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Bob Schwadron, 212-468-3616
HOME BLOOD PRESSURE MONITORING
HELPS PREDICT THOSE WHO WILL CROSS
THE HYPERTENSION BORDER
University of Michigan Investigators Find Home Monitoring
More Reliable Than Office Blood Pressure Readings
NEW YORK, NY -- Simple and inexpensive home blood pressure
monitoring helps predict which borderline hypertensive patients will
develop persistent high blood pressure and those whose blood pressure
will revert to normal ranges.
This was a key finding by University of Michigan Medical School
researchers when they evaluated time-related blood pressure trends as
part of the Tecumseh Blood Pressure Study. The study originally involved
a group of 946 residents of Tecumseh, MI, age 18-to-42, who were
unaware of abnormalities in their blood pressure when they were first
evaluated between 1986 and 1989. Three years later, 735 Tecumseh
residents were examined.
"The investigators found that the blood pressure readings
obtained when patients were trained to measure their own readings at
home were more reproducible and reliable than those readings obtained
during office visits," explains Michael Weber, MD, an editor of the
American Journal of Hypertension in the November issue.
Nearly 50 million Americans have high blood pressure, called the
silent killer because it prematurely ages the body's arteries and can lead
to strokes, heart attacks and kidney disease, often without warning.
"Physicians regularly measure blood pressure in their patients in
order to determine those who have hypertension and should be treated,"
says Dr. Weber. "However, there are some individuals whose blood
pressures are slightly higher than normal, but not quite high enough to be
regarded as truly hypertensive. Some of these borderline individuals
over time will become hypertensive, but others will tend to fall back into
the normal range."
He said that borderline hypertensives ideally should be monitored
by a physician every six to 12 months to learn whether or not
hypertension is developing. "With a society that is highly mobile, and with
frequent changes of health plans among patients, these long-term
follow-ups are frequently disrupted," Dr. Weber explains.
Of the 735 Tecumseh residents who were seen at both
examinations, 79 were originally classified as hypertensive (blood
pressure reading exceeding 140 mm Hg systolic and 90 mm Hg diastolic).
At the second examination three years later, there were 98
hypertensives.
"However, 60 (61%) of these were new hypertensives," the
authors of the study, "Home Blood Pressure as a Predictor of Future
Blood Pressure Stability in Borderline Hypertension," note. "Of subjects
who were hypertensive at the first examination, only 38 (49%) remained
hypertensive also at the second examination, whereas 41 (51%)
became normotensive after three years."
The University of Michigan Medical School researchers note that
"it is accepted that 25% of cardiovascular mortality from hypertension
accrues among subjects whose diastolic blood pressure is 90 to 95 mm
Hg. It is assumed that most of this excess accrues from transition from
borderline to more advanced forms of hypertension."
Since borderline hypertension is a strong precursor of future
hypertension, the authors point out that blood pressure reduction in this
group of subjects may have a major impact on public health. They also
note that "if a health care system were interested in detecting future
hypertensives among normotensive subjects, home blood pressure
monitoring in overweight subjects might be useful."
As for using home blood pressure monitors, the Tecumseh study
showed that after a short period of instruction 99% of all subjects could
accurately measure their blood pressure.
"The ability to measure blood pressure was not affected by the
patient's educational or socioeconomic status and the readings were
highly reproducible," the Tecumseh investigators said. "This combined
with the fact that inexpensive sphygmomanometers with built-in
stethoscopes in the cuff are readily available suggests that blood
pressure self measurement is an easy procedure that can be adopted
routinely into clinical practice.
"Our data suggest that to use home blood pressure for prediction
of future blood pressure trends one needs to average a large number of
home readings," the authors conclude. "In practical terms this is not a
problem once they learn the technique, patients do not mind obtaining
multiple readings particularly if they are provided with a handy daily log
for blood pressure recording."
Authors of the Tecumseh Study are Shawna D. Nesbitt, John V.
Amerena, Eric Grant, Kenneth A. Jamerson, Hong Lu, Alan Weder and
Stevo Julius. They are from the Division of Hypertension at the University
of Michigan Medical School.
The American Society of Hypertension is the largest US
organization devoted exclusively to hypertension and related
cardiovascular diseases. The organization is committed to alerting
physicians, allied health professionals and the public about new medical
options, facts, research findings and treatment choices designed to
reduce the risk of cardiovascular disease.
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