Blood pressure control and cardiovascular outcomes in normal-weight, overweight, and obese hypertensive patients treated with three different antihypertensives in ALLHAT.

Objective: Epidemiologically, there is a strong relationship between BMI and blood pressure (BP) levels. We prospectively examined randomization to first-step chlorthalidone, a thiazide-type diuretic; amlodipine, a calcium-channel blocker; and lisinopril, an angiotensin-converting enzyme inhibitor, on BP control and cardiovascular outcomes in a hypertensive cohort stratified by baseline BMI [kg/m(2); normal weight (BMI <25), overweight (BMI = 25-29.9), and obese (BMI >30)].

Achieved blood pressures in the secondary prevention of small subcortical strokes (SPS3) study: challenges and lessons learned.

Background: Lowering blood pressure (BP) after stroke remains a challenge, even in the context of clinical trials. The Secondary Prevention of Small Subcortical Strokes (SPS3) BP protocol, BP management during the study, and achieved BPs are described here.

Methods: Patients with recent symptomatic lacunar stroke were randomized to 1 of 2 levels of systolic BP (SBP) targets: lower: <130mm Hg, or higher: 130-149mm Hg.

Predictors of lowering SBP to assigned targets at 12 months in the Secondary Prevention of Small Subcortical Strokes study.

Objective: Lowering blood pressure for secondary stroke prevention remains a challenge. These analyses were conducted to identify factors predicting achievement of SBP targets in the Secondary Prevention of Small Subcortical Strokes (SPS3) study.

Methods: SPS3 is a randomized trial assigning patients with lacunar stroke to two targets of SBP control (130-149 mmHg or <130 mmHg).

Discarding the first of three nurse-auscultatory or oscillometric blood pressure measurements does not improve the association of office blood pressure with ABPM.

Objective: Guidelines for office blood pressure (BP) measurements recommend two or more readings at each visit. It has been suggested that discarding the first reading may improve the diagnostic utility of office readings. We compare two methods of office BP measurement to determine whether discarding the first BP affects their association with ambulatory blood pressure monitoring (ABPM) readings.

Diagnosis and management of chronic kidney disease.

As the US population has continued to age, the number of patients with chronic kidney disease (CKD) has dramatically increased. Faced with this increase, clinicians need a better understanding of what an elevated serum creatinine level represents and a simple codified approach to evaluating renal failure. Creatinine, a muscle waste product, has an imperfect but predictable association with the glomerular filtration rate (GFR).

Novel use of Kaplan-Meier methods to explain age and gender differences in hypertension control rates.

Despite 40 years of research demonstrating the efficacy of antihypertensive medications for lowering blood pressure and decreasing cardiovascular disease, hypertension control rates worldwide remain low. We explored here how both medication efficacy rates and patient/physician decision-making (discontinuation rates) affect overall hypertension control rates. To do this we introduced the use of Kaplan-Meier methodology to predict hypertension control rates separately within age strata.

What is adequate hypertension control? Having your dinner and dessert too.

Now that many options for treating hypertension are available and the studies of their use have proliferated, selecting a specific antihypertensive agent for a specific condition often receives an inordinate amount of attention from physicians. Controlling the blood pressure per se should be our primary concern ("dinner"), while choosing agents that may have added benefit in specific situations is secondary ("dessert").

Reliability and validity of blood pressure measurement in the Secondary Prevention of Small Subcortical Strokes study.

Rationale: The Secondary Prevention of Small Subcortical Strokes study is a multicenter, international trial funded by the National Institutes of Health testing the role of lowering systolic blood pressure to <130 mmHg in the prevention of stroke recurrence and cognitive decline in patients with recent symptomatic small subcortical stroke. Reliable and unbiased blood pressure measurement is critical to successful completion of the trial.

Methods: We looked at the reliability and validity of both the device used for blood pressure measurement and observer performance during measurement to assess the quality of blood pressure determination in the study.

The occurrence of the alerting response is independent of the method of blood pressure measurement in hypertensive patients.

Objective: Current guidelines stress the need for more than one measurement of blood pressure in the hypertensive patient. The frequency with which the first blood pressure significantly exceeds subsequent blood pressures (alerting response) is unknown. Participants in a hypertension treatment trial before initiation of therapy were included in post-hoc analyses to investigate the alerting response separately for trained nurse blood pressure measurements with mercury sphygmomanometer and measurements taken by an Omron 705 CP automated device.

Utility of ambulatory blood pressure monitoring in children and adolescents.

Diagnosis of hypertension is critically dependent on accurate blood pressure measurement. "Accurate" refers to carefully following the guidelines for blood pressure measurement laid out for children and adults to minimize observer and subject errors that commonly occur in clinical blood pressure measurement. Accurate blood pressure measurement is more important in children and adolescents as the misdiagnosis of hypertension may have a life-long adverse impact on insurability and employment.

The impact of observer and patient factors on the occurrence of digit preference for zero in blood pressure measurement in a hypertension specialty clinic: evidence for the need of continued observation.

Background: Many investigators have reported unconscious over-reporting of the terminal digit zero but little literature exists on observer or patient-related factors that may predict the occurrence. This study analyzes the occurrence of zero preference in 52,827 blood pressure (BP) measurements in 8513 patients by 11 hypertension nurse specialists in the Hypertension Division at Mayo Clinic, Rochester, Minnesota.

Methods: Data from the electronic database of the Hypertension Division from April 1997 to September 2001 were analyzed for the occurrence of zero preference.

The trained observer better predicts daytime ABPM diastolic blood pressure in hypertensive patients than does an automated (Omron) device.

Objectives: Accurate blood pressure measurement is critical to successful clinical trials. Concerns about observer errors have led to the use of automated oscillometric devices without evidence that their performance is similar to that of trained observers. This study compares blood pressures obtained by trained observers and with an oscillometric device (Omron 705CP) to 24-h ambulatory blood pressure monitoring.

Limited (6-h) ambulatory blood pressure monitoring is a valid replacement for the office blood pressure by trained nurse clinician in the diagnosis of hypertension.

Objective: To assess the ability of limited ambulatory blood pressure monitoring as a valid replacement for office blood pressure measurement done to American Heart Association criteria in diagnosing hypertension.

Methods: In all, 105 adults, who had been referred for limited ambulatory blood pressure monitoring, participated in the study. Limited ambulatory blood pressure monitoring consisted of 6 h of blood pressure measurement while ambulatory at the Mayo Clinic, using a SpaceLabs 90207 (SpaceLabs Medical, Issaquah, Washington, USA) collecting six readings per hour for the period of observation.

A survey of validated automated home blood pressure monitors available for the Internet shopper.

Objective: Self-measurement of blood pressure using an automated home blood pressure monitoring (AHBPM) is increasingly used in hypertension management. Internet commerce increases dramatically each year. This study looked to identify the availability of validity of AHBPM and the correct cuff size to go with the AHBPM.

Does evidence-based medicine suggest that physicians should not be measuring blood pressure in the hypertensive patient?

The most common reason for an outpatient physician visit is for the diagnosis and treatment of hypertension. The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) VII, which is increasingly evidence-based, advises the clinician to use studies of the mean response and benefit derived from reduction in blood pressure (BP) from antihypertensive therapy and to translate this data into recommendations for the individual hypertensive patient. We believe that the increasingly aggressive approach to hypertension mandated by JNC VII calls into question the use of physician-measured BP.

The Accoson Greenlight 300, the first non-automated mercury-free blood pressure measurement device to pass the International Protocol for blood pressure measuring devices in adults.

Background: Accurate blood pressure measurement is critical to successful care of the hypertensive patient. The mercury manometer is rapidly being removed from clinical practice due to concerns about environmental contamination. The Accoson Greenlight 300 device is the first non-automated mercury-free device for auscultatory blood pressure measurement to pass the International Protocol for validation of blood pressure measuring devices in adults.

The changing distribution of arm circumferences in NHANES III and NHANES 2000 and its impact on the utility of the 'standard adult' blood pressure cuff.

Background: Accurate blood pressure measurement is dependent on using a blood pressure cuff that is appropriate to the patient's arm circumference.

Objective: This study identifies the change in distribution of arm circumferences in the United States and its impact on usage of the 'standard adult' cuff.

Method: The most current National Health and Nutritional Examination Survey (NHANES) data, available on the website (http://www.