Association of work-related psychosocial factors and day-to-day home blood pressure variation: the Finn-Home study.

OBJECTIVES: Stress, and particularly job strain, has been found to associate with ambulatory blood pressure (BP). Moreover, BP is known to vary between days. One potential over-looked factor underlying this day-to-day BP variation could be work-related psychosocial factors. Thus, we aimed to study the association between job strain, job demands, job control and day-to-day BP variation. METHODS: The home BP of 754 regularly working participants (mean age 50.9 ±â€Š4.8, women 51%) of the Finn-Home Study was measured twice in the morning and twice in the evening over seven days. Average SBP and DBP were calculated for each day. Work-related psychosocial factors were measured with survey. Multivariable-adjusted generalized linear models were used for statistical analysis. RESULTS: We found a greater SBP/DBP decrease between weekdays and weekend among participants with high job strain (-1.8 [95% confidence interval, 95% CI, -2.7 to -0.8]/-1.7 [95% CI, -2.3 to -1.1] mmHg) compared to participants with low job strain (-0.7 [95% CI, -1.1 to -0.2]/-0.7 [95% CI, -1.0 to -0.4] mmHg). The participants with high job demands showed a higher BP decrease between weekdays and weekend (-1.4 [95% CI, -2.0 to -0.8]/-1.3 [95% CI, -1.6 to -0.9] mmHg) than the participants with low job demands (-0.5 [95% CI, -1.1 to 0.0]/-0.6 [95% CI, -1.0 to -0.3] mmHg). We did not find BP differences regarding job control. CONCLUSION: High job strain and high job demands were associated with a greater BP reduction from weekdays to the weekend. Work-related psychosocial factors should be considered when assessing day-to-day BP variation.

Blood pressure variability: methodological aspects, clinical relevance and practical indications for management - a European Society of Hypertension position paper ∗.

Blood pressure is not a static parameter, but rather undergoes continuous fluctuations over time, as a result of the interaction between environmental and behavioural factors on one side and intrinsic cardiovascular regulatory mechanisms on the other side. Increased blood pressure variability (BPV) may indicate an impaired cardiovascular regulation and may represent a cardiovascular risk factor itself, having been associated with increased all-cause and cardiovascular mortality, stroke, coronary artery disease, heart failure, end-stage renal disease, and dementia incidence. Nonetheless, BPV was considered only a research issue in previous hypertension management guidelines, because the available evidence on its clinical relevance presents several gaps and is based on heterogeneous studies with limited standardization of methods for BPV assessment. The aim of this position paper, with contributions from members of the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability and from a number of international experts, is to summarize the available evidence in the field of BPV assessment methodology and clinical applications and to provide practical indications on how to measure and interpret BPV in research and clinical settings based on currently available data. Pending issues and clinical and methodological recommendations supported by available evidence are also reported. The information provided by this paper should contribute to a better standardization of future studies on BPV, but should also provide clinicians with some indications on how BPV can be managed based on currently available data.

Agreement Between Ambulatory and Home Blood Pressure Monitoring in Detecting Nighttime Hypertension and Nondipping Patterns in the General Population.

BACKGROUND: Nighttime blood pressure (BP) and nondipping pattern are strongly associated with hypertensive end-organ damage. However, no previous studies have compared the diagnostic agreement between ambulatory and home monitoring in detecting these BP patterns in the general population. METHODS: We studied a population-based sample of 180 persons aged 32-80 years. The study protocol included 24-hour ambulatory BP monitoring, home daytime measurements over 7 days, home nighttime measurements (6 measurements over 2 consecutive nights using a timer-equipped home device), and ultrasound measurements for left ventricular mass index (LVMI) and carotid intima-media thickness (IMT). We defined nondipping as a <10% reduction in nighttime BP compared with daytime BP, and nighttime hypertension as BP ≥ 120/70 mm Hg. RESULTS: The agreement between ambulatory and home monitoring for detecting nighttime hypertension was good (80%, κ = 0.56, P < 0.001). However, their agreement in detecting nondipping status was poor (54%, κ = 0.12, P = 0.09). The magnitude of ambulatory systolic BP dipping percent was 1.7% higher than on home monitoring (P = 0.004), whereas no difference was observed for diastolic BP dipping (difference: 0.7%, P = 0.33). LVMI and IMT were significantly greater among individuals with nighttime hypertension than in normotensive individuals, irrespective of the measurement method. However, only ambulatory nondippers, but not home nondippers, had more advanced end-organ damage than dippers. CONCLUSION: We observed a good agreement between ambulatory and home BP monitoring in detecting nighttime hypertension in the general population. Two-night home monitoring could offer an inexpensive and feasible method for the diagnosis of nighttime hypertension.

Optimal Schedule for Assessing Home BP Variability: The Finn-Home Study.

BACKGROUND: Current guidelines make no recommendations on the optimal timing or number of measurements for assessing home blood pressure variability (HBPV). Our aim was to elucidate the optimal schedule for measuring HBPV in relation to cardiovascular risk. METHODS: In total, 1,706 Finnish adults (56.5 ± 8.5 years; 54% women) self-measured their home blood pressure (HBP) twice in the morning and evening during 7 consecutive days. The participants were followed up for cardiovascular events. We examined the association between HBPV (coefficient of variation based on 2 through 7 measurement days) and cardiovascular events using Cox regression models adjusted for HBP and other cardiovascular risk factors. RESULTS: During a follow-up of 11.8 ± 3.1 years, 216 cardiovascular events occurred. Systolic morning HBPV based on three (hazard ratio [HR], 1.039; 95% confidence interval, 1.006-1.074, model c statistic 0.737) through seven (HR, 1.057; 95% confidence interval, 1.012-1.104, model c statistic 0.737) measurement days was significantly associated with cardiovascular events. Agreement in classification to normal vs. increased morning day-to-day HBPV between consecutive measurement days became substantial (κ = 0.69 for systolic and κ = 0.68 for diastolic) after the fourth measurement day. The associations of diastolic HBPV, evening HBPV, all-day HBPV, and variability based on first measurements of each measurement occasion, with cardiovascular outcomes were nonsignificant or remained significant only after the sixth measurement day. CONCLUSIONS: Our results suggest systolic HBP should be measured twice in the morning for at least 3 days when assessing HBPV. Increasing the number of measurement days from 3 to 7 results in marginal improvement in prognostic accuracy.

Relation of blood pressure and organ damage: comparison between feasible, noninvasive central hemodynamic measures and conventional brachial measures.

OBJECTIVE: The present cross-sectional study investigated whether central SBP and pulse pressure (PP) measured noninvasively with a novel cuff-based stand-alone monitor are more strongly associated with hypertensive end-organ damage than corresponding brachial measures. METHODS: We investigated the cross-sectional association of central versus brachial SBP and PP with echocardiographic left ventricular mass index (LVMI), LV hypertrophy (LVH), carotid intima-media thickness (IMT), and increased IMT (IMT ≥ 75th percentile) among 246 participants drawn from the general population (mean age 57.2 years, 55.3% women). RESULTS: All blood pressure (BP) measures were positively correlated with LVMI and IMT (P < 0.001 for all). Brachial and central SBP correlated equally strongly with LVMI (r = 0.42 versus 0.40, P for difference 0.19) and IMT (r = 0.32 versus 0.33, P = 0.60). However, brachial PP correlated more strongly than central PP with LVMI (r = 0.34 versus 0.27, P = 0.03) and IMT (r = 0.40 versus 0.35, P = 0.04). In multivariable-adjusted logistic models, all four BP measures were significantly associated with LVH and increased IMT (P ≤ 0.03 for all). However, the diagnostic accuracy of logistic regression models that included brachial or central hemodynamic parameters was similar for LVH [area under curve (AUC) for SBP: 0.74 versus 0.76, P = 0.16; AUC for PP: 0.75 versus 0.73, P = 0.35] and IMT (AUC for SBP: 0.61 versus 0.61, P = 0.67; AUC for PP: 0.63 versus 0.61, P = 0.29). CONCLUSION: Our findings suggest that central SBP and PP measured with a stand-alone noninvasive BP monitor do not improve diagnostic accuracy for end-organ damage over corresponding brachial measures.

Outcome-Driven Thresholds for Increased Home Blood Pressure Variability.

Increased blood pressure (BP) variability predicts cardiovascular disease, but lack of operational thresholds limits its use in clinical practice. Our aim was to define outcome-driven thresholds for increased day-to-day home BP variability. We studied a population-based sample of 6238 individuals (mean age 60.0±12.9, 56.4% women) from Japan, Greece, and Finland. All participants self-measured their home BP on ≥3 days. We defined home BP variability as the coefficient of variation of the first morning BPs on 3 to 7 days. We assessed the association between systolic/diastolic BP variability (as a continuous variable and in deciles of coefficient of variation) and cardiovascular outcomes using Cox regression models adjusted for cohort and classical cardiovascular risk factors, including BP. During a follow-up of 9.3±3.6 years, 304 cardiovascular deaths and 715 cardiovascular events occurred. A 1 SD increase in systolic/diastolic home BP variability was associated with increased risk of cardiovascular mortality (hazard ratio, 1.17/1.22; 95% confidence interval, 1.06-1.30/1.11-1.34; P=0.003/<0.0001) and cardiovascular events (hazard ratio, 1.13/1.14; 95% confidence interval, 1.05-1.21/1.07-1.23; P=0.0007/0.0002). Compared with the average risk in the whole population, risk of cardiovascular deaths (hazard ratio, 1.66/1.84; 95% confidence interval, 1.27-2.17/1.42-2.37; P=0.0002/<0.0001) and events (hazard ratio, 1.46/1.42; 95% confidence interval, 1.21-1.76/1.17-1.71; P<0.0001/0.0004) was increased in the highest decile of systolic/diastolic BP variability (coefficient of variation>11.0/12.8). Increased home BP variability predicts cardiovascular outcomes in the general population. Individuals with a systolic/diastolic coefficient of variation of day-to-day home BP >11.0/12.8 may have an increased risk of cardiovascular disease. These findings could help physicians identify individuals who are at an increased cardiovascular disease risk.

The association between home vs. ambulatory night-time blood pressure and end-organ damage in the general population.

OBJECTIVE: The aim of this study was to test the agreement between night-time home and night-time ambulatory blood pressure (BP) and to compare their associations with hypertensive end-organ damage for the first time in the general population. METHODS: A population sample of 248 participants underwent measurements for night-time home BP (three measurements on two nights with a timer-equipped home device), night-time ambulatory BP, pulse wave velocity (PWV), carotid intima-media thickness (IMT) and echocardiographic left ventricular mass index (LVMI). RESULTS: No significant or systematic differences were observed between mean night-time ambulatory and home BPs (systolic/diastolic difference: 0.7 ±â€Š7.6/0.2 ±â€Š6.0 mmHg, P = 0.16/0.64). All night-time home and ambulatory BPs were positively correlated with PWV, IMT and LVMI (P < 0.01 for all). No significant differences in Pearson's correlations between end-organ damage and night-time home or ambulatory BP were observed (P ≥ 0.11 for all comparisons using Dunn and Clark's Z), except for a slightly stronger correlation between PWV and ambulatory SBP than for home SBP (r = 0.57 vs. 0.50, P = 0.03). The adjusted R of all multivariable-adjusted models for PWV, IMT or LVMI that included night-time home or ambulatory SBP/DBP were within 2/1%. CONCLUSION: Our study demonstrates that night-time home and ambulatory measurements produce similar BP values that have comparable associations with end-organ damage in the general population even when a clinically feasible measurement protocol is used for measuring night-time home BP. In the future, night-time home BP measurement may offer a feasible and easily accessible alternative to ambulatory monitoring for the measurement of night-time BP.

Agreement between ambulatory, home, and office blood pressure variability.

OBJECTIVE: Ambulatory, home, and office blood pressure (BP) variability are often treated as a single entity. Our aim was to assess the agreement between these three methods for measuring BP variability. METHODS: Twenty-four-hour ambulatory BP monitoring, 28 home BP measurements, and eight office BP measurements were performed on 461 population-based or hypertensive participants. Five variability indices were calculated for all measurement methods: SD, coefficient of variation, maximum-minimum difference, variability independent of the mean, and average real variability. Pearson's correlation coefficients were calculated for indices measured with different methods. The agreement between different measurement methods on the diagnoses of extreme BP variability (participants in the highest decile of variability) was assessed with kappa (κ) coefficients. RESULTS: SBP/DBP variability was greater in daytime (coefficient of variation: 9.8 ±â€Š2.9/11.9 ±â€Š3.6) and night-time ambulatory measurements (coefficient of variation: 8.6 ±â€Š3.4/12.1 ±â€Š4.5) than in home (coefficient of variation: 4.4 ±â€Š1.8/4.7 ±â€Š1.9) and office (coefficient of variation: 4.6 ±â€Š2.4/5.2 ±â€Š2.6) measurements (P < 0.001/0.001 for all). Pearson's correlation coefficients for systolic/diastolic daytime or night-time ambulatory-home, ambulatory-office, and home-office variability indices ranged between 0.07-0.25/0.12-0.23, 0.13-0.26/0.03-0.22 and 0.13-0.24/0.10-0.19, respectively, indicating, at most, a weak positive (r < 0.3) relationship. The agreement between measurement methods on diagnoses of extreme SBP/DBP variability was only slight (κ < 0.2), with the κ coefficients for daytime and night-time ambulatory-home, ambulatory-office, and home-office agreement varying between-0.014-0.20/0.061-0.15, 0.037-0.18/0.082-0.15, and 0.082-0.13/0.045-0.15, respectively. CONCLUSION: Shorter-term and longer-term BP variability assessed by different methods of BP measurement seem to correlate only weakly with each other. Our study suggests that BP variability measured by different methods and timeframes may reflect different phenomena, not a single entity.

The impact of the day of the week on home blood pressure: the Finn-Home study.

OBJECTIVE: The impact of the day of the week on home blood pressure (BP) level and day-to-day BP profile is unknown. Our objectives were to examine (i) how the initial measurement day of the week affects 3-day and 7-day mean home BP and (ii) the BP variation between different days of the week. PARTICIPANTS AND METHODS: The study included a population sample of 1852 participants aged 44-74 years. Home BP was measured twice in the morning and evening on 7 consecutive days. The days of the week on which home BP was measured were recorded. BP means were compared with analysis of variance and the t-test. RESULTS: There were no overall differences in mean systolic/diastolic BPs initiated on various days of the week (3-day means: P=0.15/0.66; 7-day means: P=0.11/0.55). Within-subject systolic/diastolic BP variation between different days of the week was small but significant (128.7±19.2-130.4±19.8/79.5±9.8-80.6±9.9 mmHg; P<0.001/<0.001). Systolic/diastolic BP was lowest during the weekend (Saturday-Sunday: 129.0±18.9/79.6±9.6 mmHg) and highest on Monday (130.4±19.8/80.6±9.9 mmHg), irrespective of the initial measurement day of the week (P for systolic/diastolic difference <0.001/<0.001). In subgroup analyses, the systolic/diastolic BP increase was greater from Saturday-Sunday to Monday among the employed than among the unemployed (1.8/1.3 vs. 0.8/0.7 mmHg; P=0.02/0.01). CONCLUSION: Seven-day home BP measurement can be initiated on any given day of the week. However, if a 3-day measurement is taken, it is recommended to keep in mind that BP is usually the lowest during the weekend, and highest at the beginning of the week, especially among the employed.

Comparison of Acceptability of Traditional and Novel Blood Pressure Measurement Methods.

BACKGROUND: Blood pressure (BP) monitor technology has developed significantly over the past years with the introduction of smaller and quieter home and ambulatory monitors that can both measure BP at night. The acceptability of different BP measurement methods using modern monitors is currently unknown. The purpose of this study was to compare patients' acceptability of traditional and novel BP measurement methods using up-to-date monitors. METHODS: A population sample of 223 participants underwent 4 office measurements on 2 occasions, a 24-hour ambulatory monitoring and 4 home measurements on 7 consecutive days with home nighttime (home-night) measurements on 2 nights. The acceptability of each method was evaluated with a questionnaire. Analysis of variance with post hoc Bonferroni correction was used to compare mean acceptability scores. RESULTS: Mean acceptability score, with a lower score indicating better acceptability, decreased from ambulatory (3.11±0.93) to home-night (2.74±0.81) to home (2.20±0.70) to office (1.95±0.63) measurements (P < 0.001 for all between-method comparisons). The largest between-method differences were observed in comfort of use and disturbance of everyday activities (P < 0.001). 73.1%, 31.8%, 1.3%, and 2.2% rated office, home, home-night, and ambulatory measurements as the most acceptable method, respectively. CONCLUSIONS: In the general population and under a research setting, office BP measurement was the method most preferred by the participants while home measurement was the second most preferred. Home-night measurement was slightly more preferred than ambulatory monitoring. However, before home-night BP measurement can be widely promoted as an alternative method for measuring nighttime BP, more evidence of its prognostic significance is needed.