Key result
Nurse-elicited isolated increases in in-office SBP were associated with target organ changes independent of ambulatory BP.
Why the study?
Does nurse-derived isolated in-office blood pressure increase correlate with target organ damage independent of ambulatory blood pressure in a community sample?
Observational (n=750)
Does nurse-derived isolated in-office blood pressure increase correlate with target organ damage independent of ambulatory blood pressure in a community sample?
Isolated increases in nurse-derived in-office blood pressure are significantly associated with target organ damage independent of ambulatory blood pressure.
Answers are grounded in this paper and cite their sources.
Should not yet change office BP assessment practices; leaves open whether nurse-elicited isolated SBP rises merit targeted interventions.
AIMS: We determined the extent to which relationships between nurse-derived blood pressures (BPs) and cardiovascular damage may be attributed to isolated increases in in-office SBP independent of ambulatory BP. METHODS: In 750 participants from a community sample, nurse-derived office BP, ambulatory BP, carotid-femoral pulse wave velocity (PWV; applanation tonometry and SphygmoCor software; n=662), and left ventricular mass indexed to height (LVMI; echocardiography; n=463) were determined. RESULTS: Nurse-derived office BP was associated with organ changes independent of 24-h BP (LVMI; partial r=0.15, P<0.005, PWV; partial r=0.21, P<0.0001) and day BP. However, in both unadjusted (P<0.0001 for both) and multivariate adjusted models (including adjustments for 24-h BP; LVMI; partial r=0.14, P<0.01, PWV; partial r=0.21, P<0.0001), nurse office-day SBP (an index of isolated increases in in-office BP) was associated with target organ changes independent of ambulatory BP and additional confounders, with the highest quartile (≥15 mmHg) showing the most marked increases in LVMI (P<0.0005) and PWV (P<0.0001) as compared to the lowest quartile (<-5 mmHg). These relationships were reproduced in those with normotensive day BP values and the quantitative effect of nurse office-day BP on target organ changes was at least equivalent to that of ambulatory BP. CONCLUSION: Nurse-elicited isolated increases in in-office BP account for a significant proportion of the relationship between nurse-derived BP and target organ changes independent of ambulatory BP. Therefore, high quality nurse-derived BP measurements do not approximate the impact of BP effects per se on cardiovascular damage.
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Maseko et al. (2013) conducted an observational in Cardiovascular damage (n=750). Nurse-elicited isolated increases in in-office systolic blood pressure vs. Lowest quartile of nurse office-day SBP (<-5 mmHg) was evaluated on Target organ changes (left ventricular mass indexed to height [LVMI] and carotid-femoral pulse wave velocity [PWV]) (partial r=0.14 for LVMI; partial r=0.21 for PWV, p=P<0.01 for LVMI; P<0.0001 for PWV). Nurse-elicited isolated increases in in-office SBP were associated with target organ changes independent of ambulatory BP.
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