TY - JOUR
T1 - Home blood pressure as a predictor of future blood pressure stability in borderline hypertension
T2 - The Tecumseh study
AU - Nesbitt, Shawna D.
AU - Amerena, John V.
AU - Grant, Eric
AU - Jamerson, Kenneth A.
AU - Lu, Hong
AU - Weder, Alan
AU - Julius, Stevo
N1 - Funding Information:
The Tecumseh Blood Pressure Study is supported by a grant from the National Heart, Lung and Blood Institute (HL 37464). The biochemical analyses were performed at the Michigan Diabetes and Training Center, which is the recipient of a grant from the National Institutes of Health (DK 20572).
PY - 1997/11
Y1 - 1997/11
N2 - We evaluated time-related blood pressure trends in the Tecumseh study participants, none of whom received antihypertensive treatment. At baseline the blood pressures were measured in the field clinic and by self measurement at home (twice daily for 7 days). After a mean of 3.2 ± 0.42 years, the clinic and home pressure readings were repeated. Nine hundred forty-six subjects had clinic and home blood pressure readings at baseline. Of these 735 (380 men, 355 women; average age, 32 years) also completed the second examination. Blood pressure, morphometric data, and biochemical measures at the first examination were used as predictors of future clinic blood pressures. Five hundred ninety-six subjects were normotensive on both examinations (81%). Of 79 subjects (10.7%) with clinic hypertension (>140 mg Hg systolic or 90 mm Hg diastolic)at baseline, 38 remained hypertensive ('sustained hypertension') and 41 became normotensive ('transient hypertension') after 3 years. Another 60 normotensives at baseline (10.4%) became hypertensive on second examination ('de novo hypertensives'; incidence; 8.1%). The home blood pressure readings on both examinations were reproducible. The three hypertensive groups had elevated home blood pressure, were overweight, had dyslipidemia, and higher insulin values. Only the home blood pressure proved predictive of subsequent blood pressure trends. A home blood pressure of 128 and 83 mm Hg or higher detected 'sustained' hypertension with a 48% sensitivity and 93% specificity. Readings of 120 and 80 mm Hg or lower predicted future normotension with a 45% sensitivity and a 91% specificity. We conclude that self determination of the blood pressure at home is useful in the management of borderline hypertension. An algorithm for the management of these patients is proposed.
AB - We evaluated time-related blood pressure trends in the Tecumseh study participants, none of whom received antihypertensive treatment. At baseline the blood pressures were measured in the field clinic and by self measurement at home (twice daily for 7 days). After a mean of 3.2 ± 0.42 years, the clinic and home pressure readings were repeated. Nine hundred forty-six subjects had clinic and home blood pressure readings at baseline. Of these 735 (380 men, 355 women; average age, 32 years) also completed the second examination. Blood pressure, morphometric data, and biochemical measures at the first examination were used as predictors of future clinic blood pressures. Five hundred ninety-six subjects were normotensive on both examinations (81%). Of 79 subjects (10.7%) with clinic hypertension (>140 mg Hg systolic or 90 mm Hg diastolic)at baseline, 38 remained hypertensive ('sustained hypertension') and 41 became normotensive ('transient hypertension') after 3 years. Another 60 normotensives at baseline (10.4%) became hypertensive on second examination ('de novo hypertensives'; incidence; 8.1%). The home blood pressure readings on both examinations were reproducible. The three hypertensive groups had elevated home blood pressure, were overweight, had dyslipidemia, and higher insulin values. Only the home blood pressure proved predictive of subsequent blood pressure trends. A home blood pressure of 128 and 83 mm Hg or higher detected 'sustained' hypertension with a 48% sensitivity and 93% specificity. Readings of 120 and 80 mm Hg or lower predicted future normotension with a 45% sensitivity and a 91% specificity. We conclude that self determination of the blood pressure at home is useful in the management of borderline hypertension. An algorithm for the management of these patients is proposed.
KW - Borderline hypertension
KW - Home blood pressure
KW - Insulin resistance
KW - Sympathetic nervous system
KW - Tecumseh Study
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U2 - 10.1016/S0895-7061(97)00267-7
DO - 10.1016/S0895-7061(97)00267-7
M3 - Article
C2 - 9397247
AN - SCOPUS:0031280220
SN - 0895-7061
VL - 10
SP - 1270
EP - 1280
JO - American Journal of Hypertension
JF - American Journal of Hypertension
IS - 11
ER -