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Office blood pressure variability in non-hypertensive patients during a preventive examination
Affiliations- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
open access
Abstract
Background: Despite advantages of ambulatory and home blood pressure monitoring, office blood pressure measurement remains the principal method for the diagnosis and management of hypertension. There still seems to be too little evidence to date showing variation in blood pressure during a medical visit and the current recommendations
are mainly based on expert’s opinions. The aim of this study was to evaluate the difference between the first two blood pressure measurements performed during a preventive examination and to verify whether the second measurement could influence clinical decisions in non-hypertensive patients.
Material and methods: The study included 52 consecutive patients without history of hypertension or other cardiovascular diseases. Blood pressure and heart rate (HR) were measured twice, the first reading after 5 minutes rest
and the second 1 minute later.
Results: Significant differences were found between the first (fBPM) and second (sBPM) blood pressure measurements, both systolic blood pressure (SBP) 142.4 mm Hg [interquartile range (IQR): 130.8–152.0] vs. 138.1 mm Hg (IQR: 125.8–149.5), p < 0.001 and diastolic blood pressure (DBP) 85.8 mm Hg (IQR: 80.0–91.5) vs. 83.9 mm Hg (IQR: 77.0–90.3), p < 0.001, and heart rate (HR) 73.1/min (IQR: 64.8–80.0) vs. 71.8/min (IQR: 64.8–77.3), p < 0.001. In 63.5% of the participants, the difference between the measurements was over 5 mm Hg for SBP values and in 23.1% of the participants for DBP values. According to fBPM, 53.8% of the patients met the criteria for the diagnosis of hypertension and according to sBPM 48.1% (NS).
Conclusion: We demonstrated substantial discrepancies between blood pressure values taken during the first and the second preventive medical check-up visit performed in the workplace. Preventive examination in the workspace is associated with similar number of false-positive results when hypertension status is evaluated as compared to regular office visits.
Abstract
Background: Despite advantages of ambulatory and home blood pressure monitoring, office blood pressure measurement remains the principal method for the diagnosis and management of hypertension. There still seems to be too little evidence to date showing variation in blood pressure during a medical visit and the current recommendations
are mainly based on expert’s opinions. The aim of this study was to evaluate the difference between the first two blood pressure measurements performed during a preventive examination and to verify whether the second measurement could influence clinical decisions in non-hypertensive patients.
Material and methods: The study included 52 consecutive patients without history of hypertension or other cardiovascular diseases. Blood pressure and heart rate (HR) were measured twice, the first reading after 5 minutes rest
and the second 1 minute later.
Results: Significant differences were found between the first (fBPM) and second (sBPM) blood pressure measurements, both systolic blood pressure (SBP) 142.4 mm Hg [interquartile range (IQR): 130.8–152.0] vs. 138.1 mm Hg (IQR: 125.8–149.5), p < 0.001 and diastolic blood pressure (DBP) 85.8 mm Hg (IQR: 80.0–91.5) vs. 83.9 mm Hg (IQR: 77.0–90.3), p < 0.001, and heart rate (HR) 73.1/min (IQR: 64.8–80.0) vs. 71.8/min (IQR: 64.8–77.3), p < 0.001. In 63.5% of the participants, the difference between the measurements was over 5 mm Hg for SBP values and in 23.1% of the participants for DBP values. According to fBPM, 53.8% of the patients met the criteria for the diagnosis of hypertension and according to sBPM 48.1% (NS).
Conclusion: We demonstrated substantial discrepancies between blood pressure values taken during the first and the second preventive medical check-up visit performed in the workplace. Preventive examination in the workspace is associated with similar number of false-positive results when hypertension status is evaluated as compared to regular office visits.
Keywords
blood pressure measurement; hypertension; preventive examination
About this articleTitle
Office blood pressure variability in non-hypertensive patients during a preventive examination
Journal
Issue
Article type
Original paper
Pages
30-35
Published online
2023-01-23
Page views
2257
Article views/downloads
307
DOI
Bibliographic record
Arterial Hypertension 2023;27(1):30-35.
Keywords
blood pressure measurement
hypertension
preventive examination
Authors
Łukasz Artyszuk
Izabela Nawrocka
Małgorzata Bieńko
Anita Pietrzak
Piotr Abramczyk
References (25)- Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. J Hypertens. 2018; 36(10): 1953–2041.
- Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018; 71: e13–e115.
- Rabi DM, McBrien KA, Sapir-Pichhadze R, et al. Hypertension Canada's 2020 Comprehensive Guidelines for the Prevention, Diagnosis, Risk Assessment, and Treatment of Hypertension in Adults and Children. Can J Cardiol. 2020; 36(5): 596–624.
- National Guideline C. National Institute for Health and Care Excellence: Clinical Guidelines. Hypertension in adults: diagnosis and management. National Institute for Health and Care Excellence (UK), London 2019.
- Pickering T, Hall J, Appel L, et al. 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. Circulation. 2005; 111(5): 697–716.
- Burkard T, Mayr M, Winterhalder C, et al. Reliability of single office blood pressure measurements. Heart. 2018; 104(14): 1173–1179.
- Veloudi P, Blizzard CL, Srikanth VK, et al. Age-dependent changes in blood pressure over consecutive office measurements: impact on hypertension diagnosis and implications for international guidelines. J Hypertens. 2017; 35(4): 753–760.
- Jose AP, Awasthi A, Kondal D, et al. Impact of repeated blood pressure measurement on blood pressure categorization in a population-based study from India. J Hum Hypertens. 2019; 33(8): 594–601.
- Lu Y, Tang O, Brady TM, et al. Simplified blood pressure measurement approaches and implications for hypertension screening: the Atherosclerosis Risk in Communities study. J Hypertens. 2021; 39(3): 447–452.
- Handler J, Zhao Y, Egan BM. Impact of the number of blood pressure measurements on blood pressure classification in US adults: NHANES 1999-2008. J Clin Hypertens (Greenwich). 2012; 14(11): 751–759.
- Levy J, Gerber LM, Wu X, et al. Nonadherence to Recommended Guidelines for Blood Pressure Measurement. J Clin Hypertens (Greenwich). 2016; 18(11): 1157–1161.
- Sebo P, Pechère-Bertschi A, Herrmann FR, et al. Blood pressure measurements are unreliable to diagnose hypertension in primary care. J Hypertens. 2014; 32(3): 509–517.
- Zdrojewski T, Rutkowski M, Bandosz P, et al. Prevalence and control of cardiovascular risk factors in Poland. Assumptions and objectives of the NATPOL 2011 Survey. Kardiol Pol. 2013; 71(4): 381–392.
- Piwońska A, Piotrowski W, Piwoński J, et al. Cardiovascular health knowledge of the Polish population. Comparison of two national multi-centre health surveys: WOBASZ and WOBASZ II. Kardiol Pol. 2017; 75(7): 711–719.
- Giusti MDe, Dito E, Pagliaro B, et al. A Survey on Blood Pressure Levels and Hypertension Control in a Sample of the Italian General Population. High Blood Press Cardiovasc Prev. 2012; 19(3): 129–135.
- Neuhauser HK, Adler C, Rosario AS, et al. Hypertension prevalence, awareness, treatment and control in Germany 1998 and 2008-11. J Hum Hypertens. 2015; 29(4): 247–253.
- Chow CK, Teo KK, Rangarajan S, et al. PURE (Prospective Urban Rural Epidemiology) Study investigators. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA. 2013; 310(9): 959–968.
- Lewington S, Clarke R, Qizilbash N, et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002; 360(9349): 1903–1913.
- Ettehad D, Emdin C, Kiran A, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016; 387(10022): 957–967.
- Charkoudian N, Rabbitts J. Sympathetic Neural Mechanisms in Human Cardiovascular Health and Disease. Mayo Clin Proc. 2009; 84(9): 822–830.
- Vianna LC, Hart EC, Fairfax ST, et al. Influence of age and sex on the pressor response following a spontaneous burst of muscle sympathetic nerve activity. Am J Physiol Heart Circ Physiol. 2012; 302(11): H2419–H2427.
- Taylor JA, Tan CO. BP regulation VI: elevated sympathetic outflow with human aging: hypertensive or homeostatic? Eur J Appl Physiol. 2014; 114(3): 511–519.
- Lambert GW, Schlaich MP, Eikelis N, et al. Sympathetic activity in obesity: a brief review of methods and supportive data. Ann N Y Acad Sci. 2019; 1454(1): 56–67.
- Tadic M, Cuspidi C, Pencic B, et al. The interaction between blood pressure variability, obesity, and left ventricular mechanics: findings from the hypertensive population. J Hypertens. 2016; 34(4): 772–780.
- Faramawi MF, Fischbach L, Delongchamp R, et al. Obesity is associated with visit-to-visit systolic blood pressure variability in the US adults. J Public Health (Oxf). 2015; 37(4): 694–700.