The Role First-Day Readings Play in a 3-Day Schedule of Self-Monitoring Home Blood Pressure Based on Prognostic Data. VAMPAHICA Study.

BACKGROUND: The optimal schedule for self-monitoring home BP (SMHBP) readings is enormously important in the diagnosis of different phenotypes related to hypertension. The aim of this study was to determine the prognostic capacity of a 3-day SMHBP schedule when using or suppressing the first-day measurements in compiling the results. METHODS: A total of 767 newly diagnosed, nontreated patients with no history of cardiovascular disease (CVD) were followed for 6.2 years. As a baseline, office BP measurements were taken for all the patients who then went on to follow a 3-day SMHBP schedule, taking 2 readings in the morning and 2 in the evening. The prognostic calculation was performed with CVD variables. The prognostic capacity of the 3-day schedule was evaluated with and without the first-day readings (12 and 8 readings). RESULTS: A total of 223 normotensive subjects (NT), 271 subjects with sustained hypertension (SHT), and 184 white-coat hypertensive subjects (WCH) were followed. The distribution of 98 (14.4%) nonfatal CV events during the follow-up was as follows: WCH 21 (11.4%), NT 9 (4.0%), and SHT 68 (25.1%). No statistically significant differences were observed in the risk of CV events (OR) for the 2 groups of hypertensives, irrespective of the schedule of readings used (SHT with vs. without first-day readings: 8.81 (4.28-18.15) vs. 8.61 (4.15-17.85) and WCH with vs. without first-day readings: 2.71(1.13-6.47) vs. 3.40 (1.49-7.78)). CONCLUSIONS: Our findings show that first-day readings do not need to be discarded in order to calculate the final value of an SMHBP schedule.

Home blood pressure self-monitoring: diagnostic performance in white-coat hypertension.

OBJECTIVE: To determine the diagnostic performance of home blood pressure self-monitoring in white-coat hypertension using a 3-day reading program. MATERIAL AND METHODS: One hundred and ninety nontreated patients recently diagnosed with mild-moderate hypertension, selected consecutively at four primary healthcare centers in the city of Barcelona, were included. Each patient underwent morning and night home blood pressure self-monitoring with readings in triplicate for three consecutive days, followed by 24-h ambulatory blood pressure monitoring. The normality cut-off point value for home blood pressure self-monitoring and daytime ambulatory blood pressure monitoring was 135/85 mmHg. RESULTS: Sixty-three patients were diagnosed with white-coat hypertension with home blood pressure self-monitoring (34.8%; 95% confidence interval: 27.9-42.2) and 74 with ambulatory blood pressure monitoring (41.6%; 95% confidence interval: 33.7-48.4). No statistically significant differences were observed between home blood pressure self-monitoring values and those of diurnal ambulatory blood pressure monitoring [137.4 (14.3)/82.1 (8.3) mmHg vs. 134.8 (11.3)/81.3 (9.5) mmHg]. Home blood pressure self-monitoring diagnostic performance parameters were sensitivity 50.0% (95% confidence interval: 38.3-61.7), specificity 75.7% (95% confidence interval: 66.3-83.2), positive and negative predictive values 58.7% (95% confidence interval: 45.6-70.8) and 68.6% (95% confidence interval: 59.4-76.7), respectively, and positive and negative probability coefficients 2.05 and 0.66, respectively. Analysis of different normality cut-off points using a receiver operating characteristic curve failed to produce significant improvement in the diagnostic performance of home blood pressure self-monitoring. CONCLUSIONS: The diagnostic accuracy of a 3-day home blood pressure self-monitoring reading program in white-coat hypertension was poor. Ambulatory blood pressure monitoring continues to be the test of choice for this indication.

Validation of the short form of the Spanish Hypertension Quality of Life Questionnaire (MINICHAL).

BACKGROUND: The finding that low health-related quality of life (HRQoL) can be a risk factor for future cardiovascular events in patients with hypertension emphasizes the need for disease-specific HRQoL assessment tools in this population. OBJECTIVE: This study evaluated the feasibility and psychometric properties of the short form of the Spanish Hypertension Quality of Life Questionnaire (MINICHAL). METHODS: An observational, prospective, multicenter study was carried out among patients with hypertension, stratified by sex and disease stage. The feasibility and validity of the MINICHAL were evaluated at baseline. Two follow-up visits were conducted at 1 and 6 months after the initial visit, during which the test-retest reliability and responsiveness to change of the MINICHAL were assessed, respectively. RESULTS: A total of 736 consecutive patients with hypertension were included. Mean (SD) administration time for the MINICHAL was 7.2 (6.5) minutes. In the validation process, factor analysis showed 2 dimensions: "State of mind" (StM) and "Somatic manifestations" (SM). The response level was high, with 94.3% of patients answering all items. Patients with a higher disease stage (ie, stage II/III hypertension) had a worse HRQoL than those with a lower disease stage (P < 0.01). Internal consistency was 0.87 for StM and 0.75 for SM. Test-retest reliability was 0.82 and 0.75 for the StM and SM dimensions, respectively. Among patients who reported experiencing a positive change in their overall health status 6 months after treatment initiation or treatment change, responsiveness to change ranged from 0.52 (better) to 1.14 (much better). CONCLUSIONS: The MINICHAL questionnaire could be administered in a short time with a high response level and was found to have acceptable psychometric properties. The MINICHAL is a potentially useful tool for the evaluation of HRQoL among patients with hypertension in the routine clinical setting.

[Relationship between clinical and therapeutic variables and health-related quality of life in patients with hypertension. MINICHAL Study]. / Relación entre variables clínicas y terapéuticas y calidad de vida relacionada con la salud en pacientes con hipertensión arterial. Estudio MINICHAL.

BACKGROUND AND OBJECTIVE: Our objective was to evaluate, through the health related quality of life (HRQoL) questionnaire MINICHAL, the influence of socio-demographic, clinical and therapeutic variables on health related quality of life of hypertensive patients. PATIENTS AND METHOD: An observational, prospective and multi-center study was carried out in hypertensive patients who were either starting or undergoing a modification of antihypertensive treatment. A total of three visits was done: a baseline visit and two follow-up visits at one and six months. At all three visits, several socio-demographic, clinical and therapeutic variables were recorded and HRQoL was measured using the MINICHAL questionnaire, the Spanish version of the Psychological General Well-Being Index, and a single question about the change in general health status. The objective was to evaluate the impact of these variables on HRQoL. RESULTS: 736 patients with hypertension were evaluated. In the multivariate analysis, gender, number of concomitant diseases, degree of hypertension, organ damage and educational level were all variables displaying a relation with HRQoL. After 6 months of treatment intensification, an improvement of HRQoL was observed. Moreover, a positive correlation was observed between the degree of reduction of blood pressure (BP) and heart rate and HRQoL improvement, especially in the State of mind dimension. CONCLUSIONS: In hypertension, a better BP control has a positive influence on HRQoL. As several clinical variables are negatively correlated with HRQoL, specific interventions are needed to correct modifiable factors.

Evolution of target organ damage by different values of self-blood pressure measurement in untreated hypertensive patients.

BACKGROUND: To determine the prognostic value of various self-blood pressure (BP) monitoring (SBPM) cutoff at the time of diagnosis. METHODS: Cohort of 466 newly diagnosed and never-treated hypertensive patients. At baseline and at 1 year, the patients underwent a physical examination, clinic BP (CBP), SBPM, and ambulatory BP monitoring (ABPM), fasting blood and urine analysis, electrocardiogram (ECG), and retinography. The diagnosis of hypertension was made based on CBP average of two readings, separated by 2 min, taken over three different days, with results ≥ 140/90 mm Hg. At 1-year follow-up, target organ damage (TOD) evolution was classified as favorable or unfavorable. RESULTS: Mean age was 57.4 years, 56.8% were men. Adjusted multivariate analysis showed that hypertensive patients with baseline SBPM <135/85 mm Hg had a more favorable evolution of left ventricular hypertrophy (LVH) (odds ratio (OR): 1.9; 95% confidence interval (CI): 1.5-2.5), high urinary albumin excretion rate (UAER) (OR: 6.9; 95% CI: 3.4-14.4), and more favorable amount of TOD evolution (OR: 1.7; 95% CI: 1.4-2.0) than those with baseline SBPM ≥ 135/85 mm Hg. Patients with baseline SBPM <130/80 mm Hg, or <125/80 mm Hg had a more favorable evolution of the amount of TOD (OR: 2.7; 95% CI: 2.0-3.6, and OR: 2.9; 95% CI: 2.1-4.1, respectively) at 1 year than those with baseline SBPM <135/85 mm Hg. CONCLUSIONS: Baseline SBPM values <130/80 mm Hg is associated with better evolution of amount of TOD than SBPM values <135/85 mm Hg. These results would support a clinical trial to test a SBPM threshold <130/80 as an optimal pressure not needing pharmacological treatment among those with CBP ≥ 140/90.