Virtual Expansion of the YMCA's Blood Pressure Self-Monitoring (BPSM) Program: Using Telehealth to Adapt an Evidence-Based Program to Reach Rural Communities in South Carolina.

CONTEXT: Disparities in cardiovascular disease prevalence and death exist among South Carolina's rural residents. Blood pressure self-monitoring (BPSM), where individuals measure their own blood pressure outside of the clinical environment, coupled with additional support, is an evidence-based, cost-effective strategy that is underutilized at large. PROGRAM: The YMCA's BPSM program is an evidence-based, 4-month program that includes 2 individualized office hours with a Healthy Heart Ambassador and 4 nutrition education sessions per month. Participants are provided with a blood pressure cuff and notebook to track their blood pressure at home in between sessions. IMPLEMENTATION: The SC Department of Health and Environmental Control partnered with the SC Alliance of YMCAs to expand the YMCA's BPSM program virtually. The traditional program was adapted to allow for virtual participant encounters. To target rural communities, partnerships were leveraged or established with rural health centers, federally qualified health centers, free medical clinics, and other state health department regions for participant referrals into the program. EVALUATION: A developmental evaluation design was utilized to monitor the virtual adaptation of the YMCA's BPSM program from April 2021 to May 2023. At the end of the project, 10 referral sources were identified to refer participants to the program. In total, 253 participants were referred to the program, 126 participants enrolled into the program, and 52 participants completed the program. Completers of the virtual program were successful in improving their blood pressure. DISCUSSION: Successes of the virtual program were not without challenges. Lessons learned from the virtual expansion of this program included ensuring participants' readiness to engage in a 4-month program, assessing participants' digital literacy, and considering broadband access in rural areas. Improvements in blood pressure and the program's reach demonstrate merit in continuing to scale the virtual adaptation of this program; however, contextual and structural factors should be considered.

A Case Series Study Assessing an Equity-Focused Implementation of Self-Monitoring Blood Pressure Programs Using Telehealth.

CONTEXT: Self-monitoring blood pressure (SMBP) programs are an evidence-based hypertension management intervention facilitated through telehealth. SMBP programs can provide a continuum of care beyond a clinical setting by facilitating hypertension management at home; however, equitable access to SMBP is a concern. OBJECTIVES: To evaluate the implementation of telehealth SMBP programs using an equity lens in 5 federally qualified health centers (FQHCs) in Massachusetts (MA). DESIGN: A prospective case series study. SETTING: Five FQHCs. PARTICIPANTS: The MA Department of Public Health (MDPH) selected 5 FQHCs to implement SMBP programs using telehealth. FQHCs were selected if their patient population experiences inequities due to social determinants of health and has higher rates of cardiovascular disease. Each of the 5 FQHCs reported data on patients enrolled in their SMBP programs totaling 241 patients examined in this study. INTERVENTION: SMBP programs implemented through telehealth. MAIN OUTCOME MEASURE: Systolic blood pressure and diastolic blood pressure. RESULTS: Approximately 53.5% of SMBP participants experienced a decrease in blood pressure. The average blood pressure decreased from 146/87 to 136/81 mm Hg. Among all patients across the 5 FQHCs, the average blood pressure decreased by 10.06/5.34 mm Hg (P < .001). Blood pressure improved in all racial, ethnic, and language subgroups. CONCLUSIONS: Five MA FQHCs successfully implemented equitable telehealth SMBP programs. SMBP participants enrolled in the programs demonstrated notable improvements in their blood pressure at the conclusion of the program. A flexible, pragmatic study design that was adjusted to meet unique patient needs; engaging nonphysician team members, particularly community health workers; adapting health information technology; and partnerships with community-based organizations were critical facilitators to program success.

Relationship between morning blood pressure variability and cerebral microbleed burden in patients with hypertension.

Cerebral microbleeds (CMBs) can be understood as a type of target organ damage caused by hypertension. We aimed to explore the association of the CMB burden with morning blood pressure (BP) variability in patients with hypertension. We divided patients with hypertension into two groups: a group with 1-10 CMBs and a group with more than 10 CMBs. The duration, grade, medication, and control of hypertension were recorded in all patients. Morning home BP measurements were performed every 3 days for a month. A total of 791 patients were recruited. Full factor model analysis showed that higher morning home diastolic BP variability (standard deviation [SD], OR = 1.080, 95% CI: 1.024-1.140, P = .005; coefficient of variation [CV], OR = 1.076, 95% CI: 1.028-1.128, P = .002) was associated with more than 10 CMBs. Morning home systolic and diastolic blood pressure variability (SD, CV, average real variability) in more than 10 non-lobar CMBs group was significantly higher than that in 1-10 non-lobar CMBs group (P < .05).The multivariate analysis showed higher morning home diastolic blood pressure variability (SD, OR = 1.124, 95% CI: 1.031-1.224, P = .008; CV, OR = 1.099, 95% CI: 1.019-1.186, P = .015; average real variability, OR = 1.055, 95% CI: 0.995-1.120, P = .075) was associated with more than 10 non-lobar CMBs. There was no significant relationship between morning home systolic blood pressure variability and more than 10 non-lobar CMBs (P > .05). Higher morning home diastolic blood pressure variability was associated with more than 10 CMBs and more than 10 non-lobar CMBs.

How many blood pressure measurements should we take in the office?

No consensus has emerged among different guidelines concerning how many blood pressure (BP) measurements should be performed at office visits in the diagnosis of hypertension. The purpose of this study was to examine the compatibility of various multiple average office BP measurements and 24-h BP monitoring (ABPM) in patients followed up in the posthoc analysis of the Cappadocia hypertension cohort. A total 1158 office BP measurements by 207 patients were examined. The results were then classified as G1 (average of the 1st and 2nd BP), G2 (average of the 2nd and 3rd), G3 (average of the 2nd, 3rd, and 4th), G4 (average of the 2nd, 3rd, 4th, and 5th), and G5 (average of all five measurements). Compatibility between the average values in the groups and concomitant 24-h ABPM data was examined. While a significant difference was observed between daytime 24-h ABPM SBP and G1 (p = .002), no difference was found in the other groups. Office DBP approached the daytime 24-h ABPM values as the number of measurements in the five groups increased, although average office DBP data in all groups were higher than daytime 24-h ABPM DBP (p = .000 for all). In light of our study results, we recommend that three office BP measurements be performed and that the average of the 2nd and 3rd measurements be used for SBP, while in terms of DBP, we recommend that as many measurements as possible be taken without the 1st value being included in the average.

Postpartum Remote Blood Pressure Monitoring Using a Mobile App in Women with a Hypertensive Disorder of Pregnancy.

BACKGROUND: Hypertensive disorders of pregnancy affect approximately 15% of pregnancies in the United States and are a leading cause of postpartum readmissions. Morbidity due to hypertension may be higher in the first several weeks postpartum. The ability to monitor blood pressure and intervene in the postpartum period is critical to reducing morbidity and mortality. LOCAL PROBLEM: At WellSpan Health, hypertensive disorders were increasing and a leading cause of severe maternal morbidity and readmission. INTERVENTIONS: A remote blood pressure monitoring app called BabyScripts™ myBloodPressure was implemented in September 2020. Prior to discharge postpartum, all patients with a diagnosis of a hypertensive disorder of pregnancy were given an automatic blood pressure cuff and instructions on how to monitor and track their blood pressure daily in the app. RESULTS: A total of 1,260 patients were enrolled in the BabyScripts™ myBloodPressure module between September 2020 and July 2022 across five maternity hospitals. Of those enrolled 74% ( n = 938) entered seven or more blood pressures, and of those who entered at least one blood pressure 9% ( n = 107) entered at least one critical range blood pressure ( ≥ 150 mmHg systolic and or ≥ 100 mmHg diastolic). CONCLUSION: Most women enrolled in the app were highly engaged and entered seven or more readings. Patients with critical blood pressures were identified; thus, the program has the potential to identify those at risk of severe complications. Barriers should be removed, and remote patient monitoring considered as a solution to improve postpartum assessment in patients with hypertensive disorders of pregnancy.

Day-To-Day Home Blood Pressure Variability and All-Cause Mortality in a Memory Clinic Population.

BACKGROUND: High day-to-day blood pressure variability (BPV) has been associated with an increased risk for cognitive decline and mortality in the general population. Whether BPV is associated with increased all-cause mortality in older people with cognitive impairment is unknown. OBJECTIVE: To investigate the association between day-to-day home BPV and all-cause mortality in older patients attending a memory clinic. METHODS: We included 279 patients attending a memory clinic, who measured home blood pressure (BP) for 7 consecutive days in the morning and evening. Within-subject BPV was defined as the variation independent of the mean (VIM). Time-to-death was verified through the Dutch population registry. Cox proportional hazard regression was used. Separate analyses were performed for morning-to-morning and evening-to-evening BPV. RESULTS: Mean age was 73±9 years, dementia and mild cognitive impairment were diagnosed in 35% and 34% respectively, and mean home BP was 139/79 mmHg. After a mean follow-up of 3.2 years, 52 patients had died. Neither day-to-day systolic nor diastolic VIM were associated with mortality (adjusted hazard ratio [HR] systolic VIM: 0.99, 95% -CI 0.92-1.06, p = 0.770, HR diastolic VIM: 1.04, 95% -CI 0.93-1.17, p = 0.517). When morning and evening measurements were analyzed separately, systolic morning-to-morning VIM was associated with mortality (adjusted HR: 1.09, 95% -CI 1.01-1.18, p = 0.033). CONCLUSION: In this study, day-to-day BPV was not associated with all-cause mortality in patients attending a memory clinic. However, morning-to-morning BPV was. Due to the short assessment window, there is still a lack of clarity; hence future research is warranted to clarify the role of all BPV components in aging.

Effects of combined training performed two or four times per week on 24-h blood pressure, glycosylated hemoglobin and other health-related outcomes in aging individuals with hypertension: Rationale and study protocol of a randomized clinical trial.

BACKGROUND: Acute blood pressure lowering after exercise seems to predict the extent of blood pressure reduction after chronic exercise training interventions. Based on that, the same weekly amount of exercise performed more frequently could be more beneficial for controlling blood pressure. PURPOSE: To compare the effects of a combined training program (resistance plus aerobic exercise) performed four or two times per week on 24-h ambulatory blood pressure and other health-related outcomes in middle-aged and older individuals with hypertension. METHODS: This study will be a randomized, parallel group, two-arm, superiority trial. Ninety-eight participants aged 50-80 years with a previous physician diagnosis of hypertension will be randomized to perform two or four sessions per week of combined training using the same total weekly overload. Primary outcomes will be 24-h ambulatory blood pressure and glycosylated hemoglobin; secondary outcomes will be endothelial function, physical fitness and quality of life. The outcomes will be assessed at baseline and at the end of 12 weeks period. RESULTS: Our conceptual hypothesis is that a combined exercise program performed four or two times per week with equalized weekly volume/overload will improve all outcomes in comparison to the baseline values, and that reductions in 24-h blood pressure and glycosylated hemoglobin will be more pronounced in the group that trained four times a week than twice. The results of this trial are expected to provide evidences to support that higher weekly frequency of combined training should be emphasized in aging adults with hypertension.

Inequities in Hypertension Control in the United States Exposed and Exacerbated by COVID-19 and the Role of Home Blood Pressure and Virtual Health Care During and After the COVID-19 Pandemic.

The COVID-19 pandemic is a public health crisis, having killed more than 514 000 US adults as of March 2, 2021. COVID-19 mitigation strategies have unintended consequences on managing chronic conditions such as hypertension, a leading cause of cardiovascular disease and health disparities in the United States. During the first wave of the pandemic in the United States, the combination of observed racial/ethnic inequities in COVID-19 deaths and social unrest reinvigorated a national conversation about systemic racism in health care and society. The 4th Annual University of Utah Translational Hypertension Symposium gathered frontline clinicians, researchers, and leaders from diverse backgrounds to discuss the intersection of these 2 critical social and public health phenomena and to highlight preexisting disparities in hypertension treatment and control exacerbated by COVID-19. The discussion underscored environmental and socioeconomic factors that are deeply embedded in US health care and research that impact inequities in hypertension. Structural racism plays a central role at both the health system and individual levels. At the same time, virtual healthcare platforms are being accelerated into widespread use by COVID-19, which may widen the divide in healthcare access across levels of wealth, geography, and education. Blood pressure control rates are declining, especially among communities of color and those without health insurance or access to health care. Hypertension awareness, therapeutic lifestyle changes, and evidence-based pharmacotherapy are essential. There is a need to improve the implementation of community-based interventions and blood pressure self-monitoring, which can help build patient trust and increase healthcare engagement.

Predictive Importance of Blood Pressure Characteristics With Increasing Age in Healthy Men and Women: The MORGAM Project.

[Figure: see text].

Controle dos níveis pressóricos em hipertensos / Pressure level control in hypertensive patients

Objetivos: Identificar o controle pressórico em hipertensos acompanhados por uma equipe da Saúde da Família. Métodos: Trata-se de um estudo longitudinal, realizado por meio da análise de prontuários de 134 indivíduos hipertensos maiores de 18 anos com, no mínimo, três aferições de pressão arterial ao longo do período citado, em uma Unidade Básica da Saúde da Família, durante o ano de 2017, no município de Itajaí (SC). Resultados: Da amostra total, 60,5% eram do sexo feminino. A faixa etária predominante foi dos 60 aos 69 anos (33,6%), e 80,7% tinham até 8 anos de escolaridade. Em relação ao número de medicações utilizadas, 34,3% estavam em monoterapia, 41,8% em terapia dupla, 17,9% em terapia tripla e 6% em terapia quádrupla. A taxa de controle pressórico foi de 28,4%. Apenas 9% da amostra apresentava índice de massa corporal dentro do ideal. No grupo compensado, 52,7% dos indivíduos apresentavam sobrepeso, enquanto 65,6% do grupo descompensado apresentavam obesidade (p<0,05). Da amostra total, 47,8% dos indivíduos eram portadores de diabetes mellitus, correspondendo a 53,1% do grupo descompensado (p<0,05). Ainda nesse grupo, 46,9% apresentavam níveis inadequados de LDL-colesterol (p<0,05), bem como 35,4% dos hipertensos descompensados apresentavam alto risco cardiovascular (p<0,05). Conclusão: Menos de um terço dos hipertensos apresentou níveis pressóricos adequados, sendo que os fatores que mostraram associação significativa com o controle da pressão arterial foram diabetes mellitus, dislipidemia, elevado índice de massa corporal e risco cardiovascular intermediário e alto.

Objectives: To identify pressure control in hypertensive patients followed by a Family Health Team. Methods: This is a longitudinal study carried out through the analysis of medical records of 134 hypertensive patients over 18 years of age, with at least three blood pressure measurements during the period mentioned, in a Primary Family Health Unit, during 2017 in the municipality of Itajaí (SC). Results: Of the total sample, 60.5% were women. The predominant age group was between 60 and 69 years (33.6%) and 80.7% had up to 8 years of schooling. Regarding the number of medications used, 34.3% were in monotherapy, 41.8% in double therapy, 17.9% in triple therapy, and 6% in quadruple therapy. The pressure control rate was 28.4%. Only 9% of the sample had optimal body mass index. In the compensated group, 52.7% of the individuals were overweight, while 65.6% of the decompensated group were obese (p<0.05). Of the total sample, 47.8% of the individuals had diabetes mellitus, corresponding to 53.1% of the decompensated group (p<0.05). Still in this group, 46.9% had inadequate LDL levels (p<0.05), as well as 35.4% of the decompensated hypertensive patients presented high cardiovascular risk (p<0.05). Conclusion: Less than one-third of hypertensive patients presented adequate blood pressure levels, and the factors showing a significant association with blood pressure control were diabetes mellitus, dyslipidemia, high body mass index, and intermediate and high cardiovascular risk

Attended Automated Office Blood Pressure Measurement Versus Ambulatory Blood Pressure Monitoring in a Primary Healthcare Setting in Chile.

OBJECTIVES: As part of the HEARTS in the Americas initiative, Chilean primary healthcare centers have implemented novel hypertension management strategies, including new diagnostic approaches. This study evaluated the concordance between attended automated office blood pressure (AOBP) measurements with an oscillometric device and ambulatory blood pressure monitoring (ABPM). METHODS: This was an observational cohort study to evaluate and compare attended AOBP and ABPM for the diagnosis of hypertension in adults in a primary healthcare setting. RESULTS: The study evaluated 309 participants (54.2 ± 15.7 years; 50.5% male) from four primary healthcare centers in Santiago, Chile. Attended AOBP measurements were obtained at the clinic on two separate days, followed by ABPM. AOBP values indicated that 69.6% of patients had a systolic blood pressure (SBP) of ≥140 mm Hg and 34.6% had a diastolic blood pressure (DBP) of ≥90 mm Hg. A total of 83.5% had hypertension, 45.3% had high SBP, and 56.0% had high DBP. ABPM values indicated that 65.0% of patients had hypertension. The combined AOBP and ABPM analysis showed that 57.0% of patients had sustained hypertension, 26.5% had white coat hypertension, 8.1% had masked hypertension, and 8.4% were normotensive. The concordance between AOBP and ABPM (κ coefficient) was low (κ = 0.133; 95% confidence interval 0.028-0.237). The comparison of AOBP and ABPM measurements (Bland-Altman plots and bias calculations) showed an important bias in BP as measured using the AOBP method, especially for SBP (13.7 ± 11.6, 95% confidence interval -9.1 to 36.5). CONCLUSIONS: Attended AOBP alone may not be sufficient for adequate classification, diagnosis, and management of hypertension in Chile or other countries with similar demographics.

Reverse Dipping of Systolic Blood Pressure Is Associated With Increased Dementia Risk in Older Men: A Longitudinal Study Over 24 Years.

[Figure: see text].

24-Hour Ambulatory Blood Pressure Variability in Children with Obstructive Sleep Apnea.

OBJECTIVE: To evaluate blood pressure (BP) variability in 24-hour ambulatory BP monitoring in children with obstructive sleep apnea (OSA). STUDY DESIGN: Case series study. METHODS: Children aged 4 to 16 years with clinical symptoms were recruited in a tertiary medical center. Overnight polysomnography and 24-hour recordings of ambulatory BP were performed for each child. The severity of OSA was classified as primary snoring (apnea-hypopnea index [AHI] < 1), mild OSA (1 ≤ AHI < 5), moderate OSA (10 > AHI ≥ 5), and severe OSA (AHI ≥ 10). The standard deviation of mean BP was used as an indicator of BP variability. RESULTS: A total of 550 children were included (mean age: 7.6 years; 70% were boys; 20% were obese). Compared with the children with primary snoring, children with severe OSA exhibited significantly higher nighttime systolic BP (108.0 vs. 100.5 mmHg, P < .001), nighttime diastolic BP (58.9 vs 55.6 mmHg, P = .002), nighttime mean arterial pressure (75.3 vs. 70.5 mmHg, P < .001), nighttime systolic BP load (40.5% vs. 25.0%, P < .001), nighttime diastolic BP load (25.3% vs. 12.9%, P < .001), and nighttime systolic BP variability (11.4 vs. 9.6, P = .001). Multiple linear regression analyses revealed an independent association between AHI and nighttime systolic BP variability (regression coefficient = 0.31, 95% CI = 0.06-0.56, P = .015) after adjustment for age, gender, adiposity, and hypertensive status. CONCLUSIONS: OSA in children is associated with increased BP and BP variability. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:2126-2132, 2021.

A randomized controlled trial on home blood pressure monitoring and quality of care in stage 2 and 3 hypertension.

In a 12-week, randomized, controlled trial, we investigated whether home blood pressure monitoring (HBPM) would improve treatment adherence and blood pressure control in stage 2 and 3 hypertension. Eligible patients (18-75 years of age and 160-199/100-119 mmHg of clinic systolic/diastolic blood pressure after a 1-week wash-out) were randomized in a 1:4 ratio to an experimental group (with HBPM) and a control group (without HBPM). All patients started antihypertensive treatment with the irbesartan 150 mg/hydrochlorothiazide 12.5 mg/day combination, with the possible addition of irbesartan 150 mg/day and uptitration to irbesartan 300 mg/hydrochlorothiazide 25 mg/day at 4 and 8 weeks of follow-up, respectively. The primary endpoint was the clinic blood pressure control (systolic/diastolic, nondiabetes <140/90 mmHg and diabetes <130/80 mmHg) rate at 12 weeks of follow-up. The randomized patients in the HBPM (n = 96) and control groups (n = 405) had similar characteristics at baseline and similar use of higher dosages of irbesartan/hydrochlorothiazide (300 mg/12.5-25 mg) at 4 (9.4% vs. 12.2%, P = 0.45) and 8 weeks of follow-up (27.1% vs. 35.5%, P = 0.13). During follow-up, both the cumulative treatment discontinuation rate (1.0% vs. 12.6%, P = 0.0008) and the less optimal treatment adherence rate (<90% of prescribed medication, 1.0% vs. 9.9%, P = 0.005) were significantly lower in the HBPM group than in the control group. The proportion of patients who achieved the goal of clinic blood pressure control at 12 weeks of follow-up was significantly higher in the HBPM group than in the control group (66.7% vs. 55.1%, P = 0.04). In conclusion, HBPM improved treatment adherence and blood pressure control in patients with hypertension, despite similar antihypertensive treatment intensities.

Soluble Urokinase-Type Plasminogen Activator Receptor, Changes of 24-Hour Blood Pressure, and Progression of Chronic Kidney Disease.

Background Soluble urokinase-type plasminogen activator receptor (suPAR) is associated with cardiovascular risks and poor renal outcomes. However, whether elevated suPAR levels are associated with 24-hour blood pressure patterns or kidney disease progression in patients with chronic kidney disease (CKD) is unclear. Methods and Results A total of 751 patients with CKD stage 1 to 5 were recruited from CMERC-HI (Cardiovascular and Metabolic Disease Etiology Research Center-High Risk) cohort study (2013-2018). The relationship of serum suPAR levels to 24-hour blood pressure parameters and CKD progression was analyzed. The median serum suPAR level was 1439.0 (interquartile range, 1026.2-2150.1) pg/mL, and the mean estimated glomerular filtration rate was 52.8±28.5 mL/min per 1.73 m2 at baseline. Patients with higher suPAR levels had significantly higher levels of office, 24-hour, daytime, and nighttime systolic blood pressure and nighttime diastolic blood pressure than those with lower suPAR levels. The highest suPAR tertile was associated with an increased risk of a reverse dipping pattern (odds ratio, 2.93; 95% CI, 1.27-6.76; P=0.01). During a follow-up of 43.2 (interquartile range, 27.0-55.6) months, the CKD progression occurred in 271 (36.1%) patients. The highest suPAR tertile was significantly associated with higher risk of CKD progression than the lowest tertile (hazard ratio [HR], 2.09; 95% CI, 1.37-3.21; P=0.001). When the relationship was reevaluated with respect to each dipping pattern (dipper, extreme dipper, nondipper, and reverse dipper), this association was consistent only in reverse dippers in whom the risk of CKD progression increased (HR, 1.43; 95% CI, 1.02-2.01; P=0.03) with every 1-unit increase in serum suPAR levels. Conclusions Elevated suPAR levels are independently associated with CKD progression, and this association is prominent in reverse dippers.

Accelerating Use of Self-measured Blood Pressure Monitoring (SMBP) Through Clinical-Community Care Models.

Self-measured blood pressure monitoring (SMBP), the regular measurement of blood pressure by a patient outside the clinical setting, plus additional support, is a proven, cost-effective but underutilized strategy to improve hypertension outcomes. To accelerate SMBP use, the Centers for Disease Control and Prevention (CDC) funded the National Association of Community Health Centers, the YMCA of the USA, and Association of State and Territorial Health Officials to develop cross-sector care models to offer SMBP to patients with hypertension. The project aimed to increase the use of SMBP through the coordinated action of health department leaders, community organizations and clinical providers. From 1/31/2017 to 6/30/2018, nine health centers in Kentucky, Missouri, and New York partnered with seven local Y associations (local Y) and their local health departments to design and implement care models that adapted existing primary care SMBP practices by leveraging capacities and resources in community and public health organizations. Nine collaborative care models emerged, shaped by available community assets, strategic priorities, and organizational culture. Overall, 1421 patients were recommended for SMBP; of those, 795 completed at least one cycle of SMBP (BP measurements morning and evening for at least three consecutive days). Of those recommended for SMBP, 308 patients were referred to a local Y to receive additional SMBP and healthy lifestyle support. Community and public health organizations can be brought into the health care delivery process and can play valuable roles in supporting patients in SMBP.

Is Masked Hypertension an underlying Cause of Unexplained Left Ventricle Hypertrophy?

OBJECTIVES: Unexplained left ventricular hypertrophy (ULVH) is defined as increased wall thickness in the absence of conditions that predispose to hypertrophy. The aim of this study was to evaluate the rate of masked hypertension in patient with unexplained left ventricle hypertrophy. METHOD: A total of 120 consecutive unexplained left ventricle hypertrophy patients without overt hypertension and diabetes and 121 healthy control subjects were included in the study. After a complete medical history and laboratory examination, patients' height, weight, waist circumference heart rate, and office blood pressure were recorded. All subjects underwent ambulatory blood pressure monitoring, and transthoracic echocardiography. RESULTS: Mean age were similar between patients with ULVH and controls. There was no significant difference in total cholesterol, HDL, LDL cholesterol and triglyceride levels, left ventricle ejection fraction, between the groups. Prevalence of Masked hypertension was significantly higher in patients with ULVH than controls (28.3% vs 6.6%, p < .001). Left ventricular mass index (141.9 ± 16.8 g/cm2 vs. 67.3 ± 10.3 g/cm2, p < .001) was significantly higher in masked hypertensive patients with ULVH compared to normotensive ULVH and control subjects. CONCLUSION: In this study, we found high prevalence of masked hypertension in ULVH patients. Patients with ULVH should be screened by ABPM to detect possible masked hypertension.

[Current status of home blood pressure measurement and relevant demographics and lifestyle characteristics of individuals with periodic measurement: a cross-sectional study in a worksite population].

OBJECTIVES: The current status of home blood pressure (HBP) measurement is unknown at a Japanese worksite. We aimed to calculate the proportion of individuals who periodically measured HBP and to explore the demographic and lifestyle characteristics of these workers. METHODS: The study included 4,664 employees aged 40-65 years who worked at a retail company and underwent health check-ups in 2018. Multivariable logistic regression models were used to estimate odds ratios (ORs) of participant's demographics and lifestyle characteristics and habits for HBP measurement by sex and medical treatment for hypertension. Periodic HBP measurement was defined as HBP measurements performed two times or more per month (opportunistic HBP measurement) among participants not being treated for hypertension, and daily measurement of HBP (everyday HBP measurement) among participants treated for hypertension. RESULTS: The percentages of opportunistic HBP measurement were 8.7% in males and 12.4% in females not being treated for hypertension. In both sexes, age (ORs per 1-year increment: 1.11 in males and 1.06 in females) and blood pressure (ORs of ≥ 140/90 mmHg: 7.42 in males and 4.71 in females compared with < 130/80 mmHg) were positively associated with opportunistic HBP measurement. Females treated for dyslipidemia (OR: 1.77), who had a self-described fast walking speed (OR: 1.49), and who exercised habitually (OR: 1.79) had significantly high ORs for opportunistic HBP measurement. Females who frequently consumed snacks after dinner had significantly lower ORs (0.65) than those who did not. The percentages of workers who did everyday HBP measurement were 21.6% in males and 25.5% in females treated for hypertension. Males treated for diabetes (OR: 0.23) had significantly lower OR than those who did not. Females treated for dyslipidemia (OR was 0.53), who had uncontrolled hypertension (OR: 0.58), consumed alcohol (OR: 0.60), and frequently ate within two hours before bed (OR: 0.54) had significantly lower ORs. Females who lived alone had significantly higher ORs (2.43) than those who did not. CONCLUSION: Approximately 10% of individuals not treated for hypertension periodically measured HBP. Age and blood pressure in males and females, and healthy lifestyles in females, were associated with having opportunistic HBP measurement. Approximately 25% of individuals treated for hypertension measured HBP every day. Individuals treated for dyslipidemia or diabetes and females with unhealthy lifestyle and uncontrolled hypertension were less likely to measure HBP every day.