Air Pollution and Home Blood Pressure: The 2021 Athens Wildfires.

INTRODUCTION: Fine particulate matter with an aerodynamic diameter < 2.5 µm (PM2.5) in the ambient air has been associated with increased blood pressure (BP) levels and new-onset hypertension. However, the association of BP with a sudden upsurge of PM2.5 in extreme conditions has not yet been demonstrated. AIM: To evaluate the association between PM2.5 pollutants the week before, during, and the week after the 2021 wildfires in Athens (Greece) and home BP measurements. METHODS: Home BP measurements were performed, and the readings were transferred to the doctor's office through a telemonitoring system on the patient's Smartphone application. Data from a calibrated, sensor-based PM2.5 monitoring network assessed PM2.5 exposure. RESULTS: PM2.5 pollutants demonstrated a gradual surge while the particle concentration was not different in the selected air pollution measurement stations. A total of 20 consecutive patients with controlled hypertension, mean age 61 ± 9 years, were included in the analysis. For one unit in µg/m3 increase of PM2.5 particle concentration, an average of 2.1 mmHg increment in systolic BP was observed after adjustment for confounders (P = 0.023). CONCLUSIONS: Our findings raise the hypothesis that short-term exposure to raised PM2.5 concentrations in the air appears to be associated with increases in systolic home BP." Telemonitoring systems of home BP recordings may provide important information for the clinical management of hypertensive patients, at least in conditions of major environmental disturbances, such as wildfires.

Home blood pressure monitoring schedule: optimal and minimum based on 2122 individual participants' data.

OBJECTIVES: Home blood pressure (HBP) monitoring has become a primary method for hypertension diagnosis and management. This analysis aimed to investigate the optimal and minimum schedule for HBP monitoring. METHODS: A retrospective analysis of cross-sectional data was performed, which involved HBP and 24-h ambulatory blood pressure (ABP) monitoring in adults performed within the context of clinical studies in Finland, Greece and UK. Participants with six to seven HBP monitoring days and at least 12 HBP readings were included. The stability of HBP was assessed by evaluating the average value of an increasing number of readings and its variability (SD). Its association with awake ABP was also assessed. RESULTS: Data from 2122 participants were analysed (mean age 53.9 ±â€Š11.3 years, males 53%, treated 34%). A progressive HBP decline was observed in succeeding days, reaching a plateau after day 3. Day 1 HBP was higher than in the next days by about 2.8/1.4 mmHg (systolic/diastolic, P < 0.001). In a 3-day HBP monitoring schedule, the exclusion of day 1 reduced average HBP and SD, with a clinically important HBP decline in 115 participants (5%) and different hypertension diagnosis in 120 participants (6%). For schedules including more than three HBP monitoring days, the exclusion of day 1 had negligible impact. The 3-day average HBP was strongly correlated with awake ABP, with a little improvement thereafter. CONCLUSION: These data support the recommendation for 7 days of HBP monitoring with a minimum of 3 days. Readings of the first day should be discarded, particularly when the minimum 3-day monitoring schedule is obtained (average readings of second and third day).

Diabetes mellitus in the era of climate change.

Worldwide, diabetes mellitus (DM) represents a major public-health problem due to its increasing prevalence in tandem with the rising trend of obesity. However, climate change, with its associated negative health effects, also constitutes a worrisome problem. Patients with DM are experiencing more visits to emergency departments, hospitalizations, morbidity and mortality during heat waves at ever-increasing numbers. Such patients are particularly vulnerable to heat waves due to impaired thermoregulatory mechanisms in conjunction with impaired autonomous nervous system responses at high temperatures, electrolyte imbalances and rapid deterioration of kidney function, particularly among those aged > 80 years and with preexisting chronic kidney disease (CKD). Moreover, exposure to cold temperatures is associated with increased rates of acute myocardial infarction as well as poor glycaemic control, although results are conflicting regarding cold-related mortality among patients with DM. In addition to extremes of temperature, air pollution as a consequence of the climate crisis may also be implicated in the increased prevalence and incidence of DM, particularly gestational DM (GDM), and lead to deleterious effects in patients with DM. Thus, more large-scale studies are now required to elucidate the association between specific air pollutants and risk of DM. This review presents the currently available evidence for the detrimental effects of climate change, particularly those related to weather variables, on patients with DM (both type 1 and type 2) and GDM. Specifically, the effects of heat waves and extreme cold, and pharmaceutical and therapeutic issues and their implications, as well as the impact of air pollution on the risk for DM are synthesized and discussed here.

Automated office blood pressure is in agreement with awake and mean 24-hour ambulatory blood pressure at the lower blood pressure range.

Automated office blood pressure measurement eliminates the white coat effect and is associated with awake ambulatory blood pressure. This study examined whether automated office blood pressure values at lower limits were comparable to those of awake and mean 24-hour ambulatory blood pressure. A total of 552 patients were included in the study, involving 293 (53.1%) men and 259 (46.9%) women, with a mean age 55.0 ± 12.5, of whom 36% were treated for hypertension. Both systolic and diastolic automated office blood pressures exhibited lower values compared to awake ambulatory blood pressure among 254 individuals with systolic automated office blood pressure <130 mm Hg (119 ± 8 mm Hg vs 125 ± 11 mm Hg, P < .0001 and 75 ± 9 mm Hg vs 79 ± 9 mm Hg, P < .0001 for systolic and diastolic BPs, respectively). Furthermore, the comparison of systolic automated office blood pressure to the mean 24-hour ambulatory blood pressure levels also showed lower values (119 ± 8 vs 121 ± 10, P = .007), whereas the diastolic automated office blood pressure measurements were similar to 24-hour ambulatory blood pressure values. Our findings show that when automated office blood pressure readings express values <130/80 mm Hg in repeated office visits, further investigation should be performed only when masked hypertension is suspected; otherwise, higher automated office blood pressure values could be used for the diagnosis of uncontrolled hypertension, especially in individuals with organ damage.

The optimal use of automated office blood pressure measurement in clinical practice.

This evidence-based article endorses the use of automated office blood pressure (AOBP). AOBP is the most favorable office blood pressure (BP) measuring technique as it provides accurate readings with 3-15 mm Hg lower values than the casual conventional office measurements with auscultatory or semi-automated oscillometric devices and relates closely to awake ABP readings. The AOBP technique seems to be superior to conventional office BP in predicting hypertension-mediated organ damage and appears to be equally reliable to awake ABP in the prediction of cardiovascular (CV) disease. AOBP readings should be obtained either unattended, with the patient alone in the examination room, or attended with the presence of personnel in the room but with no talking to the patient, although this recommendation is not frequently followed in routine clinical practice. To optimize office BP readings, the type of device, the rest period before AOBP measurements (preceding rest), and the time intervals between measurements were evaluated. As AOBP readings have the advantage of removing many confounding factors, the authors propose to perform measurements with a preceding rest in all patients at the initial visit; if AOBP readings remain <130 mm Hg in subsequent visits, measurements could be accepted, otherwise, if are higher, patients should be evaluated by out-of-office BP measurements.

Phenotypes of masked hypertension: Isolated ambulatory, isolated home and dual masked hypertension.

OBJECTIVES: Masked hypertension (MH) is defined as normal office blood pressure (OBP) and elevated ambulatory (ABP) or home blood pressure (HBP). This study assessed MH identified by each of these two methods. METHODS: A retrospective analysis of cross-sectional data in treated and untreated adults from Greece, Finland and UK who had OBP, HBP and 24-h ABP measurements was performed. Dual MH was defined as normal OBP and elevated HBP and ABP, isolated ambulatory MH as normal OBP and HBP and elevated ABP and isolated home MH as normal OBP and ABP and elevated HBP. RESULTS: Of 1971 participants analyzed, 445 (23%) had MH on ABP and/or HBP (age 57.1 ±â€Š10.8 years, men 55%, treated 49%). Among participants with any MH, 215 had dual MH (48%), 132 isolated ambulatory MH (30%) and 98 isolated home MH (22%). Moreover, 55% had high-normal, 35% normal and 10% optimal OBP. In logistic regression analysis isolated ambulatory MH was predicted by younger age (OR 0.35, P < 0.01 per 10 years increase), whereas isolated home MH was predicted by older age (OR 2.05, P < 0.01 per 10 years increase). CONCLUSION: Masked hypertension diagnosed by ABP and not HBP monitoring or the reverse is not uncommon. Age appears to be the most important determinant of isolated ambulatory or home MH, with the former being more common in younger participants and the latter in older ones. Only half of participants with MH have high-normal OBP, whereas the rest have lower levels.

Automated office blood pressure measurements obtained with and without preceding rest are associated with awake ambulatory blood pressure.

Automated office blood pressure (AOBP) measurement, attended or unattended, eliminates the white coat effect (WCE) showing a strong association with awake ambulatory blood pressure (ABP). This study examined the difference in AOBP readings, with and without 5 minutes of rest prior to three readings recorded at 1-min intervals. Cross-sectional data from 100 randomized selected hypertensives, 61 men and 39 women, with a mean age of 52.2 ± 10.8 years, 82% treated, were analyzed. The mean systolic AOBP values without preceding rest were 127.0 ± 18.2 mm Hg, and the mean systolic AOBP values with 5 minutes of preceding rest were 125.7 ± 17.9 mm Hg (P = .05). A significant order effect was observed for the mean systolic BP values when AOBP without 5 minutes of preceding rest was performed as the first measurement (130.0 ± 17.7 vs 126.5 ± 16.2, P = .008). When we used a target systolic AOBP ≥ 130 mm Hg, awake ABP yielded lower readings, while at a target systolic AOBP value of < 130 mm Hg higher awake ABP values were obtained. Our findings indicate that systolic AOBP can be initially checked without any preceding rest and if readings are normal can be accepted. Otherwise, when AOBP is ≥ 130 mm Hg, measurements should be rechecked with 5 minutes of rest.

Ambulatory versus home blood pressure monitoring: frequency and determinants of blood pressure difference and diagnostic disagreement.

OBJECTIVES: Out-of-office blood pressure evaluation assessed using ambulatory (ABP) or home (HBP) monitoring is currently recommended for hypertension management. We evaluated the frequency and determinants of diagnostic disagreement between ABP and HBP measurements. METHODS: Cross-sectional data from 1971 participants (mean age 53.8 ±â€Š11.4 years, 52.6% men, 32% treated) from Greece, Finland and the United Kingdom were analyzed. The diagnostic disagreement between HBP and daytime ABP was regarded as certain when (i) the two methods diagnosed a different blood pressure phenotype, (ii) the absolute HBP-ABP difference was more than 10/5 mmHg (systolic/diastolic) and (iii) ABP and HBP had a more than 5 mmHg difference from the respective hypertension threshold. RESULTS: In 1574 participants (79.9%), there was agreement between HBP and ABP in diagnosing hypertensive phenotypes (kappa 0.70). Of the remaining 397 participants (20.1%) with diagnostic disagreement, 95 had clinically irrelevant HBP-ABP differences, which reduced the disagreement to 15.3%. When cases with ABP and/or HBP differing ≤5 mmHg from the respective hypertension threshold were excluded, the certain disagreement between the two methods was reduced to 8.2%. Significant determinants of the HBP-ABP difference were age, sex, study center, BMI, cardiovascular disease history, office hypertension and antihypertensive treatment. Antihypertensive drug treatment, alcohol consumption and office normotension independently increased the odds of diagnostic disagreement. CONCLUSION: These data suggest that there is considerable diagnostic agreement between HBP and ABP, and that these methods are interchangeable for clinical decisions in most patients. However, considerable disagreement between the two methods occurs in an appreciable minority, most likely due to methodological and patient-related factors.

Attended Versus Unattended Automated Office Blood Pressure: A Systematic Review and Meta-analysis.

INTRODUCTION: Automated office blood pressure (AOBP) has been proposed for blood pressure (BP) assessment in the office because it shows a strong association with the awake ambulatory BP. However, it remains unknown whether the presence or absence of an observer modulates AOBP readings. AIM: To determine the difference between unattended and attended AOBP measurements through systematic review and meta-analysis. METHODS: We searched the PubMed and the Cochrane Collaboration Library and we screened the references' list of relevant reports to identify potentially eligible articles. For included studies, quality was assessed by using the Quality Assessment for Diagnostic Accuracy Studies 2. The weighted pooled BP difference with 95% confidence interval (CI) between unattended and attended AOBP was estimated under the random effects model. RESULTS: Twelve studies (1762 subjects) were included. The systolic and diastolic BP difference between unattended and attended AOBP measurements was - 3.66 (- 6.58 to - 0.75) and - 1.67 (- 2.78 to - 0.55) mmHg, respectively. Heterogeneity across studies was high (I2 = 97,1% for systolic and I2 = 89% for diastolic BP, P < 0.001) and was partially determined by the sequence of performing unattended and attended BP measurements, the device used for AOBP, the geographic region in which studies were performed and the presence of a resting period before unattended AOBP. CONCLUSIONS: Due to the high heterogeneity, we cannot rely on the weighted pooled estimate. However, the available evidence suggests that attended AOBP yielded higher systolic and diastolic BP levels and it seems that the procedural methodology determines partially the statistical heterogeneity across studies.

Morning Surge and Peak Morning Ambulatory Blood Pressure Versus Automated Office Blood Pressure in Predicting Cardiovascular Disease.

INTRODUCTION: Automated office blood pressure (AOBP) has been recently shown to predict equally well to ambulatory blood pressure (ABP), conventional office blood pressure (OBP) and home blood pressure (HBP), cardiovascular (CV) events among hypertensives. AIM: To compare AOBP recording and ABP monitoring in order to evaluate morning blood pressure (BP) peak in predicting CV events and deaths in hypertensives. METHODS: We assessed 236 initially untreated hypertensives, examined between 2009 and 2013. The end points were CV and non-CV death and any CV event including myocardial infarction, evidence of coronary heart disease, heart failure hospitalization, severe arrhythmia, stroke, and symptomatic peripheral artery disease. We fitted proportional hazards models using the different modalities as predictors and evaluated their predictive performance using two metrics: the Akaike's Information Criterion, and Harrell's C-index. RESULTS: After a mean follow-up of 7 years, 23 subjects (39% women) had at least one CV event. In Cox regression models, systolic conventional OBP, AOBP and peak morning BP were predictive of CV events (p < 0.05). The Akaike Information Criterion showed smaller values for AOBP than peak morning BP, indicating a better performance in predicting CV events (227.2736 and 238.7413, respectively). The C-index was 0.6563 for systolic AOBP and 0.6243 for peak morning BP indicating a better predicting ability for AOBP. CONCLUSION: In initially untreated hypertensives, AOBP appears to be at least equally reliable to 24-h monitoring in the evaluation of morning BP peak in order to detect CV disease whereas the sleep-trough and preawakening morning BP surge did not indicate such an effect.

Unobserved automated office BP is similar to other clinic BP measurements: A prospective randomized study.

Results of the SPRINT study have been disputed, based on the assumption that unattended BP measurements do not correlate with usual BP measurements. In this study, the authors investigated the correlation of unattended SPRINT-like measurements with other conventional measurements. All BP measurements were taken with the patient seated in a comfortable chair with the legs uncrossed and not speaking during the procedure. For the purpose of this study, sixty-five patients, mostly male (93%), were recruited from our hypertension clinic and all were on antihypertensive medication (av 3.0 ± 1.1). Patients were at high cardiovascular risk with high rates of comorbidities, av age 68 ± 12 years, 49% with diabetes, 34% with mild CKD (CKD 1-3, average eGFR 55.0 ± 13 mL/min/1.73 m2 ), and 20% with history of stable coronary artery disease. All BP measurements were similar with no statistically significant difference (one-way ANOVA, P = 0.621). Compared to unattended SPRINT BP values (139.77 ± 19.22/75.42 ± 11.72 mm Hg), the clinic BP measurements were numerically slightly higher but with a NS P value (P = 0.163). Similarly, unattended BP measurements were similar to values taken by the clinic physician. In a smaller cohort of 11 patients, the authors compared unobserved vs observed SPRINT-like BP measurements, and in 13 patients, the authors compared unobserved SPRINT-like BP measurements to average home BP measurements (Table 3). There were no significant differences between any of the subgroups (one-way ANOVA, P = 0.816 for systolic and P = 0.803 for diastolic). The authors conclude that unattended BP measurements taken (the SPRINT way) are similar to other conventional office blood pressure measurements.

Attended and Unattended Automated Office Blood Pressure Measurements Have Better Agreement With Ambulatory Monitoring Than Conventional Office Readings.

BACKGROUND: Automated office blood pressure (AOBP) measurement is superior to conventional office blood pressure (OBP) because it eliminates the "white coat effect" and shows a strong association with ambulatory blood pressure. METHODS AND RESULTS: We conducted a cross-sectional study in 146 participants with office hypertension, and we compared AOBP readings, taken with or without the presence of study personnel, before and after the conventional office readings to determine whether their variation in blood pressure showed a difference in blood pressure values. We also compared AOBP measurements with daytime ambulatory blood pressure monitoring and conventional office readings. The mean age of the studied population was 56±12 years, and 53.4% of participants were male. Bland-Altman analysis revealed a bias (ie, mean of the differences) of 0.6±6 mm Hg systolic for attended AOBP compared with unattended and 1.4±6 and 0.1±6 mm Hg bias for attended compared with unattended systolic AOBP when measurements were performed before and after conventional readings, respectively. A small bias was observed when unattended and attended systolic AOBP measurements were compared with daytime ambulatory blood pressure monitoring (1.3±13 and 0.6±13 mm Hg, respectively). Biases were higher for conventional OBP readings compared with unattended AOBP (-5.6±15 mm Hg for unattended AOBP and oscillometric OBP measured by a physician, -6.8±14 mm Hg for unattended AOBP and oscillometric OBP measured by a nurse, and -2.1±12 mm Hg for unattended AOBP and auscultatory OBP measured by a second physician). CONCLUSIONS: Our findings showed that independent of the presence or absence of medical staff, AOBP readings revealed similar values that were closer to daytime ambulatory blood pressure monitoring than conventional office readings, further supporting the use of AOBP in the clinical setting.

Hypertension and atrial fibrillation: a bench to bedside perspective.

Atrial Fibrillation (AF) is the most common cardiac arrhythmia in clinical practice and its prevalence increases markedly with advancing age, worldwide. Almost every primary care physician, internist, or cardiologist, has dealt with stroke or with other complications of AF. Still, its management remains a hot issue for clinicians and the debate over which treatment strategy is the best is ongoing. Moreover, AF increases significantly the total cardiovascular (CV) morbidity and mortality. Despite a great bulk of data in the existing medical literature, the pathophysiology of AF in patients with hypertensive heart disease (HHD) is poorly understood, and the underlying signaling pathways linking hypertension (HTN) to AF remain to be fully elucidated. The scope of this article is to discuss the myocardial anatomical and physiological alterations that occur in HTN, and highlight the proposed electrophysiological mechanisms that cause the hypertensive heart to fibrillate. In addition, we will focus on the latest ESC 2016 guidelines for the risk stratification of AF patients as a tool to guide anticoagulation which represents the mainstay of treatment for AF. Last, the other therapeutic approaches for hypertensives with AF currently adopted for optimal patient management will be reviewed.

Persistent Afebrile Abdominal Pain: An Unusual Case of Segmental Colitis in an Immunocompromised Host.

In this report we describe a case of a 66-year-old woman who presented with right upper quadrant abdominal pain and bloody diarrhea. A workup revealed immunodeficiency, an immunologic profile with low complement levels resembling systemic lupus erythematosus, and a circumferential colonic wall lesion located in the ascending colon. After endoscopy and biopsy, the mass lesion was attributed to "double hit" diffuse large B-cell lymphoma, categorized as high grade large B-cell non-Hodgkin lymphoma according to the most recent revised 2016 World Health Organisation classification and considered to be a rare and highly aggressive tumor. The diagnosis of colonic lymphoma can be challenging due to a diversity of clinical presentation and requires a high index of suspicion. As the literature of such documented reports is limited, this case suggests further investigations. ABBREVIATIONS: GI: gastrointestinal tract, DLBCL: diffuse large B cell lymphoma, DH: double hit lymphoma, SLE: systemic lupus erythematosus, ANA: antinuclear antibodies, anti-ssDNA: anti-single-stranded DNA, BCL: B-cell lymphoma protein, MUM-1/IRF4: multiple myeloma oncogene 1/interferon regulatory factor 4, HGBL: high grade B-cell lymphoma, anti-dsDNA: anti-double-stranded DNA.

Home, automated office, and conventional office blood pressure as predictors of cardiovascular risk.

Automated office blood pressure (AOBP) has recently been shown to closely predict cardiovascular (CV) events in the elderly. Home blood pressure (HBP) has also been accepted as a valuable method in the prediction of CV disease. This study aimed to compare conventional office BP (OBP), HBP, and AOBP in order to evaluate their value in predicting CV events and deaths in hypertensives. We assessed 236 initially treatment naïve hypertensives, examined between 2009 and 2013. The end points were any CV and non-CV event including mortality, myocardial infarction, coronary heart disease, hospitalization for heart failure, severe arrhythmia, stroke, and intermittent claudication. We fitted proportional hazards models using the different modalities as predictors and evaluated their predictive performance using three metrics: time-dependent receiver operating characteristics curves, the Akaike's Information Criterion, and Harrell's C-index. After a mean follow-up of 7 years, 23 participants (39% women) had experienced ≥1 CV event. Conventional office systolic (hazard ratio [HR] per 1 mm Hg increase in BP, 1.028; 95% confidence interval [CI], 1.009-1.048), automated office systolic (HR per 1 mm Hg increase in BP, 1.031; 95% CI, 1.008-1.054), and home systolic (HR, 1.025; 95% CI, 1.003-1.047) were predictive of CV events. All systolic BP measurements were predictive after adjustment for other CV risk factors (P < .05). The predictive performance of the different modalities was similar. Conventional OBP was significantly higher than AOBP and average HBP. AOBP predicts equally well to OBP and HBP CV events. It appears to be comparable to HBP in the assessment of CV risk, and therefore, its introduction into guidelines and clinical practice as the reference method for assessing BP in the office seems reasonable after verification of these findings by randomized trials.

Night-time home versus ambulatory blood pressure in determining target organ damage.

OBJECTIVE: This study aimed to evaluate the association of night-time blood pressure (BP) assessed by home blood pressure (HBP) or ambulatory blood pressure (ABP) monitoring with preclinical target organ damage in untreated hypertension. METHODS: Untreated hypertensive study participants were evaluated with ABP monitoring (24-h) and HBP monitoring during daytime (6 days, duplicate morning and evening measurements) and night-time (automated asleep measurements, three nights, 3-hourly measurements/night). Target organ damage was assessed by echocardiographic left ventricular mass index (LVMI), common carotid intima-media thickness (cIMT), urine albumin excretion (UAE), and ankle-brachial index (ABI). RESULTS: A total of 131 study participants were analysed [mean age 52.1 ±â€Š11.9 (SD) years, BMI 29.9 ±â€Š5.3  kg/m2, men 58%, cardiovascular disease history 6.1%]. Daytime and night-time HBP were slightly higher than the respective ABP values (mean difference for systolic daytime/night-time 3.5 ±â€Š10.6/2.6 ±â€Š9.8  mmHg, P < 0.01 for both comparisons and diastolic -0.3 ±â€Š6.8/1.2 ±â€Š6.2  mmHg, P = NS/0.02, respectively). There was a strong correlation between daytime ABP and HBP (r = 0.71/0.72, systolic/diastolic), as well as between the respective night-time values (r = 0.80/0.79; all P < 0.01). Night-time ABP and HBP presented strong and comparable correlations with all the indices of preclinical target organ damage. In multivariate analyses, both LVMI (R2 = 0.26) and cIMT (R2 = 0.25) were determined by night-time systolic HBP, age and male sex; UAE (R2 = 0.28) by night-time systolic HBP and male sex; ABI (R2 = 0.20) by male sex and night-time home pulse pressure. CONCLUSION: In untreated hypertensives, night-time BP assessed by home monitoring appears to be as good as night-time ambulatory monitoring in determining preclinical target organ damage.

Automated office blood pressure is associated with urine albumin excretion in hypertensive subjects.

BACKGROUND: We aimed to investigate the association between automated office blood pressure (AOBP) readings and urine albumin excretion (UAE), and to assess if this association is as close as that between 24-h ambulatory blood pressure (ABP) and UAE. A strong association would suggest that AOBP may serve as an indicator of early renal impairment. METHODS: In a sample of 162 hypertensives, we compared AOBP with ABP measurements and their associations with UAE in two consecutive 24-h urine collections measured by an immunoturbidimetric assay. Microalbuminuria was defined as UAE of 30-300 mg/24 h. RESULTS: The age of the subjects was 53 ± 13 (mean ± s.d.) years. Twenty-two were microalbuminuric. In those, AOBP and 24-h ABP were higher than in the normoalbuminuric subjects: 152 ± 19 and 147 ± 20 vs. 138 ± 15 and 130 ± 11 mm Hg for systolic blood pressure (SBP), and 97 ± 15 and 92 ± 14 vs. 86 ± 10 and 82 ± 8 mm Hg for diastolic blood pressure (DBP) (P < 0.001). Correlations between AOBP and 24-h ABP with log-transformed urine albumin were 0.30 (P < 0.001) and 0.43 (P < 0.001) for SBP and 0.27 (P < 0.001) and 0.33 (P < 0.001) for DBP. Adjusting for age, sex, body mass index, and estimated glomerular filtration rate, both AOBP and 24-h ABP were independently associated with urine albumin (P < 0.001 for both associations). Receiver operating characteristics curve analysis showed a similar predictive ability for microalbuminuria for AOBP and for 24-h ABP (area under the curve: 0.819 (P < 0.001) for SBP, 0.836 (P < 0.001) for DBP vs. 0.830 (P < 0.001) for SBP and 0.845 (P < 0.001) for DBP). CONCLUSIONS: In this study, microalbuminuria correlated similarly with high-quality AOBP and ABP readings, further supporting the use of AOBP in the clinical setting.

Automated office versus home measurement of blood pressure in the assessment of morning hypertension.

OBJECTIVE: To compare the quality and accuracy of morning blood pressure (BP) readings as taken by automated office BP (AOBP) and morning home BP (mHBP) techniques using morning ambulatory BP (mABP) measurements as the gold standard. METHODS: A total of 139 individuals were included, 70 men and 69 women, mean age 53±13 years. The average AOBP readings as measured using a Microlife Watch BP office device taking triplicate automated simultaneous readings of both arms were compared with mHBP monitored on 6 routine days, using a validated automated electronic device. Both modalities were also compared with the ambulatory readings of the 3 h of waking (mABP3h). RESULTS: The AOBP values were slightly higher than the mABP3h (mean difference 8.2 mmHg, 95% limits of agreement, -18.8 to 35.2 mmHg for the systolic BP and mean difference 4.3 mmHg, 95% limits of agreement, -15.3 to 23.9 mmHg for the diastolic BP). Systolic and diastolic AOBP readings correlated with mABP3h (r=0.66, P=0.001 and r=0.64, P=0.001, respectively). Agreement was fair between AOBP and mHBP in the detection of morning hypertensive patients (agreement 70%, κ=0.32) as compared with AOBP and mABP3h (agreement 67%, κ=0.32) and mHBP and mABP3h (agreement 65%, κ=0.31). CONCLUSION: The AOBP technique could replace mHBP monitoring in the assessment of morning BP, as it provides comparable data in relation to the awake ambulatory BP. Given the simplicity of this method, it could be more readily applied in a larger number of individuals.