Home BP (HBP) monitoring may improve the management of hypertension in patients with chronic kidney disease (CKD). However, few studies (a total of 980 patients identified in 6 studies in a recent metaanalysis) have been conducted in CKD to evaluate HBP in comparison to clinic-obtained BP (CBP). Methods: Patients were recruited from 17 renal and cardiologic clinics if they had a glomerular filtration rate, estimated by means of the Cockcroft equation, <60 mL/min and/or a proteinuria >1.0 g/24 h. 243 patients were screened for the study; and 225 patients qualified (61% men; mean age: 67 ± 13 years; 37% with diabetes). Patients recorded their morning and evening HBP during 3 consecutive days using the same validated Microlife BP (3AC1–1 PC, used on average mode) monitor to collect their CBP. Mean HBPs were significantly lower than mean CBPs of 9.0 ± 15.1 mmHg for SBP and of 7.0 ± 10.0 mmHg for DBP. However, 23% of the patients had a higher mean HBP compared to their CBP. CBPs were significantly correlated (p < 0.001) with the differences between CBPs and HBPs (Figures 1 A et 1B).Mean HBPs were significantly lower in the evening for SBP and decreased significantly from day 1 to day 3 for both SBP and DBP. Our real life study provides additional data on BP in renal patients. Both white coat and reverse effects are very common and related to Clinic BP. HBP that has been reported to be more reliable than Clinic BP should improve the crucial control of BP in CKD

Background: Masked hypertension has been associated with obese and overweight individuals; however, most studies do not mention the use of large cuffs for home BP measurements in patients with oversized arms. Our goal was to test the impact of cuff size on hypertension status in patients with oversized arms. Patients and Methods: 53 treated hypertensive patients (mean age 60 ± 13 y; mean BMI 36 ± 5 kg/m2 (range 25–48)) with an arm circumference >33 cm (range33–45 cms) have been included. After the office visit, they performed two cycles of home blood pressure measurements according to the French Society of Hypertension protocol with a standard cuff, and a large cuff, using the Microlife® BP A100 PLUS validated device. Home BP < 135/85 mmHg was the cut-off used to classify the patients in terms of BP control. Results: Mean office BP was 143 ± 17/85 ± 11 mmHg. Home BP measurements were 141 ± 14 / 84 ± 11 mmHg and 134 ± 13 / 80 ± 10 mmHg with the standard and the large cuff respectively (mean difference 6.9 / 4.0 mmHg for SBP/DBP p < 0.0001). The prevalence of white-coat and masked hypertension with the 2 different cuffs is summarized in the figure. The use of an appropriate large cuff for home BP evaluation led to a 3-fold decrease in masked hypertension and a 3-fold increase in white-coat hypertension. Conclusion: The use of inappropriate cuffs for home BP measurements has a significant and epidemiological impact by modifying substantially the prevalence of white-coat and masked hypertension. Large adult cuffs for home BP devices, commonly needed by hypertensive patients, are not always easily available for purchase, and charging extra for large adult cuffs is a potential hindrance to consumers purchasing the correct cuff size for accurate blood pressure measurement and should be eliminated. Future studies in the field of masked hypertension should specify the use of appropriate cuffs for home BP measurements in order to avoid any technical bias.

Objective: in patients with uncontrolled systolic hypertension, to estimate the value of home blood pressure monitoring in addition to office blood pressure for inclusion in a trial.Methods: 80 patients with systolic hypertension, defined as SBP >= 140 mmHg and pulse pressure >= 60 mmHg, were treated for 4 weeks with a thiazide diuretic at usual dose (25 mg HCTZ or 1.5 mg indapamide or methyclothiazide 5 mg). Blood pressure was measured using an automatic monitor (Omron M6) at office and at home in the 3 days prior the visit. Subjects with an uncontrolled hypertension were included in the second part of the trial only if there fulfilled inclusion criteria: office SBP 140 mmHg and home SBP >= 135 mmHg (mean of 18 measurements obtained on 3 consecutive days) and office pulse pressure >= 60 mmHg.Results: after 4 weeks with diuretic treatment, 62% of patients fulfilled 3 criteria and were included in the second part of the trial. It was observed 76% of patients with office SBP >= 140 mmHg, 72% with office pulse pressure >= 60 mmHg and 70% with both office SBP and PP criteria. However, only 67% of patients had home SBP >= 135 mmHg. Discrepancy between office and home SBP was observed and subjects with a white coat hypertension was noticed in 14% and masked hypertension in 5%.Conclusion: if patients with systolic hypertension have to be included into a drug trial because there are uncontrolled, home blood pressure monitoring in addition to office blood pressure is a very useful criteria for inclusion because misclassifications due to white coat or masked hypertension is frequent in these patients.

OBJECTIVES To compare home blood pressure values obtained with two validated OMRON (wrist or arm) monitors used sequentially in the same subject. METHODS In 265 hypertensive subjects referred to hypertension specialists, a self measurement of blood pressure was performed sequentially with an OMRON M4-I (arm cuff, A/A, BHS validation) or OMRON RX-I (wrist cuff, B/B, BHS validation). Each patient recorded home blood pressure during two periods of 4 days with 3 measures in the morning and 3 in the evening. Order for use of each monitor was randomised. With wrist devices, subjects were advised to keep the arm at heart level during measurements. BP values were reported on a standardized document. Patients were asked by a questionnaire about the tolerance and feasibility of the 2 methods. RESULTS In this population, aged 59 +/- 14 years, with 60% of men and a mean blood pressure of 152 +/- 21 / 86 +/- 14 mmHg, the home blood pressure values were 143 +/- 20/81 +/- 11 mmHg with the arm monitor and 135 +/- 10 / 80 +/- 11 mmHg with the wrist monitor. Mean SBP adjusted on age, initial blood pressure level and period order was significantly lower when home blood pressure monitoring has been recorded with a wrist monitor as compared to an arm monitor (p < 0.001). Self measurement of blood pressure was felt as easy in 92% with the arm monitor and in 96% with the wrist monitor (p < 0.05). Self measurement of blood pressure was felt as constraining in 14% with the arm monitor and in 7% with the wrist monitor (p < 0.01). The feasibility between the two devices was good with none of the value missing in 86% with the arm monitor and in 85% with the wrist monitor. The missing values were in 56% the fourth day. CONCLUSION Despite the use of two validated monitors, mean SBP is significantly lower when home blood pressure monitoring is recorded with a wrist monitor as compared to an arm monitor. Uncertainty in the arm position with the use of wrist device could explain these results. When advising home blood pressure monitoring, care should be taken to recommend only the use of validated devices and to prefer the use of arm devices in order to avoid the uncertainty of an inadequate utilisation.

OBJECTIVES:To evaluate the characteristics of hypertensive subjects who practise self measurement of blood pressure (SMBP) and their conditions of use, and to identify the properties of subjects using SMBP according the usual guidelines.METHODS:In 531 consecutive hypertensive subjects, referred to hypertension specialists, possessing a SMBP a questionnaire evaluating the condition of use of SMBP was given. Subjects following the guidelines about the use of SMBP have been compared to those using SMBP without specific design of supervision.RESULTS:In this population, aged 62 +/- 14 years, with 57% of men and a mean blood pressure of 147 +/- 23/82 +/- 12 mmHg, the SMBP devices have been bought without medical advice in 50% of cases (265/531). In 45% of cases (239/531), SMBP were made at the wrist. SMBP device was used every days in 26% of cases, every weeks in 27% of cases, every month or more in 22% of cases and only in case of uneasiness in 25% of cases. Blood pressure was measured only in the morning in 25% of cases, in the morning and evening in 31%, only the evening in 8% and at any time of the day in 36% of cases. More frequently 2 BP measurements were realized (47%) and in 19% of cases 3 measurements have been performed. In 15% of cases, the measurements were performed on 3 or 4 days consecutively, more frequently (85%) the measurements were realized without specific design ("once in awhile"). The data of SMBP were noted and showed to the doctor in 34% of cases. Only 12% (64/531) of subjects followed the usual guidelines concerning the use of SMBP (2 or 3 measurements, in the morning and the evening, during 3 or 4 consecutive days). Subjects following the guidelines for SMBP use have a higher SBP at the office than those using SMBP without specific design of supervision (155 +/- 25 mmHg vs 146 +/- 22 mmHg; p<0.01).CONCLUSION:Among hypertensives referred to hypertension specialists most of subjects use SMBP device without a specific design of supervision. Subjects with the most severe hypertension are those who have the best formation for SMBP.

: Monday, June 14, 2004: ORAL SESSIONS: Poster Session 19: Therapeutics and Clinical Pharmacology

Objectives: To evaluate compliance with antihypertensive therapy by a self-report in patients referred to hypertension specialists.Methods: We studied 484 treated hypertensive subjects referred to several hypertension clinics and who were treated since at least one year. Patients were asked to fill in the Compliance Evaluation Test (CET), a questionnaire with 6 questions previously validated to assess factors that could affect medication compliance. We defined patients as "good compliant" when "No" was answered to the 6 items, as "minor noncompliant" when 1 or 2 "Yes" were answered, and as "noncompliant" when 3 or more "Yes" were answered. A good agreement was demonstrated between CET score and compliance evaluated by the number of pills missed during the previous month according to patient interview.Results: We observed 8% of "noncompliant", 53% of "minor noncompliant" and 39% of "good compliant".[GRAPHIC]Logistic regression analysis including age, sex, education level, blood pressure level and the number of antihypertensive tablets confirm the statistical differences observed.Conclusions : In clinical practice, a method of assessing medication compliance is to ask the patient for a self-report interview. We demonstrated that the compliance evaluation test is able to detect factors usually associated with poor compliance (young age, elevated blood pressure, number of tablets per day). The use of the compliance evaluation test may help physicians to face the problem of nonadherence, among their hypertensive patients.

OBJECTIVES:To evaluate compliance with antihypertensive therapy by a self-report in patients referred to hypertension specialists.METHODS:We studied 484 treated hypertensive subjects referred to several hypertension clinics and who were treated since at least one year. Patients were asked to fill in the Compliance Evaluation Test (CET), a questionnaire with 6 questions previously validated to assess factors that could affect medication compliance. We defined patients as "good compliant" when "No" was answered to the 6 items, as "minor noncompliant" when 1 or 2 "Yes" were answered, and as "noncompliant" when 3 or more "Yes" were answered. A good agreement was demonstrated between CET score and compliance evaluated by the number of pills missed during the previous month according to patient interview.RESULTS:We observed 8% of "noncompliant", 53% of "minor noncompliant" and 39% of "good compliant". [table: see text] Logistic regression analysis including age, sex, education level, blood pressure level and the number of antihypertensive tablets confirm the statistical differences observed.CONCLUSIONS:In clinical practice, a method of assessing medication compliance is to ask the patient for a self-report interview. We demonstrated that the compliance evaluation test is able to detect factors usually associated with poor compliance (young age, elevated blood pressure, number of tablets per day). The use of the compliance evaluation test may help physicians to face the problem of nonadherence among their hypertensive patients.