BACKGROUND: The optimal setting and number of blood pressure (BP) measurements that should be used for clinical decision making and quality reporting are uncertain. OBJECTIVE: To compare strategies for home or clinic BP measurement and their effect on classifying patients as having BP that was in or out of control. DESIGN: Secondary analysis of a randomized, controlled trial of strategies to improve hypertension management. (ClinicalTrials.gov registration number: NCT00237692) SETTING:Primary care clinics affiliated with the Durham Veterans Affairs Medical Center. PATIENTS: 444 veterans with hypertension followed for 18 months. MEASUREMENTS: Blood pressure was measured repeatedly by using 3 methods: standardized research BP measurements at 6-month intervals; clinic BP measurements obtained during outpatient visits; and home BP measurements using a monitor that transmitted measurements electronically. RESULTS: Patients provided 111,181 systolic BP (SBP) measurements (3218 research, 7121 clinic, and 100,842 home measurements) over 18 months. Systolic BP control rates at baseline (mean SBP<140 mm Hg for clinic or research measurement; <135 mm Hg for home measurement) varied substantially, with 28% classified as in control by clinic measurement, 47% by home measurement, and 68% by research measurement. Short-term variability was large and similar across all 3 methods of measurement, with a mean within-patient coefficient of variation of 10% (range, 1% to 24%). Patients could not be classified as having BP that was in or out of control with 80% certainty on the basis of a single clinic SBP measurement from 120 mm Hg to 157 mm Hg. The effect of within-patient variability could be greatly reduced by averaging several measurements, with most benefit accrued at 5 to 6 measurements. LIMITATION: The sample was mostly men with a long-standing history of hypertension and was selected on the basis of previous poor BP control. CONCLUSION: Physicians who want to have 80% or more certainty that they are correctly classifying patients' BP control should use the average of several measurements. Hypertension quality metrics based on a single clinic measurement potentially misclassify a large proportion of patients. PRIMARY FUNDING SOURCE: U.S. Department of Veterans Affairs Health Services Research and Development Service.
RCT Entities:
BACKGROUND: The optimal setting and number of blood pressure (BP) measurements that should be used for clinical decision making and quality reporting are uncertain. OBJECTIVE: To compare strategies for home or clinic BP measurement and their effect on classifying patients as having BP that was in or out of control. DESIGN: Secondary analysis of a randomized, controlled trial of strategies to improve hypertension management. (ClinicalTrials.gov registration number: NCT00237692) SETTING: Primary care clinics affiliated with the Durham Veterans Affairs Medical Center. PATIENTS: 444 veterans with hypertension followed for 18 months. MEASUREMENTS: Blood pressure was measured repeatedly by using 3 methods: standardized research BP measurements at 6-month intervals; clinic BP measurements obtained during outpatient visits; and home BP measurements using a monitor that transmitted measurements electronically. RESULTS:Patients provided 111,181 systolic BP (SBP) measurements (3218 research, 7121 clinic, and 100,842 home measurements) over 18 months. Systolic BP control rates at baseline (mean SBP<140 mm Hg for clinic or research measurement; <135 mm Hg for home measurement) varied substantially, with 28% classified as in control by clinic measurement, 47% by home measurement, and 68% by research measurement. Short-term variability was large and similar across all 3 methods of measurement, with a mean within-patient coefficient of variation of 10% (range, 1% to 24%). Patients could not be classified as having BP that was in or out of control with 80% certainty on the basis of a single clinic SBP measurement from 120 mm Hg to 157 mm Hg. The effect of within-patient variability could be greatly reduced by averaging several measurements, with most benefit accrued at 5 to 6 measurements. LIMITATION: The sample was mostly men with a long-standing history of hypertension and was selected on the basis of previous poor BP control. CONCLUSION: Physicians who want to have 80% or more certainty that they are correctly classifying patients' BP control should use the average of several measurements. Hypertension quality metrics based on a single clinic measurement potentially misclassify a large proportion of patients. PRIMARY FUNDING SOURCE: U.S. Department of Veterans Affairs Health Services Research and Development Service.
Authors: Amy G Huebschmann; Trina Mizrahi; Alyssa Soenksen; Brenda L Beaty; Thomas D Denberg Journal: J Clin Hypertens (Greenwich) Date: 2012-03-16 Impact factor: 3.738
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Authors: Edward D Siew; T Alp Ikizler; Michael E Matheny; Yaping Shi; Jonathan S Schildcrout; Ioana Danciu; Jamie P Dwyer; Manakan Srichai; Adriana M Hung; James P Smith; Josh F Peterson Journal: Clin J Am Soc Nephrol Date: 2012-03-15 Impact factor: 8.237
Authors: Nancy R Kressin; Karen E Lasser; Michael Paasche-Orlow; Jeroan Allison; Arlene S Ash; William G Adams; Christopher W Shanahan; Aaron Legler; Steven D Pizer Journal: Med Care Date: 2015-06 Impact factor: 2.983
Authors: Paul Muntner; Paula T Einhorn; William C Cushman; Paul K Whelton; Natalie A Bello; Paul E Drawz; Beverly B Green; Daniel W Jones; Stephen P Juraschek; Karen L Margolis; Edgar R Miller; Ann Marie Navar; Yechiam Ostchega; Michael K Rakotz; Bernard Rosner; Joseph E Schwartz; Daichi Shimbo; George S Stergiou; Raymond R Townsend; Jeff D Williamson; Jackson T Wright; Lawrence J Appel Journal: J Am Coll Cardiol Date: 2019-01-29 Impact factor: 24.094
Authors: Herbert I Hurwitz; Pamela S Douglas; John P Middleton; George W Sledge; David H Johnson; David A Reardon; Dafeng Chen; Oliver Rosen Journal: Oncologist Date: 2013-03-13