Home and clinic blood pressure responses in elderly individuals with systolic hypertension

William C. Cushman; Daniel A. Duprez; Howard S. Weintraub; Das Purkayastha; Dion Zappe; Rita Samuel; Joseph L. Izzo

doi:10.1016/j.jash.2012.03.001

Home and clinic blood pressure responses in elderly individuals with systolic hypertension

William C. Cushman, Daniel A. Duprez, Howard S. Weintraub, Das Purkayastha, Dion Zappe, Rita Samuel, Joseph L. Izzo

Medicine - Cardiology Division

Research output: Contribution to journal › Article › peer-review

4 Scopus citations

Abstract

Home blood pressure (BP) monitoring may enhance assessment of BP control. In this 16-week study, men and women 70 years or older with systolic BP between 150 and 200 mm Hg were randomized to receive valsartan/hydrochlorothiazide (V/HCTZ) 160/12.5 mg (n = 128), HCTZ 12.5 mg (n = 128), or V 160 mg (n = 128) for 4 weeks. Participants whose BP was 140/90 mm Hg or higher at weeks 4, 8, or 12 were uptitrated to a maximum of V/HCTZ 320/25 mg. Participants were evaluated by home BP monitoring using an automated device weekly before taking daily study medication (n = 301). Baseline BP ± SD for clinic (165.5 ± 11.8/85.1 ± 9.5 mm Hg) was approximately 3/1 mm Hg greater than home readings (162.5 ± 15.8/84.3 ± 10.2 mm Hg). Reductions in BP ± SEM at week 4 were similar for clinic (12.6 ± 1.0/4.7 ± 0.5 mm Hg) and home (10.9 ± 1.1/3.8 ± 0.5 mm Hg) readings (P = .25/P = .23; clinic versus home); differences between V/HCTZ and HCTZ or V were also similar for both home and clinic readings and results by either technique correlated significantly (P < .0001). Home BP measurements confirm that treatment initiated with V/HCTZ versus monotherapy resulted in greater antihypertensive efficacy. Home BP monitoring, if done with proper technique, provides a reliable indicator of BP control in elderly patients and may help guide drug dosing and titration.

Original language	English (US)
Pages (from-to)	210-218
Number of pages	9
Journal	Journal of the American Society of Hypertension
Volume	6
Issue number	3
DOIs	https://doi.org/10.1016/j.jash.2012.03.001
State	Published - 2012

Bibliographical note

Funding Information:
Funding/support: This study was funded by Novartis Pharmaceuticals Corporation , East Hanover, New Jersey, USA. Editorial assistance from Oxford PharmaGenesis was funded by Novartis Pharmaceuticals Corporation . The authors express their appreciation to Colleen Faller of Novartis Pharmaceuticals Corporation for expert assistance in project management ( ClinicalTrials.gov identifier: NCT00698646 ).

Funding Information:
Conflict of interest: W.C.C.: Consultancies at Takeda, Merck, Daiichi-Sankyo, Omron; grant support from Merck; stock ownership/financial interests: none. D.A.D.: Speakers’ Bureau at Novartis Pharmaceuticals Corporation, Forest, Pfizer, Merck; advisory boards at Novartis Pharmaceuticals Corporation, Pfizer, Abbott; grant support from Novartis Pharmaceuticals Corporation, Roche; stock ownership/financial interests: none. H.S.W.: consultancies at Gilead; Speakers’ Bureau at Novartis Pharmaceuticals Corporation, Daiichi-Sankyo, Takeda, AstraZeneca, Gilead, Abbott, Kowa; grant support: none; stock ownership/financial interests: none. D.P., D.Z., and R.S. are employees of Novartis Pharmaceuticals Corporation. J.L.I.: Consultancies at Boehringer-Ingelheim, Forest Laboratories, Novartis Pharmaceuticals Corporation, Daiichi-Sankyo, Takeda; grant support from GlaxoSmithKline, Novartis Pharmaceuticals Corporation; stock ownership/financial interests: none.

Keywords

Hydrochlorothiazide
blood pressures monitoring technique
randomized controlled trial
valsartan

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title = "Home and clinic blood pressure responses in elderly individuals with systolic hypertension",

abstract = "Home blood pressure (BP) monitoring may enhance assessment of BP control. In this 16-week study, men and women 70 years or older with systolic BP between 150 and 200 mm Hg were randomized to receive valsartan/hydrochlorothiazide (V/HCTZ) 160/12.5 mg (n = 128), HCTZ 12.5 mg (n = 128), or V 160 mg (n = 128) for 4 weeks. Participants whose BP was 140/90 mm Hg or higher at weeks 4, 8, or 12 were uptitrated to a maximum of V/HCTZ 320/25 mg. Participants were evaluated by home BP monitoring using an automated device weekly before taking daily study medication (n = 301). Baseline BP ± SD for clinic (165.5 ± 11.8/85.1 ± 9.5 mm Hg) was approximately 3/1 mm Hg greater than home readings (162.5 ± 15.8/84.3 ± 10.2 mm Hg). Reductions in BP ± SEM at week 4 were similar for clinic (12.6 ± 1.0/4.7 ± 0.5 mm Hg) and home (10.9 ± 1.1/3.8 ± 0.5 mm Hg) readings (P = .25/P = .23; clinic versus home); differences between V/HCTZ and HCTZ or V were also similar for both home and clinic readings and results by either technique correlated significantly (P < .0001). Home BP measurements confirm that treatment initiated with V/HCTZ versus monotherapy resulted in greater antihypertensive efficacy. Home BP monitoring, if done with proper technique, provides a reliable indicator of BP control in elderly patients and may help guide drug dosing and titration.",

keywords = "Hydrochlorothiazide, blood pressures monitoring technique, randomized controlled trial, valsartan",

author = "Cushman, {William C.} and Duprez, {Daniel A.} and Weintraub, {Howard S.} and Das Purkayastha and Dion Zappe and Rita Samuel and Izzo, {Joseph L.}",

note = "Funding Information: Funding/support: This study was funded by Novartis Pharmaceuticals Corporation , East Hanover, New Jersey, USA. Editorial assistance from Oxford PharmaGenesis was funded by Novartis Pharmaceuticals Corporation . The authors express their appreciation to Colleen Faller of Novartis Pharmaceuticals Corporation for expert assistance in project management ( ClinicalTrials.gov identifier: NCT00698646 ). Funding Information: Conflict of interest: W.C.C.: Consultancies at Takeda, Merck, Daiichi-Sankyo, Omron; grant support from Merck; stock ownership/financial interests: none. D.A.D.: Speakers{\textquoteright} Bureau at Novartis Pharmaceuticals Corporation, Forest, Pfizer, Merck; advisory boards at Novartis Pharmaceuticals Corporation, Pfizer, Abbott; grant support from Novartis Pharmaceuticals Corporation, Roche; stock ownership/financial interests: none. H.S.W.: consultancies at Gilead; Speakers{\textquoteright} Bureau at Novartis Pharmaceuticals Corporation, Daiichi-Sankyo, Takeda, AstraZeneca, Gilead, Abbott, Kowa; grant support: none; stock ownership/financial interests: none. D.P., D.Z., and R.S. are employees of Novartis Pharmaceuticals Corporation. J.L.I.: Consultancies at Boehringer-Ingelheim, Forest Laboratories, Novartis Pharmaceuticals Corporation, Daiichi-Sankyo, Takeda; grant support from GlaxoSmithKline, Novartis Pharmaceuticals Corporation; stock ownership/financial interests: none. ",

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AU - Duprez, Daniel A.

AU - Weintraub, Howard S.

AU - Purkayastha, Das

AU - Zappe, Dion

AU - Samuel, Rita

AU - Izzo, Joseph L.

N1 - Funding Information: Funding/support: This study was funded by Novartis Pharmaceuticals Corporation , East Hanover, New Jersey, USA. Editorial assistance from Oxford PharmaGenesis was funded by Novartis Pharmaceuticals Corporation . The authors express their appreciation to Colleen Faller of Novartis Pharmaceuticals Corporation for expert assistance in project management ( ClinicalTrials.gov identifier: NCT00698646 ). Funding Information: Conflict of interest: W.C.C.: Consultancies at Takeda, Merck, Daiichi-Sankyo, Omron; grant support from Merck; stock ownership/financial interests: none. D.A.D.: Speakers’ Bureau at Novartis Pharmaceuticals Corporation, Forest, Pfizer, Merck; advisory boards at Novartis Pharmaceuticals Corporation, Pfizer, Abbott; grant support from Novartis Pharmaceuticals Corporation, Roche; stock ownership/financial interests: none. H.S.W.: consultancies at Gilead; Speakers’ Bureau at Novartis Pharmaceuticals Corporation, Daiichi-Sankyo, Takeda, AstraZeneca, Gilead, Abbott, Kowa; grant support: none; stock ownership/financial interests: none. D.P., D.Z., and R.S. are employees of Novartis Pharmaceuticals Corporation. J.L.I.: Consultancies at Boehringer-Ingelheim, Forest Laboratories, Novartis Pharmaceuticals Corporation, Daiichi-Sankyo, Takeda; grant support from GlaxoSmithKline, Novartis Pharmaceuticals Corporation; stock ownership/financial interests: none.

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N2 - Home blood pressure (BP) monitoring may enhance assessment of BP control. In this 16-week study, men and women 70 years or older with systolic BP between 150 and 200 mm Hg were randomized to receive valsartan/hydrochlorothiazide (V/HCTZ) 160/12.5 mg (n = 128), HCTZ 12.5 mg (n = 128), or V 160 mg (n = 128) for 4 weeks. Participants whose BP was 140/90 mm Hg or higher at weeks 4, 8, or 12 were uptitrated to a maximum of V/HCTZ 320/25 mg. Participants were evaluated by home BP monitoring using an automated device weekly before taking daily study medication (n = 301). Baseline BP ± SD for clinic (165.5 ± 11.8/85.1 ± 9.5 mm Hg) was approximately 3/1 mm Hg greater than home readings (162.5 ± 15.8/84.3 ± 10.2 mm Hg). Reductions in BP ± SEM at week 4 were similar for clinic (12.6 ± 1.0/4.7 ± 0.5 mm Hg) and home (10.9 ± 1.1/3.8 ± 0.5 mm Hg) readings (P = .25/P = .23; clinic versus home); differences between V/HCTZ and HCTZ or V were also similar for both home and clinic readings and results by either technique correlated significantly (P < .0001). Home BP measurements confirm that treatment initiated with V/HCTZ versus monotherapy resulted in greater antihypertensive efficacy. Home BP monitoring, if done with proper technique, provides a reliable indicator of BP control in elderly patients and may help guide drug dosing and titration.

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Home and clinic blood pressure responses in elderly individuals with systolic hypertension

Abstract

Bibliographical note

Keywords

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