Automated office blood pressure measurements in primary care are misleading in more than one third of treated hypertensives: The VALENTINE-Greece Home Blood Pressure Monitoring study

A Kollias; S S Papadatos; A F Dominiczak; G Parati; G S Stergiou; Valentine-Greece Home Blood Pressure Monitoring Study Group

doi:10.1016/j.hjc.2019.01.005

Automated office blood pressure measurements in primary care are misleading in more than one third of treated hypertensives: The VALENTINE-Greece Home Blood Pressure Monitoring study

Hellenic J Cardiol. 2020 May-Jun;61(3):174-177. doi: 10.1016/j.hjc.2019.01.005. Epub 2019 Jan 9.

Authors

A Kollias¹, S S Papadatos², A F Dominiczak², G Parati³, G S Stergiou⁴; Valentine-Greece Home Blood Pressure Monitoring Study Group

Collaborators

Valentine-Greece Home Blood Pressure Monitoring Study Group:
E Demerouti⁵, D Voulgaris⁵, I Papadakis⁵, A Karsanidis⁵, A Triantafillou⁵, S Garzonis⁵, G Gourgoulis⁵, A Trikalinou⁵, P Karidas⁵, D Savvalas⁵, T Aggelopoulos⁵, A Alevizos⁵, A Moraiti⁵, E Rosmarakis⁵, G Chatzigeorgiou⁵, V Antonakis⁵, A Alexandropoulou-Tsirka⁵, I Markaki⁵, S Astrinakis⁵, V Roilidis⁵, S Polymeros⁵, E Chariatis⁵, V Panageas⁵, A Kontoriga⁵, M Patsioura⁵, A Kleftaki-Manta⁵, A Kalantaridou⁵, S Kourouklis⁵, G Papakonstantinos⁵, P Barouni⁵, E Grekidou⁵, A Sklaveniti⁵, I Kolovou⁵, A Antoniadis⁵, I Pelekanos⁵, N Zervaki Drakou⁵, K Tikka-Zoumpou⁵, V Dalaklidou⁵, A Menti⁵, A Christofeli⁵, T Androutsakos⁵, D Doulgerakis⁵, I Oikonomopoulou⁶, M Moschos⁶, D Koutras⁶, I Skias⁶, P Boutsikos⁷, M Matsaggoura-Sameli⁷, M Riga⁸, P Sainis⁹, E Mitilinaiou-Karakozi¹⁰, K Mainas¹¹, K Nikolaou¹¹, S Chatziparaskevas¹¹, O Ozai¹¹, G Vogiatzis¹², L Lilis¹², D Plaskas¹², S Chatzizisi¹², A Gianasmidis¹², E Petrovitsos¹², G Koykoyfikis¹², A Pittas¹², D Rovithis¹², A Ioannidis¹², E Dalamaga¹², G Kladas¹², N Afthonidis¹², E Pourou¹², S Katainidis¹², M Gavrilidou¹², P Kourtidou¹², L Tsamopoulos¹³, K Kairis¹³, S Arampatzi¹⁴, C Basoukos¹⁵, K Daskalakis¹⁶, V Megianis¹⁶, D Simintiridou¹⁶, T Christoforidis¹⁶, G Lafazanis¹⁷, L Chatzioannidis¹⁷, C Stephopoulos¹⁸, K Karanika-Chandolia¹⁸, E Teneketzi¹⁹, C Mellidis¹⁹, P Tsepelis¹⁹, C Louspas²⁰, M Biternas²¹, T Xionis²², D Tsantilas²², M Kosmanou²², I Gougousis²³, F Chatzi²⁴, A Vassos²⁴, S Bitchavas²⁵, E Dalaveris²⁶, G Spiroulias²⁷, I Anastasopoulos²⁸, D Karlis²⁹, D Chiotis²⁹, G Christodoulou³⁰, D Arfanakis³¹, V Psarogianni-Sinou³², S Kokkinos³³, I Anifantis³⁴, P Alogogianni³⁵, A Michas³⁶, A Oikonomou³⁷, A Charalampous³⁷, P Papadopoulos³⁸, M Philipoiou Kotsoni³⁹, P Dragonas⁴⁰, E Laskari⁴¹, G Tsiamtsiouri⁴², V Kritsova-Avgerou⁴³, T Tiligadas⁴⁴, N Vrettos⁴⁵, N Vernardos⁴⁶, M Melessanakis⁴⁷, A Melidoniotis⁴⁷, E Liodakis⁴⁷, A Manousakis⁴⁸, C Galanakis⁴⁸, I Lampousakis⁴⁸, E Vyzoukakis⁴⁸, G Strimpouli⁴⁸, I Patramanis⁴⁹, D Chatziliadou⁴⁹, K Nioti⁴⁹, D Koynalakis⁴⁹, I Tserkis⁵⁰, C Androutsopoulou⁵⁰, C Liavvas⁵¹, D Karaoglanidou⁵²

Affiliations

¹ Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece.
² Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK.
³ Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy; Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, S.Luca Hospital, Milano, Italy.
⁴ Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece. Electronic address: gstergi@med.uoa.gr.
⁵ Attica, Greece.
⁶ Chalkida, Greece.
⁷ Thiva, Greece.
⁸ Salamina, Greece.
⁹ Aegina, Greece.
¹⁰ Chios, Greece.
¹¹ Komotini, Greece.
¹² Thessaloniki, Greece.
¹³ Drama, Greece.
¹⁴ Didymoteicho, Greece.
¹⁵ Kavala, Greece.
¹⁶ Serres, Greece.
¹⁷ Veria, Greece.
¹⁸ Katerini, Greece.
¹⁹ Giannitsa, Greece.
²⁰ Aridaia, Greece.
²¹ Edessa, Greece.
²² Larisa, Greece.
²³ Ptolemaida, Greece.
²⁴ Trikala, Greece.
²⁵ Igoumenitsa, Greece.
²⁶ Volos, Greece.
²⁷ Achaia, Greece.
²⁸ Kalamata, Greece.
²⁹ Tripoli, Greece.
³⁰ Kiato, Greece.
³¹ Korinthos, Greece.
³² Stylida, Greece.
³³ Nafplio, Greece.
³⁴ Xylokastro, Greece.
³⁵ Loutraki, Greece.
³⁶ Patra, Greece.
³⁷ Aitoloakarnania, Greece.
³⁸ Sparti, Greece.
³⁹ Krestena, Greece.
⁴⁰ Zakynthos, Greece.
⁴¹ Messini, Greece.
⁴² Karpenissi, Greece.
⁴³ Lamia, Greece.
⁴⁴ Nafpaktos, Greece.
⁴⁵ Ierapetra, Greece.
⁴⁶ Sitia, Greece.
⁴⁷ Rethymno, Greece.
⁴⁸ Chania, Greece.
⁴⁹ Heraklion, Greece.
⁵⁰ Rhodes, Greece.
⁵¹ Chalkidiki, Greece.
⁵² Imathia, Greece.

PMID: 30639355
DOI: 10.1016/j.hjc.2019.01.005

Abstract

Background: This study assessed the diagnostic reliability of automated office blood pressure (OBP) measurements in treated hypertensive patients in primary care by evaluating the prevalence of white coat hypertension (WCH) and masked uncontrolled hypertension (MUCH) phenomena.

Methods: Primary care physicians, nationwide in Greece, assessed consecutive hypertensive patients on stable treatment using OBP (1 visit, triplicate measurements) and home blood pressure (HBP) measurements (7 days, duplicate morning and evening measurements). All measurements were performed using validated automated devices with bluetooth capacity (Omron M7 Intelli-IT). Uncontrolled OBP was defined as ≥140/90 mmHg, and uncontrolled HBP was defined as ≥135/85 mmHg.

Results: A total of 790 patients recruited by 135 doctors were analyzed (age: 64.5 ± 14.4 years, diabetics: 21.4%, smokers: 20.6%, and average number of antihypertensive drugs: 1.6 ± 0.8). OBP (137.5 ± 9.4/84.3 ± 7.7 mmHg, systolic/diastolic) was higher than HBP (130.6 ± 11.2/79.9 ± 8 mmHg; difference 6.9 ± 11.6/4.4 ± 7.6 mmHg, p < 0.001). WCH phenomenon (high OBP with low HBP) was observed in 22.7% of the patients, MUCH (low OBP with high HBP) in 15.8%, uncontrolled hypertension (high OBP with high HBP) in 29.9%, and controlled hypertension (low OBP with low HBP) in 31.6%. In multivariate logistic regression analysis, WCH was determined by stage-1 systolic hypertension (odds ratio [OR] 8.6, 95% confidence intervals [CI] 5.7, 13.1) and female gender (OR 1.6, 95% CI 1.1, 2.4), whereas MUCH was determined by high-normal systolic OBP (OR 6.2, 95% CI 3.8, 10.1) and male gender (OR 2.0, 95% CI 1.2, 3.1).

Conclusions: In primary care, automated OBP measurements are misleading in approximately 40% of treated hypertensive patients. HBP monitoring is mandatory to avoid overtreatment of subjects with WCH phenomenon and prevent undertreatment and subsequent excess cardiovascular disease in MUCH.

Keywords: control; diagnosis; hypertension; out-of-office blood pressure.

MeSH terms

Blood Pressure
Blood Pressure Determination
Blood Pressure Monitoring, Ambulatory*
Female
Greece / epidemiology
Humans
Hypertension* / diagnosis
Hypertension* / drug therapy
Hypertension* / epidemiology
Male
Middle Aged
Primary Health Care
Reproducibility of Results