Tolerability of the Oscar 2 ambulatory blood pressure monitor among research participants: a cross-sectional repeated measures study.

BACKGROUND: Ambulatory blood pressure monitoring (ABPM) is increasingly used to measure blood pressure (BP) in research studies. We examined ease of use, comfort, degree of disturbance, reported adverse effects, factors associated with poor tolerability, and association of poor tolerability with data acquisition of 24-hour ABPM using the Oscar 2 monitor in the research setting. METHODS: Sixty adults participating in a research study of people with a history of borderline clinic BP reported on their experience with ABPM on two occasions one week apart. Poor tolerability was operationalized as an overall score at or above the 75th percentile using responses to questions adapted from a previously developed questionnaire. In addition to descriptive statistics (means for responses to Likert-scaled "0 to 10" questions and proportions for Yes/No questions), we examined reproducibility of poor tolerability as well as associations with poor tolerability and whether poor tolerability was associated with removal of the monitor or inadequate number of BP measurements. RESULTS: The mean ambulatory BP of participants by an initial ABPM session was 148/87 mm Hg. After wearing the monitor the first time, the degree to which the monitor was felt to be cumbersome ranged from a mean of 3.0 to 3.8, depending on whether at work, home, driving, or other times. The most bother was interference with normal sleeping pattern (mean 4.2). Wearers found the monitor straightforward to use (mean 7.5). Nearly 67% reported that the monitor woke them after falling asleep, and 8.6% removed it at some point during the night. Reported adverse effects included pain (32%), skin irritation (37%), and bruising (7%). Those categorized as having poor tolerability (kappa = 0.5 between sessions, p = 0.0003) were more likely to report being in fair/poor health (75% vs 22%, p = 0.01) and have elevated 24-hour BP average (systolic: 28% vs 17%, p = 0.56; diastolic: 30% vs 17%, p = 0.37). They were also more likely to remove the monitor and have inadequate numbers of measurements. CONCLUSIONS: The Oscar 2 ABPM device is straightforward to use but can interfere with sleep. Commonly reported adverse effects include pain, skin irritation, and bruising. Those who tolerate the monitor poorly are more likely to report being in fair or poor health and to remove it, particularly at night.

Effects of labeling patients as prehypertensive.

BACKGROUND: Labeling patients as hypertensive has some negative effects. The effects of being labeled as having prehypertension are unknown. We examined whether the label of prehypertension exerts a negative effect on patients' perceived health and whether it motivates people to adopt lifestyle recommendations to prevent hypertension. METHODS: We randomized 97 prehypertensive adults to either a labeling message or a generic (no label) message. At 3 months we assessed self-reports of change in perceived health and reported adoption of lifestyle recommendations to try to prevent hypertension. RESULTS: Except for more participants with asthma in the label group, the 2 groups were similar at baseline. Among the 70 participants who provided 3-month follow-up data, 18 people (56%) in the no-label group and 22 people (58%) in the label group reported their health as the same; 13 people (41%) in the no label group and 16 people (42%) in the label group reported health as better; and 1 person (in no label group) reported his health as worse. At 3 months there were no differences in reports of changing eating habits (risk ratio [RR], 1.06; 95% CI, 0.86-1.31), cutting down on salt (RR, 0.99; 95% CI, 0.84-1.15), reducing alcohol intake (RR, 1.23; 95% CI, 0.80-1.90), or exercising (RR, 1.17; 95% CI, 0.91-1.51) to try to prevent hypertension. CONCLUSION: Being labeled as prehypertensive seems to exert neither harmful nor helpful effects.