patients completing the study underwent both HBPM protocols. For BP measurements, both protocols followed the SBC recommendations, as previously described1515 O'Brien E, Parati G, Stergiou G, Asmar R, Beilin L, Bilo G, et al; European Society of HypertensionWorking Group on Blood Pressure Monitoring. European society of hypertension position paper on ambulatory blood pressure monitoring. J Hypertens. 2013;31(9):1731-68. Erratum in J Hypertens. 2013;31(12):2467.,2222 Almeida AE, Stein R, Gus M, Nascimento JA, Arévalo JR, Fuchs FD, et al. Improved diagnostic accuracy of a three-day protocol of home blood pressure monitoring for the diagnosis of arterial hypertension. Blood Press Monit. 2013;18(2):119-26..
Flowchart of population recruitment. IM: insufficient measurements; CI: cognitive impairment; WIC: written informed consent; HBPM: home blood pressure monitoring; ABPM: ambulatory blood pressure monitoring
ABPM protocol: the recommendations for ABPM were in accordance with those of the SBC V guidelines for ABPM77 Sociedade Brasileira de Cardiologia, Sociedade Brasileira de Hipertensão, Sociedade Brasileira de Nefrologia. V Diretrizes Brasileiras de Monitoração Ambulatorial da Pressão Arterial (MAPA V) e III Diretrizes de Monitoração Residencial da Pressão Arterial (MRPA III). Arq Bras Cardiol. 2011;97(3 supl.3):1-24., with SBP and DBP measurements taken every 15 minutes during wakefulness and every 20 minutes during sleep.
HBPM protocol: for both protocols, in the morning of the first day, patients underwent the first three BP measurements with a trained nurse, and received all instructions about the protocols to be followed at home. The numbers and times of measurements are shown in Figure 2. On the three-day HBPM protocol, up to 33 BP measurements could be obtained, and, on the five-day HBPM protocol, up to 27 measurements. In both protocols, participants were instructed to take three measurements in the presence of any sign or symptom, at any time of the day, and record them on the diary.
To assess the impact of micturition and afternoon measurements on the accuracy of the three-day protocol as compared with that of the five-day protocol, the following sets of measurements were considered:
-
three-day HBPM with all measurements (standard three-day HBPM);
-
three-day HBPM with measurements taken before morning micturition and in the afternoon (HBPM-BM+AM);
-
three-day HBPM with post-morning-micturition and evening measurements (HBPM-PM+EM).
Devices
ABPM: the Spacelabs 90207 monitor (Spacelabs, Washington, DC, United States)
validated by the British Hypertension Society was used2323 British Hypertension Society (BHS) Ambulatory blood pressure measuring
devices oscillometric mode and automatic digital blood pressure devices for clinical
use and also suitable for home/self assessment. [Accessed in 2012 Jun 21]. Available
from: http://www.bhsoc.org/bp-monitors/bp-monitors/
http://www.bhsoc.org/bp-monitors/bp-moni...
.
HBPM: the validated Microlife BP A 100 Plus device (Microlife, Heerbrugg, Switzerland) was used2424 Stergiou GS, Giovas PP, Neofytou MS, Adamopoulos DN. Validation of the Microlife BP A 100 Plus device for self-home blood pressure measurement according to the International Protocol. Blood Press Monit. 2006;11(3):157-60..
Definitions and measurements of major variables
Systemic arterial hypertension assessed with ABPM was defined as systolic blood pressure (SBP) > 130 mmHg and diastolic blood pressure (DBP) > 80 mmHg in 24 hours. For ABPM during wakefulness, those values were SBP > 135 mmHg and DBP > 85 mmHg. For HBPM, the criterion adopted for the diagnosis of SAH was SBP at home > 135 mmHg and DBP at home > 85 mmHg77 Sociedade Brasileira de Cardiologia, Sociedade Brasileira de Hipertensão, Sociedade Brasileira de Nefrologia. V Diretrizes Brasileiras de Monitoração Ambulatorial da Pressão Arterial (MAPA V) e III Diretrizes de Monitoração Residencial da Pressão Arterial (MRPA III). Arq Bras Cardiol. 2011;97(3 supl.3):1-24.. For ABPM, wakefulness was defined as the time interval between waking up and going to bed, according to records documented in the diary.
Urinary albumin
On the initial exam, urinary albumin concentration, MAU, was measured in a urine
sample by using immunoturbidimetric assay (AlbuminLatex, BioSystems S.A., Barcelona,
Spain). At our laboratory, the mean intra-assay and interassay coefficients of
variation were 2.4% and 5.7%, respectively, the lower limit of detection was 0.9
mg/L, and the cutoff point for the diagnosis of MAU was > 15 mg/L. The MAU
determined from a single urine specimen is highly correlated with 24-hour urinary
albumin excretion2525 Zelmanovitz T, Gross JL, Oliveira JR, Paggi A, Tatsch M, Azevedo MJ. The
receiver operating characteristics curve in the evaluation of a random urine specimen
as a screening test for diabetic nephropathy. Diabetes Care.
1997;20(4):516-9.
26 Dyer AR, Greenland P, Elliott P, Daviglus ML, Claeys G, Kesteloot H, et
al; INTERMAP Research Group. Evaluation of measures of urinary albumin excretion in
epidemiologic studies. Am J Epidemiol. 2004;160(11):1122-31.-2727 Lambers Heerspink HJ, Brantsma AH, de Zeeuw D, Bakker SJ, de Jong PE,
Gransevoort RT; PREVEND Study Group. Albuminuria assessed from first-morning-void
urine samples versus 24-hour urine collections as a predictor of cardiovascular
morbidly and mortality. Am J Epidemiol. 2008;168(8):897-905..
Echocardiography
To assess left ventricular mass (LVM), two-dimensional echocardiography with a Sonosite M-turbo machine (M-turbo Sonosite Inc., Bothell, WA, USA) was used. The measurements were taken according to the American Society of Echocardiography recommendations2828 Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E,Pellikka PA, et al; Chamber Quantification Writing Group; American Society of Echocardiography's Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography's guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18(12):1440-63.. The LVM (g) was calculated by using the Devereux equation2929 Devereux RB, Reichek N. Echocardiographic determination of left ventricular mass in man: anatomic validation of the method. Circulation. 1977;55(4):613-8. , and the LVM index (LVMI) in this study was defined as LVM (g)/body surface (m2). The diagnosis criteria for LVH were LVMI values of ≥ 115 g/m2 and ≥ 95 g/m2 for men and women, respectively2828 Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E,Pellikka PA, et al; Chamber Quantification Writing Group; American Society of Echocardiography's Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography's guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18(12):1440-63.,2929 Devereux RB, Reichek N. Echocardiographic determination of left ventricular mass in man: anatomic validation of the method. Circulation. 1977;55(4):613-8. .
Statistical analysis
All parameters were typed by a single trained examiner and independently of collection into a single database for further analysis. Data were assessed with the IBM SPSS Statistics 19 (IBM Company, USA). The continuous variables were described as mean ± standard deviation. The means of the BPs between the tests were compared by using ANOVA for repeated measures. To assess the impact of drug use in the population, the hierarchical log-linear model with multinomial distribution was used. The area under the Receiver Operating Characteristic (ROC) curve was calculated, and the accuracy of HBPM protocols was described based on sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively), and positive and negative likelihood ratios (PLR and NLR, respectively) with their respective 95% confidence intervals. Agreement between the diagnosis of SAH established by using ABPM during wakefulness, MAU, LVH and the two three-day HBPM protocols was assessed by use of kappa coefficient, ROC curve and intraclass correlation coefficient. The associations between ABPM and three-day HBPM were presented with the intraclass correlation coefficient, and dispersion and Bland-Altman plots. An alpha error probability < 5% was considered significant.
Results
Of the 204 patients invited to participate in this study, 169 accepted and 158 concluded it (Figure 1)2222 Almeida AE, Stein R, Gus M, Nascimento JA, Arévalo JR, Fuchs FD, et al. Improved diagnostic accuracy of a three-day protocol of home blood pressure monitoring for the diagnosis of arterial hypertension. Blood Press Monit. 2013;18(2):119-26.. Those who refused to participate and were excluded from the study had the same characteristics of the population assessed regarding age, sex and body mass index (BMI).
On initial assessment, four patients were excluded, one due to arrhythmia (atrial fibrillation) and three due to cognitive impairment. On ABPM, two patients were excluded due to insufficient number of measurements, because of equipment battery failure. On the three-day HBPM protocol, two patients left the study due to a trip, and, on the five-day HBPM protocol, one patient was excluded because of insufficient measurements (forgot to take BP measurements on the last two days), and two patients were excluded due to a trip. Regarding the patients who concluded all protocols, no change was observed in their lifestyle, medications and usual hours during the study. In the three-day protocol, 24 BP measurements were taken, and, in the five-day protocol, 19 measurements.
Table 1 shows the major characteristics of the population comprised of overweight middle-aged patients with slight predominance of the female sex. Half of them were on anti-hypertensive drugs, ABPM being mainly indicated for SAH diagnosis and treatment. The final diagnoses of 'white coat hypertension' and 'masked hypertension' were established in 18.3% and 3.1% of the patients, respectively. Assessment by using hierarchical log-linear model with multinomial distribution showed no difference regarding the use of drugs (p = 0.221). No significant difference in MAU between men and women was found (16 ± 11 mg/L; 14 ± 10 mg/L; p = 0.121). The mean LVMI values were 112 ± 15 g/m2 and 88 ± 9 g/m2 for men and women, respectively (p = 0.001).
Table 2 shows the means of ABPM during wakefulness, standard three-day HBPM, three-day HBPM-BM+AM, three-day HBPM-PM+EM, and five-day HBPM, with significant differences between them for SBP and DBP. Figure 3 shows the dispersion and Bland-Altman plots for SBP and DBP, with smaller dispersion and better agreement of the BM+AM protocol as compared with the PM+EM protocol of the three-day HBPM obtained by associating with ABPM during wakefulness.
Mean ± SD of systolic blood pressure (SBP) and diastolic blood pressure (DBP) of ambulatory blood pressure monitoring (ABPM) and of the different HBPM protocols
Dispersion and Bland-Altman plots of blood pressure measurements comparing 3-day home blood pressure monitoring (HBPM) with ambulatory blood pressure monitoring (ABPM). BM+AM: measurements taken before morning micturition and in the afternoon; PM+EM: measurements taken post morning micturition and in the evening; DBP: diastolic blood pressure; SBP: systolic blood pressure
Table 3 shows a difference in kappa values between the three-day HBPM protocols when the micturition subject is considered in the analysis. Table 4 shows better diagnosis accuracy for the standard three-day HBPM and three-day HBPM-BM+AM protocols, considering ABPM during wakefulness as gold-standard. Table 5 shows that, using the cutoff points previously defined for the diagnosis of SAH and considering all forms of ambulatory measurements, the standard three-day HBPM protocol, the three-day HBPM-BM+AM protocol and the ABPM during wakefulness protocol had the best agreement and correlated better with the diagnosis of MAU and LVH.
Kappa statistic for the diagnosis of hypertension considering ambulatory blood pressure monitoring (ABPM) during wakefulness as gold-standard
Accuracy of home blood pressure monitoring (HBPM) protocols considering ambulatory blood pressure monitoring (ABPM) during wakefulness as gold-standard
Agreement and correlation between the diagnosis of hypertension and the diagnosis of microalbuminuria and left ventricular hypertrophy
Discussion
The major finding in this study was that, considering ABPM during wakefulness as gold-standard for the diagnosis of SAH, the HBPM protocol including BP measurements taken before the first morning micturition and in the afternoon had the best accuracy to diagnose SAH as compared with the other protocols assessed. In addition, that three-day HBPM protocol performed better than the longer five-day protocol, thus being useful and having a practical potential to the routine assessment of hypertensive individuals. Furthermore, that strategy correlates better with prognostic markers, such as MAU and LVH. Because of the clinical relevance of that finding, three-day HBPM protocols should include measurements taken before morning micturition and in the afternoon.
Studies considering the importance of micturition for HBPM accuracy lack in the literature. The SBC guidelines77 Sociedade Brasileira de Cardiologia, Sociedade Brasileira de Hipertensão, Sociedade Brasileira de Nefrologia. V Diretrizes Brasileiras de Monitoração Ambulatorial da Pressão Arterial (MAPA V) e III Diretrizes de Monitoração Residencial da Pressão Arterial (MRPA III). Arq Bras Cardiol. 2011;97(3 supl.3):1-24.,1515 O'Brien E, Parati G, Stergiou G, Asmar R, Beilin L, Bilo G, et al; European Society of HypertensionWorking Group on Blood Pressure Monitoring. European society of hypertension position paper on ambulatory blood pressure monitoring. J Hypertens. 2013;31(9):1731-68. Erratum in J Hypertens. 2013;31(12):2467. on that investigation method recommend BP measurement in the morning after micturition. However, such recommendation is not supported by any scientific reference, being thus empirical. The Japanese Society of Hypertension guideline66 Imai Y, Otsuka K, Kawano Y, Shimada K, Hayashi H, Tochikubo O, et al; Japanese Society of. Hypertension Japanese Society of Hypertension (JSH) guidelines for self-monitoring of blood pressure at home. Hypertens Res. 2003;26(10):771-82. makes the same recommendation, based on one single Japanese study published as an abstract and showing BP elevation associated with morning urinary bladder distension. In defining the HBPM protocol, the European1515 O'Brien E, Parati G, Stergiou G, Asmar R, Beilin L, Bilo G, et al; European Society of HypertensionWorking Group on Blood Pressure Monitoring. European society of hypertension position paper on ambulatory blood pressure monitoring. J Hypertens. 2013;31(9):1731-68. Erratum in J Hypertens. 2013;31(12):2467.,3030 Parati G, Stergiou GS, Asmar R, Bilo G, de, Leeuw P Imai Y, et al; ESH Working Group on Blood Pressure Monitoring. European Society of Hypertensionpractice guidelines for home blood pressure monitoring. J Hum Hypertens. 2010;24(12):779-85. and North-American99 Pickering TG, Miller NH, Ogedegbe G, Krakoff LR, Artinian NT, Goff D; American Heart Association, American Society of, Hypertension Preventive Cardiovascular Nurses Association. 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(1):1-9. guidelines make no reference to that subject.
In addition, the circadian variation of BP depends on three major factors: physical activity, autonomic function and sodium sensitivity3131 Agarwal R. Regulation of circadian blood pressure: from mice to astronauts. Curr Opin Nephrol Hypertens. 2010;19(1):51-8.. Fagius and Karhuvaara32 have shown an association between BP elevation and urinary bladder distension in 16 healthy individuals after fluid ingestion. That finding has been justified by the vesicovascular stimulus related to an increase in sympathetic flow, which is mediated by vasoconstrictor neurons, thus increasing BP. Scott et al3333 Scott EM, Greenwood JP, Gilbey SG, Stoker JB, Mary DA. Water ingestion increases sympathetic vasoconstrictor discharge in normal human subjects. Clin Sci (Lon). 2001;100(3):335-42. have shown that, in healthy individuals, the BP elevation that follows water ingestion is associated with increases in serum norepinephrine levels, in sympathetic activity and in peripheral vascular resistance. Callegaro et al3434 Callegaro CC, Moraes RS, Negrão CE, Trombetta IC, Rondon MU, Teixeira MS, et al. Acute water ingestion increases arterial blood pressure in hypertensive and normotensive subjects. J Hum Hypertens. 2007;21(7):564-70., studying normotensive and hypertensive individuals, have reported that the BP increase after acute water ingestion could be explained by an increased vasoconstrictor sympathetic activity. Studies assessing cold exposure3535 Hintsala H, Kandelberg A, Herzig KH, Rintamäki H, Mäntysaari M, Rantala A, et al. Central aortic blood pressure of hypertensive men during short-term cold exposure. Am J Hypertens. 2014;27(5):656-64. and mental stress exposure3636 Sudano I, Spieker L, Binggeli C, Ruschitzka F, Lüscher TF, Noll G, et al. Coffee blunts mental stress-induced blood pressure increase in habitual but not in nonhabitual coffee drinkers. Hypertension. 2005;46(3):521-6. have also reported BP elevation due to sympathetic activity. All those factors can be considered as part of the BP circadian cycle complex, and there is convincing evidence that it plays an important role in BP variability regulation3737 Rudic RD. Time is of the essence: vascular implications of the circadian clock. Circulation. 2009;120(17):1714-21.. Thus, those questions should be assessed at the time the accuracy of BP measuring tests is assessed for a prolonged time or of proposed HBPM protocols. Thus, by discriminating BP in a more reliable way, the diagnosis and treatment of SAH can be better established, and target-organ lesions prevented in the long run. In that scenario, adding measurements to the standard HBPM, considering first-morning micturition and stress at workplace, can influence the accuracy of the method for SAH diagnosis.
The number of measurements of HBPM should be considered, although the optimal number to
be used remains controversial in the different guidelines66 Imai Y, Otsuka K, Kawano Y, Shimada K, Hayashi H, Tochikubo O, et al;
Japanese Society of. Hypertension Japanese Society of Hypertension (JSH) guidelines
for self-monitoring of blood pressure at home. Hypertens Res.
2003;26(10):771-82.
7 Sociedade Brasileira de Cardiologia, Sociedade Brasileira de
Hipertensão, Sociedade Brasileira de Nefrologia. V Diretrizes Brasileiras de
Monitoração Ambulatorial da Pressão Arterial (MAPA V) e III Diretrizes de Monitoração
Residencial da Pressão Arterial (MRPA III). Arq Bras Cardiol. 2011;97(3
supl.3):1-24.
8 Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, et al;
Task Force Members. 2013 ESH/ESC Guidelines for the management of arterial
hypertension: the Task Force for the management of arterial hypertension of the
European Society of Hypertension (ESH) and of the European Society of Cardiology
(ESC). J Hypertens. 2013;31(7):1281-357. -99 Pickering TG, Miller NH, Ogedegbe G, Krakoff LR, Artinian NT, Goff D;
American Heart Association, American Society of, Hypertension Preventive
Cardiovascular Nurses Association. 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(1):1-9. ,1111 1. Ogihara T, Kikuchi K, Matsuoka H, Fujita T, Higaki J, Horiuchi M, et
al; Japanese Society of Hypertension Committee. The Japanese Society of Hypertension.
Guidelines for the Management of Hypertension (JSH 2009). Hypertens Res.
2009;32:3-107. Erratum in: Hypertens Res 2009;32(4):318.,1515 O'Brien E, Parati G, Stergiou G, Asmar R, Beilin L, Bilo G, et al;
European Society of HypertensionWorking Group on Blood Pressure Monitoring. European
society of hypertension position paper on ambulatory blood pressure monitoring. J
Hypertens. 2013;31(9):1731-68. Erratum in J Hypertens.
2013;31(12):2467.,1616 Parati G, Stergiou GS, Asmar R, Bilo G, Leeuw P, Imai Y, et al; ESH
Working Group on Blood Pressure Monitoring. European Society of Hypertensionpractice
guideline for home blood pressure monitoring. J Hum Hypertens.
2010;24(12):779-85.. Garcia-Vera and
Sanz2121 Garcia-Vera MP, Sanz J. How many self-measured blood pressure readings
are needed to estimate hypertensive patients "true" blood pressure? J Behav Med.
1999;22(1):93-113. have assessed HBPM in 43 treated
hypertensive patients. In their study, two BP measurements were taken in the morning, in
the afternoon during work, and in the evening. That procedure was repeated after one and
six months. The results have shown that two measurements would suffice, one at the
workplace and the other at home, on three consecutive days, to obtain reliable BP
estimates. Another finding from that study is that BP measurements at the workplace were
consistently higher than those obtained at home. Kario et al3838 Kario K, James GD, Marion R, Ahmed M, Pickering TG. The influence of
work- and home-related stress on the levels and diurnal variation of ambulatory blood
pressure and neurohumoral factors in employed women. Hypertens Res.
2002;25(4):499-506. have assessed the influence of work-and home-related stress on
sympathetic activation and BP in 134 women. Those authors have shown that work-related
stress increased BP levels throughout the day, and the home-related stress induced an
additional sympathetic activation. Those data corroborate our protocol, which includes
one measurement in the afternoon during work, which better correlated with the diagnosis
of SAH.
Den Hond et al3939 Hond ED, Celis H, Fagard R, Keary L, Leeman M, O'Brien E, et al. Self-measured versus ambulatory blood pressure in the diagnosis of hypertension. J Hypertens. 2003;21(4):717-22., studying 247 patients, have compared HBPM with ABPM during wakefulness (SAH ≥ 135/85 mmHg) by using a protocol with three measurements taken in the morning and evening for seven days. They have found sensitivity, specificity, PPV, NPV and kappa statistic of 68.4%, 88.6%, 33.3%, 97.1% and 0.380, respectively. Comparing their findings with ours originating from the three-day HBPM-BM+AM protocol, theirs have a greater number of measurements taken during the day. However, the results indicate that our protocol performed better, evidencing that not only the number of measurements can influence the accuracy of different protocols, but the time such measurements are taken should be considered.
Limitations
First, ABPM during wakefulness was considered gold-standard for the diagnosis of SAH. It is worth noting that the standard reference to define the best HBPM protocol should be the occurrence of clinical outcomes assessed on longitudinal studies. However, some studies, such as the PAMELA4040 Sega R, Facchetti R, Bombelli M, Cesana G, Corrao G, Grassi G, et al. Prognostic value of ambulatory and home blood pressure compared with office blood pressure in the general population: follow-up results from the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study. Circulation. 2005;111(14):1777-83. and FINN-Home4141 Niiranen TJ, Hänninen MR, Johansson J, Reunanen A, Jula AM. Home-measured blood pressure is a stronger predictor of cardiovascular risk than office blood pressure: the Finn-Home study. Hypertension. 2010;55(6):1346-51. studies, have also used ABPM as gold-standard. Second, our three-day HBPM protocol had a higher number of measurements per day as compared with the five-day HBPM protocol. Thus, our results may be a mere consequence of approximation bias. Nevertheless, data clearly showed that the three-day HBPM protocol was better than the five-day HBPM protocol, and that measurements taken at different times had a significant importance to the result, suggesting it should be preferred in clinical practice. The feasibility and efficacy of a HBPM protocol with a greater number of measurements require better assessment in longitudinal studies.
Conclusion
The three-day HBPM protocol comprising measurements taken before first-morning micturition and in the afternoon has better agreement with the diagnosis of SAH, considering 24-hour ABPM as gold-standard, and associates better with prognostic markers as compared with the five-day HBPM protocol.
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1Mancia G, Sega R, Bravi C, De Vito G, Valagussa F, Cesana G, et al. Ambulatory blood pressure normality: results from the PAMELA study. J Hypertens. 1995;13(12 Pt 1):1377-90.
-
2Ohkubo T, Imai Y, Tsuji I, Nagai K, Ito S, Satoh H, et al. Reference values for 24-hour ambulatory blood pressure monitoring based on a prognostic criterion: the Ohasama Study. Hypertension. 1998;32(2):255-9.
-
3Bombelli M, Sega R, Facchetti R, Corrao G, Polo Friz H, Vertemati AM, et al. Prevalence and clinical significance of a greater ambulatory versus office blood pressure ('reversed white coat' condition) in a general population. J Hypertens. 2005;23(3):513-20.
-
4Clement DL, De Buyzere ML, De Bacquer DA, de Leeuw PW, Duprez DA, Fagard RH, et al; Office versus Ambulatory Pressure Study Investigators. Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension. N Engl J Med. 2003;348(24):2407-15.
-
5Staessen 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(6):539-46.
-
6Imai Y, Otsuka K, Kawano Y, Shimada K, Hayashi H, Tochikubo O, et al; Japanese Society of. Hypertension Japanese Society of Hypertension (JSH) guidelines for self-monitoring of blood pressure at home. Hypertens Res. 2003;26(10):771-82.
-
7Sociedade Brasileira de Cardiologia, Sociedade Brasileira de Hipertensão, Sociedade Brasileira de Nefrologia. V Diretrizes Brasileiras de Monitoração Ambulatorial da Pressão Arterial (MAPA V) e III Diretrizes de Monitoração Residencial da Pressão Arterial (MRPA III). Arq Bras Cardiol. 2011;97(3 supl.3):1-24.
-
8Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, et al; Task Force Members. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31(7):1281-357.
-
9Pickering TG, Miller NH, Ogedegbe G, Krakoff LR, Artinian NT, Goff D; American Heart Association, American Society of, Hypertension Preventive Cardiovascular Nurses Association. 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(1):1-9.
-
100. Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN, et al; Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Recommendations for blood pressure measurement in humans 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(1):142-61.
-
111. Ogihara T, Kikuchi K, Matsuoka H, Fujita T, Higaki J, Horiuchi M, et al; Japanese Society of Hypertension Committee. The Japanese Society of Hypertension. Guidelines for the Management of Hypertension (JSH 2009). Hypertens Res. 2009;32:3-107. Erratum in: Hypertens Res 2009;32(4):318.
-
12Verberk WJ, Kroon AA, Jongen-Vancraybex HA, de Leeuw PW. The applicability of home blood pressure measurement in clinical practice: a review of literature. Vasc Health Risk Manag. 2007;3(6):959-66.
-
13Celis H, Den Hond E, Staessen JA. Self-measurement of blood pressure at home in the management of hypertension. Clin Med Res. 2005;3(1):19-26.
-
14Staesson JA, Den Hond E, Celis H, Fagard R, Keary L, Vandenhoven G, et al; Treatment of HypertensionBased on Home or Office Blood Pressure (THOP) Trial Investigators. Antihypertensive treatment based on blood pressure measurement at home or in the physician's office: a randomized controlled trial. JAMA. 2004;291(8):955-64.
-
15O'Brien E, Parati G, Stergiou G, Asmar R, Beilin L, Bilo G, et al; European Society of HypertensionWorking Group on Blood Pressure Monitoring. European society of hypertension position paper on ambulatory blood pressure monitoring. J Hypertens. 2013;31(9):1731-68. Erratum in J Hypertens. 2013;31(12):2467.
-
16Parati G, Stergiou GS, Asmar R, Bilo G, Leeuw P, Imai Y, et al; ESH Working Group on Blood Pressure Monitoring. European Society of Hypertensionpractice guideline for home blood pressure monitoring. J Hum Hypertens. 2010;24(12):779-85.
-
17Verberk WJ, Kroon AA, Kessels AG, Lenders JW, Thien T, van Montfrans GA, et al. The optimal scheme of self blood pressure measurement as determined from ambulatory blood pressure recordings. J Hypertens. 2006;24(8):1541-8.
-
18Celis H, Cort P De, Fagard R, Thijs L, Staessen JA. For how many days should blood pressure be measured at home in older patients before steady levels are obtained? J Hum Hypertens. 1997;11(10):673-7.
-
19Ohkubo T, Asayama K, Kikuya M, Metoki H, Hoshi H, Hashimoto J, et al. How many times should blood pressure be measured at home for better prediction of stroke risk? Ten-year follow-up results from the Ohasama study. J Hypertens. 2004;22(6):1099-104.
-
20Brook RD. Home blood pressure: accuracy is independent of monitoring schedules. Am J Hypertens. 2000;13(6 Pt 1):625-31.
-
21Garcia-Vera MP, Sanz J. How many self-measured blood pressure readings are needed to estimate hypertensive patients "true" blood pressure? J Behav Med. 1999;22(1):93-113.
-
22Almeida AE, Stein R, Gus M, Nascimento JA, Arévalo JR, Fuchs FD, et al. Improved diagnostic accuracy of a three-day protocol of home blood pressure monitoring for the diagnosis of arterial hypertension. Blood Press Monit. 2013;18(2):119-26.
-
23British Hypertension Society (BHS) Ambulatory blood pressure measuring devices oscillometric mode and automatic digital blood pressure devices for clinical use and also suitable for home/self assessment. [Accessed in 2012 Jun 21]. Available from: http://www.bhsoc.org/bp-monitors/bp-monitors/
» http://www.bhsoc.org/bp-monitors/bp-monitors/ -
24Stergiou GS, Giovas PP, Neofytou MS, Adamopoulos DN. Validation of the Microlife BP A 100 Plus device for self-home blood pressure measurement according to the International Protocol. Blood Press Monit. 2006;11(3):157-60.
-
25Zelmanovitz T, Gross JL, Oliveira JR, Paggi A, Tatsch M, Azevedo MJ. The receiver operating characteristics curve in the evaluation of a random urine specimen as a screening test for diabetic nephropathy. Diabetes Care. 1997;20(4):516-9.
-
26Dyer AR, Greenland P, Elliott P, Daviglus ML, Claeys G, Kesteloot H, et al; INTERMAP Research Group. Evaluation of measures of urinary albumin excretion in epidemiologic studies. Am J Epidemiol. 2004;160(11):1122-31.
-
27Lambers Heerspink HJ, Brantsma AH, de Zeeuw D, Bakker SJ, de Jong PE, Gransevoort RT; PREVEND Study Group. Albuminuria assessed from first-morning-void urine samples versus 24-hour urine collections as a predictor of cardiovascular morbidly and mortality. Am J Epidemiol. 2008;168(8):897-905.
-
28Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E,Pellikka PA, et al; Chamber Quantification Writing Group; American Society of Echocardiography's Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography's guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18(12):1440-63.
-
29Devereux RB, Reichek N. Echocardiographic determination of left ventricular mass in man: anatomic validation of the method. Circulation. 1977;55(4):613-8.
-
30Parati G, Stergiou GS, Asmar R, Bilo G, de, Leeuw P Imai Y, et al; ESH Working Group on Blood Pressure Monitoring. European Society of Hypertensionpractice guidelines for home blood pressure monitoring. J Hum Hypertens. 2010;24(12):779-85.
-
31Agarwal R. Regulation of circadian blood pressure: from mice to astronauts. Curr Opin Nephrol Hypertens. 2010;19(1):51-8.
-
32Fagius J, Karhuvaara S. Sympathetic activity and blood pressure increases with bladder distension in humans. Hypertension. 1989;14(5):511-51.
-
33Scott EM, Greenwood JP, Gilbey SG, Stoker JB, Mary DA. Water ingestion increases sympathetic vasoconstrictor discharge in normal human subjects. Clin Sci (Lon). 2001;100(3):335-42.
-
34Callegaro CC, Moraes RS, Negrão CE, Trombetta IC, Rondon MU, Teixeira MS, et al. Acute water ingestion increases arterial blood pressure in hypertensive and normotensive subjects. J Hum Hypertens. 2007;21(7):564-70.
-
35Hintsala H, Kandelberg A, Herzig KH, Rintamäki H, Mäntysaari M, Rantala A, et al. Central aortic blood pressure of hypertensive men during short-term cold exposure. Am J Hypertens. 2014;27(5):656-64.
-
36Sudano I, Spieker L, Binggeli C, Ruschitzka F, Lüscher TF, Noll G, et al. Coffee blunts mental stress-induced blood pressure increase in habitual but not in nonhabitual coffee drinkers. Hypertension. 2005;46(3):521-6.
-
37Rudic RD. Time is of the essence: vascular implications of the circadian clock. Circulation. 2009;120(17):1714-21.
-
38Kario K, James GD, Marion R, Ahmed M, Pickering TG. The influence of work- and home-related stress on the levels and diurnal variation of ambulatory blood pressure and neurohumoral factors in employed women. Hypertens Res. 2002;25(4):499-506.
-
39Hond ED, Celis H, Fagard R, Keary L, Leeman M, O'Brien E, et al. Self-measured versus ambulatory blood pressure in the diagnosis of hypertension. J Hypertens. 2003;21(4):717-22.
-
40Sega R, Facchetti R, Bombelli M, Cesana G, Corrao G, Grassi G, et al. Prognostic value of ambulatory and home blood pressure compared with office blood pressure in the general population: follow-up results from the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study. Circulation. 2005;111(14):1777-83.
-
41Niiranen TJ, Hänninen MR, Johansson J, Reunanen A, Jula AM. Home-measured blood pressure is a stronger predictor of cardiovascular risk than office blood pressure: the Finn-Home study. Hypertension. 2010;55(6):1346-51.
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Author contributionsConception and design of the research: Almeida AEM, Stein R, Gus M, Fuchs FD, Ribeiro JP; Acquisition of data: Almeida AEM, Arévalo JRG; Analysis and interpretation of the data: Almeida AEM, Stein R, Gus M, Nascimento JA, Belli KC, Arévalo JRG, Ribeiro JP; Statistical analysis: Almeida AEM, Stein R, Nascimento JA, Ribeiro JP; Obtaining financing: Stein R, Gus M, Fuchs FD; Writing of the manuscript: Almeida AEM, Stein R, Gus M, Nascimento JA, Belli KC, Fuchs FD, Ribeiro JP; Critical revision of the manuscript for intellectual content: Almeida AEM, Stein R, Gus M, Belli KC, Arévalo JRG, Fuchs FD, Ribeiro JP.
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Sources of FundingThis study was partially funded by CNPq.Ricardo Stein and Miguel Gus are Level 2 CNPq investigators. Flávio Dani Fuchs is Level 1A CNPq investigator.
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Study AssociationThis article is part of the thesis of Doctoral submitted by Antonio Eduardo Monteiro de Almeida, from Universidade Federal do Rio Grande do Sul.
Publication Dates
-
Publication in this collection
23 Sept 2014 -
Date of issue
Oct 2014
History
-
Received
20 Dec 2013 -
Reviewed
24 May 2014 -
Accepted
29 May 2014