Long term monitoring in patients receiving treatment to lower blood pressure: analysis of data from placebo controlled randomised controlled trial
Reads0
Chats0
TLDR
The likelihood that observed increases in blood pressure reflected true increases rose with the time between measurements such that the ratio of true positives to false positives reached parity at 21 months.Abstract:
Objective To determine the value of monitoring blood pressure by quantifying the probability that observed changes in blood pressure reflect true changes.
Design Analysis of blood pressure measurements of patients in the perindopril protection against recurrent stroke study (PROGRESS).
Setting Randomised placebo controlled trial carried out in 172 centres in Asia, Australasia, and Europe.
Participants 1709 patients with history of stroke or transient ischaemic attack randomised to fixed doses of perindopril and indapamide.
Measurements Mean of two blood pressure measurements in patients receiving treatment recorded to the nearest 2 mm Hg with a standard mercury sphygmomanometer at baseline and then at three months, six months, nine months, and 15 months and then every six months to 33 months.
Results There was no change in the mean blood pressure of the cohort during the 33 month follow-up. Six months after blood pressure was stabilised on treatment, if systolic blood pressure was measured as having increased by >10 mm Hg, six of those measurements would be false positives for every true increase of ≥10 mm Hg. The corresponding value for an increase of 20 mm Hg was over 200. Values for 5 mm Hg and 10 mm Hg increases in diastolic blood pressure were 3.5 and 39, respectively. The likelihood that observed increases in blood pressure reflected true increases rose with the time between measurements such that the ratio of true positives to false positives reached parity at 21 months.
Conclusions Usual clinical approaches to the monitoring of patients taking drugs to lower blood pressure have a low probability of yielding reliable information about true changes in blood pressure. Evidence based guidelines for monitoring treatment response are urgently required to guide clinical practice.
Trial registration Australia and New Zealand Clinical Trial Registry.read more
Citations
More filters
Journal ArticleDOI
Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension.
Peter M. Rothwell,Sally C Howard,Eamon Dolan,Eoin O'Brien,Joanna Dobson,Björn Dahlöf,Peter S. Sever,Neil R Poulter +7 more
TL;DR: Visit-to-visit variability in systolic blood pressure (SBP) and maximum SBP are strong predictors of stroke, independent of mean SBP.
Journal ArticleDOI
Limitations of the usual blood-pressure hypothesis and importance of variability, instability, and episodic hypertension
TL;DR: The authors discusses shortcomings of the usual blood pressure hypothesis, provides background to accompanying reports on the importance of blood pressure variability in prediction of risk of vascular events and in accounting for benefits of antihypertensive drugs, and draws attention to clinical implications and directions for future research.
Journal ArticleDOI
Guideline for the diagnosis and management of hypertension in adults - 2016.
Genevieve Gabb,Genevieve Gabb,Arduino A. Mangoni,Craig S. Anderson,Craig S. Anderson,Diane Cowley,John S Dowden,Jonathan Golledge,G.J. Hankey,FS Howes,Les Leckie,Vlado Perkovic,Markus P. Schlaich,Nicholas Zwar,Tanya Medley,Leonard F Arnolda +15 more
TL;DR: The National Heart Foundation of Australia has updated the Guide to management of hypertension 2008: assessing and managing raised blood pressure in adults (updated December 2010).
Journal ArticleDOI
2013 Ambulatory Blood Pressure Monitoring Recommendations for the Diagnosis of Adult Hypertension, Assessment of Cardiovascular and other Hypertension-associated Risk, and Attainment of Therapeutic Goals
Chronotherapeutics,Vascular Risk,Ramon C. Hermida,Michael H. Smolensky,Diana E. Ayala,Francesco Portaluppi +5 more
TL;DR: ABPM should be viewed as the new gold standard to diagnose true hypertension, accurately assess consequent tissue/organ, maternal/fetal, and CVD risk, and individualize hypertension chronotherapy.
Journal ArticleDOI
Measuring blood pressure for decision making and quality reporting: where and how many measures?
Benjamin Powers,Maren K. Olsen,Valerie Smith,Robert F. Woolson,Hayden B. Bosworth,Eugene Z. Oddone +5 more
TL;DR: In this paper, blood pressure readings during clinical encounters are used to determine the adequacy of hypertension treatment and as measures of quality of care and the secondary analysis of 444 veterans in a h...
References
More filters
Journal ArticleDOI
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).
Giuseppe Mancia,Robert Fagard,Krzysztof Narkiewicz,Josep Redon,Alberto Zanchetti,Michael Böhm,Thierry Christiaens,Renata Cifkova,Guy De Backer,Anna F. Dominiczak,Maurizio Galderisi,Diederick E. Grobbee,Tiny Jaarsma,Paulus Kirchhof,Sverre E. Kjeldsen,Stéphane Laurent,Athanasios J. Manolis,Peter M. Nilsson,Luis M. Ruilope,Roland E. Schmieder,Per Anton Sirnes,Peter Sleight,Margus Viigimaa,Bernard Waeber,Faiez Zannad,Michel Burnier,Ettore Ambrosioni,Mark Caufield,Antonio Coca,Michael H. Olsen,Costas Tsioufis,Philippe van de Borne,José Luis Zamorano,Stephan Achenbach,Helmut Baumgartner,Jeroen J. Bax,Héctor Bueno,Veronica Dean,Christi Deaton,Çetin Erol,Roberto Ferrari,David Hasdai,Arno W. Hoes,Juhani Knuuti,Philippe Kolh,Patrizio Lancellotti,Aleš Linhart,Petros Nihoyannopoulos,Massimo F Piepoli,Piotr Ponikowski,Juan Tamargo,Michal Tendera,Adam Torbicki,William Wijns,Stephan Windecker,Denis Clement,Thierry C. Gillebert,Enrico Agabiti Rosei,Stefan D. Anker,Johann Bauersachs,Jana Brguljan Hitij,Mark J. Caulfield,Marc De Buyzere,Sabina De Geest,Geneviève Derumeaux,Serap Erdine,Csaba Farsang,Christian Funck-Brentano,Vjekoslav Gerc,Giuseppe Germanò,Stephan Gielen,Herman Haller,Jens Jordan,Thomas Kahan,Michel Komajda,Dragan Lovic,Heiko Mahrholdt,Jan Östergren,Gianfranco Parati,Joep Perk,Jorge Polónia,Bogdan A. Popescu,Zeljko Reiner,Lars Rydén,Yuriy Sirenko,Alice Stanton,Harry A.J. Struijker-Boudier,Charalambos Vlachopoulos,Massimo Volpe,David A. Wood +89 more
TL;DR: In this article, a randomized controlled trial of Aliskiren in the Prevention of Major Cardiovascular Events in Elderly people was presented. But the authors did not discuss the effect of the combination therapy in patients living with systolic hypertension.
Journal ArticleDOI
2007 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).
Giuseppe Mancia,Guy De Backer,Anna F. Dominiczak,Renata Cifkova,Robert Fagard,Giuseppe Germanò,Guido Grassi,Anthony M. Heagerty,Sverre E. Kjeldsen,Stéphane Laurent,Krzysztof Narkiewicz,Luis M. Ruilope,Andrzej Rynkiewicz,Roland E. Schmieder,Harry A.J. Struijker Boudier,Alberto Zanchetti +15 more
TL;DR: 2007 Guidelines for the Management of Arterial Hypertension : The Task Force for the management of Arterspertension of the European Society ofhypertension (ESH) and of theEuropean Society of Cardiology (ESC).
Journal ArticleDOI
Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient ischaemic attack
Stephen MacMahon,Bruce Neal,Christophe Tzourio,Anthony Rodgers,Mark Woodward,J. Cutler,Craig S. Anderson,John Chalmers,T. Ohkubo,M. G. Bouser,Stephen M. Davis,Geoffrey A. Donnan,L. Hansson,Stephen B. Harrap,K. R. Lees,L. Liu,G. Mancia,T. Omae,J. Reid,R. Sega,A. Terent,C. Warlow,N. Anderson,C. Bladin,B.C. Chambers,G. Gordon,N. Sharpe,Rory Collins,Peter Sandercock,John Simes,P. Sleight,A. Brnabic,S. Colman,L. Francis,A. Lee,L. Gong,M.-G. Bousser,T. Yamaguchi,F. William,Q. Deng,D. X. Hu,William Y.S. Wang,A. L. Wu,L. Y. Ma,Z. Y. Tao,V. Biousse,Karine Berthet,L. Ben Slamia,C. Le Denmat,S. Crespi,G. Foglia,C. Fujimoto,S. Matsumura,K. Marttala,M. Pettersson,M. Safwenberg,J. Fenton,Y. McIlvenna,R. Currie,H. Bartram,J. Briad,A. Clague,Y. Cleverly,M. Cosson,A. Culpan,D. Douglas,S. Flett,B. Gray,T. Holloway,A. Milne,R. Prasad,Y. Ratnasabapathy,A. Santos,M. Wills,T. Agnew,Neil Chapman,N. Lewis,B. Mullane +77 more
TL;DR: This blood-pressure-lowering regimen reduced the risk of stroke among both hypertensive and non-hypertensive individuals with a history of stroke or transient ischaemic attack, irrespective of their blood pressure.
Journal ArticleDOI
2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension.
TL;DR: There is evidence that specific agents have benefits for patients with particular compelling indications, and that monotherapy is inadequate for the majority of patients, and for patients without a compelling indication for a particular drug class, a low dose of diuretic should be considered for initiation of therapy.
2007 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
Giuseppe Mancia,Anna F. Dominiczak,Robert Fagard,Anthony M. Heagerty,Sverre E. Kjeldsen,Stéphane Laurent,Roland E. Schmieder,Alec Vahanian,John Camm,Veronica Dean,Kenneth Dickstein,Christian Funck-Brentano,José Luis Zamorano,Serap Erdine,Krzysztof Narkiewicz,Enrico Agabiti-Rosei,Lars H Lindholm,Peter M. Nilsson,Stamatis Adamopoulos,Jean-Michel Mallion,Athanasios J. Manolis,Josep Redon,Pieter A. Van Zwieten,Margus Viigimaa +23 more
TL;DR: Since 2003 considerable additional evidence on important issues related to diagnostic and treatment approaches to hypertension has become available and therefore updating of the previous guidelines has been found advisable.
Related Papers (5)
Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient ischaemic attack
Stephen MacMahon,Bruce Neal,Christophe Tzourio,Anthony Rodgers,Mark Woodward,J. Cutler,Craig S. Anderson,John Chalmers,T. Ohkubo,M. G. Bouser,Stephen M. Davis,Geoffrey A. Donnan,L. Hansson,Stephen B. Harrap,K. R. Lees,L. Liu,G. Mancia,T. Omae,J. Reid,R. Sega,A. Terent,C. Warlow,N. Anderson,C. Bladin,B.C. Chambers,G. Gordon,N. Sharpe,Rory Collins,Peter Sandercock,John Simes,P. Sleight,A. Brnabic,S. Colman,L. Francis,A. Lee,L. Gong,M.-G. Bousser,T. Yamaguchi,F. William,Q. Deng,D. X. Hu,William Y.S. Wang,A. L. Wu,L. Y. Ma,Z. Y. Tao,V. Biousse,Karine Berthet,L. Ben Slamia,C. Le Denmat,S. Crespi,G. Foglia,C. Fujimoto,S. Matsumura,K. Marttala,M. Pettersson,M. Safwenberg,J. Fenton,Y. McIlvenna,R. Currie,H. Bartram,J. Briad,A. Clague,Y. Cleverly,M. Cosson,A. Culpan,D. Douglas,S. Flett,B. Gray,T. Holloway,A. Milne,R. Prasad,Y. Ratnasabapathy,A. Santos,M. Wills,T. Agnew,Neil Chapman,N. Lewis,B. Mullane +77 more