Usefulness of Home Blood Pressure Reflected Anti-hypertensive Treatment and the Evolution of Blood Pressure Profiles

BACKGROUND: It is still unclear how self-measured home blood pressure (BP) evolves over time in treated hypertensive patients, and the usefulness of home BP based treatment is under debate. METHODS: The patients whose anti-hypertensive medications had not been changed at least 6 months were enrolled. They measured home BP at enrollment and at study end. The patients were classified into controlled hypertension (CH), hypertension with white coat effect (WCH), hypertension with reverse white coat effect (RWCH), and uncontrolled hypertension (UH), based on their clinic and home BP. Their home BP profiles were reflected in the patients' treatments, instead of relying solely on clinic BP. RESULTS: Ninety patients (mean age, 56.5 +/- 9.9; male, 57.8%) were analyzed and mean follow-up duration was 34.1 +/- 3.6 months. CH, WCH, RWCH, and UH patients were 33.3% (30 patients), 37.8% (34 patients), 5.6% (5 patients), and 23.3% (21 patients), respectively at enrollment. Almost all CH and WCH patients remained in normal range of home BP whereas about half of RWCH and UH patients moved to CH or WCH. As a result, the proportion of RWCH and UH decreased at the end of follow-up. Overall clinic and home BP reduced significantly in all groups. Clinic BP declined significantly in WCH and UH, whereas home BP declined significantly in RWCH and UH. That means the BP profiles shifted toward more reasonable states. CONCLUSIONS: BP profiles shifted toward more reasonable states after home BP based adjustment of anti-hypertensive medication. Measurement of home BP might be beneficial in anti-hypertensive treatment.

Antihypertensive Effect of Saikokaryukotsuboreito Accompanied by Objective Changes in Autonomic Balance / 日本東洋医学雑誌

We report the case of a 46-year-old man with hypertension whose blood pressure decreased due to saiko-karyukotsuboreito consumption.The patient also presented with some symptoms that suggested autonomic imbalance. After consuming 7.5g/day of a spray-dried powder of saikokaryukotsuboreito (Tsumura & Co.) for 3 months, his blood pressure measured at office was considerably lower. Twenty-four hour ambulatory blood pressure monitoring revealed that the surge in morning blood pressure, which is considered to be a risk factor for cerebrovascular disease, diminished in addition to the 24-hour mean blood pressure. A postural test revealed that his autonomic balance, which had been in a sympathetic dominant state, was inversely inclined to a parasympathetic dominant state.Our case report suggests that saikokaryukotsuboreito acts on the autonomic nervous system, which in turn exerts an antihypertensive effect, and that this effect is helpful in lowering the blood pressure in hypertensive patients whose autonomic balance is impaired due to stress.

Blood pressure measurements taken by patients are similar to home and ambulatory blood pressure measurements

OBJECTIVE: To compare blood pressure measurements taken at home by physicians, nurses, and patients with office blood pressure measurement , ambulatory blood pressure monitoring and home blood pressure measurement. METHODS: A total of 44 patients seen by a home care program were studied. Protocol 1 a) blood pressure was measured by the patient, a physician and a nurse during a regular home visit (Home1); b) home blood pressure measurement was measured for 4 days (HBPM1); c) office blood pressure measurement was measured by a physician, a nurse, and the patient; and by 24-hour ambulatory blood pressure monitoring. Protocol 2 blood pressure was measured by the patient, a physician, and a nurse during a special home visit in the presence of a physician and a nurse only (Home2); and b) home blood pressure measurement was taken for the second time (HBPM2). Echocardiography, guided by a two-dimensional echocardiograph, was performed. RESULTS: Protocol 1: a) office blood pressure measurement and Home1 were significantly higher than ambulatory blood pressure monitoring, except for systolic and diastolic office blood pressure measurement taken by the patient or a family member, systolic blood pressure taken by a nurse, and diastolic blood pressure taken by a physician. b) ambulatory blood pressure monitoring and HBPM1 were similar. Protocol 2: a) HBPM2 and Home2 were similar. b) Home2 was significantly lower than Home1, except for diastolic blood pressure taken by a nurse or the patient. There were significant relationships between: a) diastolic blood pressure measured by the patient and the thickness of the interventricular septum, posterior wall, and left ventricular mass; and b) ambulatory and HBPM2 diastolic and systolic blood pressure taken by a physician (home2) and left ventricular mass. Therefore, the data indicate that home blood pressure measurement and ambulatory blood pressure monitoring had good prognostic values relative to "office...

The Comparison of White Coat Effect in Elderly White Coat Hypertensive Patients with Youngers

BACKGROUND: White coat hypertension is a common finding in hypertensive populations. The phenomenon of white coat hypertension may reflect an abnormally vigorous sympathetic response to the environment of the measurement, especially the presence of the measuring nurse or physician. The author evaluated the magnitude of the white coat effect in elderly white coat hypertensive patients compared to youngers. METHODS: This study included 38 white coat hypertensive patients(20 youngers, 18 olders) between May 2000 and April 2005. All patients had clinic blood pressure> or =140/90mmHg on at least 2 visits and systolic and diastolic 24-hour, daytime, night-time blood pressure and heart rate were recorded. RESULTS: 1) The mean clinic systolic blood pressure was significantly correlated to daytime ambulatory systolic blood pressure(r=0.472, p60 years old). 2) In group B, daytime ambulatory diastolic blood pressure of male patients was significantly higher than females (male: 77.7+/-5.7mmHg, female: 74.1+/-4.5mmHg, p=0.041). 3) The magnitude of the white coat effect during systolic and diastolic periods was greater in the group B than group A (Group A: 28.9+/-10.4mmHg/13.3+/-7.9mmHg, Group B: 45.8+/-17.4mmHg/18.4+/-8.3mmHg, p>0.001/p=0.041). CONCLUSION: The magnitude of the white coat effect in elderly white coat hypertensive patients was greater than the youngers.

The Comparison of White Coat Effect in Elderly White Coat Hypertensive Patients with Youngers

BACKGROUND: White coat hypertension is a common finding in hypertensive populations. The phenomenon of white coat hypertension may reflect an abnormally vigorous sympathetic response to the environment of the measurement, especially the presence of the measuring nurse or physician. The author evaluated the magnitude of the white coat effect in elderly white coat hypertensive patients compared to youngers. METHODS: This study included 38 white coat hypertensive patients(20 youngers, 18 olders) between May 2000 and April 2005. All patients had clinic blood pressure> or =140/90mmHg on at least 2 visits and systolic and diastolic 24-hour, daytime, night-time blood pressure and heart rate were recorded. RESULTS: 1) The mean clinic systolic blood pressure was significantly correlated to daytime ambulatory systolic blood pressure(r=0.472, p60 years old). 2) In group B, daytime ambulatory diastolic blood pressure of male patients was significantly higher than females (male: 77.7+/-5.7mmHg, female: 74.1+/-4.5mmHg, p=0.041). 3) The magnitude of the white coat effect during systolic and diastolic periods was greater in the group B than group A (Group A: 28.9+/-10.4mmHg/13.3+/-7.9mmHg, Group B: 45.8+/-17.4mmHg/18.4+/-8.3mmHg, p>0.001/p=0.041). CONCLUSION: The magnitude of the white coat effect in elderly white coat hypertensive patients was greater than the youngers.

Prevalence of white coat hypertension and its effect on left ventricular hypertrophy / 中华全科医师杂志

Objectives To investigate the frequency of white coat hypertension (WCH) in all patients with hypertension (HT) and its effect on left ventricular hypertrophy (LVH).Methods A total of 224 patients (with an average age of 51 years, 155 males) with seated diastolic blood pressure of (95～114) mm Hg in clinic were recruited into this study. Their blood pressure was monitored dynamically for 24 h with non-invasive ambulatory method at the same day, and M-mode bi-dimensional echocardiography, electrocardiograph, determinations of serum levels of lipid and glucose were also performed for them. ResultsOverall, 10.3% of HT patients were classified as WHT, with the highest in the grade 1 HT patients (19.4%), 10.1% in the grade 2 HT and 1.6% in the grade 3 HT ( P

Determinants of White Coat Effect in Essential Hypertension

BACKGROUND: White coat effect (WCE) and white coat hypertension (WCH) are relatively prevalent in clinical situation (20 - 57% of WCH in the hypertensive population). The aim of this study was to analyze the determinant factors of WCE. METHODS: A prospective study was carried out in outpatient clinic in a consecutive hypertensives without receiving pharmacologic treatment. Twenty-four hour ambulatory blood pressure monitoring (ABPM) was performed following more than two resting blood pressure (BP) determinations carried out with the interval of 1 - 2 weeks by mercury sphygmomanometer. WCE was calculated for systolic and diastolic BP as the difference between a clinic BP (CBP) and an average daytime ambulatory BP (ABP). WCH was defined as;BP in the clinic > or = 140/90 mmHg with a mean daytime BP by ABPM < or =137/< or =89 mmHg. RESULTS: 1) Two hundred thirty-five patients (mean age 49.7 years, females 74%) were studied. Thirty-seven percent in male and forty-six percent in female patients fulfilled WCH criteria. 2) CBP was significantly correlated to daytime ABP (systolic BP;r=.47, p<.001 and diastolic BP;r=.65, p<.001). 3) The magnitude of WCE was greater in the group of WCH (28.9+14.6/19.3+6.9 mmHg) than ambulatory hypertensives (15.1+15.7/13.0+8.2 mmHg) (p<.001). 4) The magnitude of WCE is significantly correlated with female (r2=.12, p<.001) and the stage of CBP according to JNC-V (r2=.23, p<.001) in systolic BP, the stage (r2=.08, p<.001) in diastolic BP, and the stage (r2=.09, p<.001) and weight (r2=.15, p<.01) in mean BP. CONCLUSIONS: The magnitude of WCE in essential hypertension diagnosed at the clinic is significantly correlated with female, the magnitude of clinic BP, and weight.