Effect of Intensive and Standard Clinic‐Based Hypertension Management on the Concordance Between Clinic and Ambulatory Blood Pressure and Blood Pressure Variability in SPRINT
Year: 2019
Type: article
Abstract: Background Blood pressure ( BP ) varies over time within individual patients and across different BP measurement techniques. The effect of different BP targets on concordance between BP measurements is unknown. The goals of this analysis are to evaluate concordance between (1) clinic and ambulatory BP , (2) clinic visit-to-visit variability and ambulatory BP variability, and (3) first and second ambulatory BP and to evaluate whether different clinic targets affect these relationships. Methods and Results The SPRINT (Systolic Blood Pressure Intervention Trial) ambulatory BP monitoring ancillary study obtained ambulatory BP readings in 897 participants at the 27-month follow-up visit and obtained a second reading in 203 participants 293±84 days afterward. There was considerable lack of agreement between clinic and daytime ambulatory systolic BP with wide limits of agreement in Bland-Altman plots of -21 to 34 mm Hg in the intensive-treatment group and -26 to 32 mm Hg in the standard-treatment group. Overall, there was poor agreement between clinic visit-to-visit variability and ambulatory BP variability with correlation coefficients for systolic and diastolic BP all <0.16. We observed a high correlation between first and second ambulatory BP ; however, the limits of agreement were wide in both the intensive group (-27 to 21 mm Hg) and the standard group (-23 to 20 mm Hg). Conclusions We found low concordance in BP and BP variability between clinic and ambulatory BP and second ambulatory BP . Results did not differ by treatment arm. These results reinforce the need for multiple BP measurements before clinical decision making.
Authors: Lama Ghazi, Nicholas M. Pajewski, Dena E. Rifkin, Jeffrey T. Bates, Tara I. Chang, William C. Cushman, Stephen P. Glasser, William E. Haley, Karen C. Johnson, William J. Kostis, Vasilios Papademetriou, Mahboob Rahman, Debra L. Simmons, Addison Taylor, Paul K. Whelton, Jackson T. Wright, Udayan Y. Bhatt, Paul E. Drawz
Institutions: University of Minnesota, Wake Forest University Health Sciences, Wake Forest University, University of California San Diego, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Stanford Medicine, Stanford University, University of Tennessee Health Science Center, Memphis VA Medical Center, University of Kentucky, Mayo Clinic in Florida, Rutgers, The State University of New Jersey, United States Department of Veterans Affairs, Georgetown University, Veterans Health Administration, University Hospitals Cleveland Medical Center, Louis Stokes Cleveland VA Medical Center, Case Western Reserve University, University of Utah, George E. Wahlen Department of VA Medical Center, Tulane University, University Hospitals of Cleveland, The Ohio State University Wexner Medical Center, The Ohio State University
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,750
Funders: University of Minnesota, National Institutes of Health, National Institute of General Medical Sciences, National Institute of Diabetes and Digestive and Kidney Diseases, National Center for Research Resources, National Center for Advancing Translational Sciences, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: Stanford Center for Clinical and Translational Education and Research (SCCTER)UL1, G1201304535, G130883262, G1346455397, G1452718737, G1534123016, G1575401839, G1815451664, G1867584024, G2244966566, G235943272, The Ohio State University Center for Clinical and Translational Science (UL1), Deuterated Analogs of Praziquantel for Treatment of Schistosomiasis, Tufts Clinical and Translational Research Institute, G268392375, Stanford Center for Clinical & Translational Education and Research (Spectrum), University of Minnesota Clinical and TranslationalmScience Institute (UMN CTSI), Ambulatory Blood Pressure and Cognitive Function in the Systolic Blood Pressure Intervention Trial, Translational Research in Hypertension and Renal Biology, UC Davis Clinical and Translational Science Center, G3759862710, Clinical and Translational Science Institute at Children's National, UF Clinical and Translational Science Award, G522538789, Institutional Clinical and Translational Science Award, G576625284, Tufts Clinical and Translation Science Institute (UL1), G6258407934, G742032275, Institutional Clinical and Translational Science Award, The Vanderbilt Institute for Clinical and Translational Research (VICTR), Clinical and Translational Science Collaborative of Cleveland, Clinical and Translational Science Collaborative of Cleveland
OpenAlex ID: W2962369409