Hypertension, Blood Pressure Monitoring, Ambulatory, Primary Health Care
Conditions
Brief summary
High blood pressure (HBP) is a major modifiable cardiovascular risk factor which prevalence is gradually increasing. Reducing blood pressure (BP) significantly decreases cardiovascular morbi-mortality. Nevertheless, BP control remains insufficient: only 51% of French patients using antihypertensive drugs achieve the BP control targets. HBP is mostly diagnosed and managed in primary care. Nevertheless, office BP measurements are unreliable for BP control and poorer predict target organ damage. Ambulatory BP measurements are recommended for HBP diagnosis and follow-up. 24-hour ambulatory blood pressure monitoring (ABPM) is the most cost-effective strategy. Its superiority has been demonstrated for HBP diagnosis and cardiovascular prognosis. In France, ABPM is poorly available and little studied in primary care. Therefore, the investigators conducted a regional prospective study to analyze the feasibility and benefits of ABPM among primary care hypertensive patients in daily practice.
Interventions
Sponsors
Association pour le Développement de la Recherche en Médecine Générale (ADRMG)
Département de Médecine Générale de Dijon (DMG)
University of Burgundy
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* patients aged over 18 years * with an office inclusion consultation systolic/diastolic BP≥ 140/90 mmHg * able to understand French language and to consent to participate in the study
Exclusion criteria
* patients aged \< 18 years * with conditions preventing technically adequate ABPM (chronic atrial fibrillation) * with contraindications to ABPM (musculotendinous disease of the upper limb, past history of phlebitis of the upper limb or phlebitis in progress, past history of olecranon bursitis or bursitis in progress) * with previous ABPM in the 12 months prior to the inclusion consultation * pregnant or lactating women
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Prevalence of white-coat hypertension | at the time of ABPM, up to 30 days after the inclusion consultation | Proportion of patients with normotension in ABPM (daytime systolic/diastolic BP\< 135/85 mmHg AND/OR nighttime BP\< 120/70 mmHg AND/OR 24-hour BP\< 130/80 mmHg) among the patients with primary care office measured BP≥ 140/90 mmHg |
| Prevalence of nocturnal hypertension | at the time of ABPM, up to 30 days after the inclusion consultation | Proportion of patients with nocturnal high blood pressure in ABPM (nighttime systolic/diastolic BP\> 120/70 mmHg) among the patients with primary care office measured BP≥ 140/90 mmHg |
| Prevalence of diurnal hypertension | at the time of ABPM, up to 30 days after the inclusion consultation | Proportion of patients with diurnal high blood pressure in ABPM (daytime systolic/diastolic BP\> 135/85 mmHg) among the patients with primary care office measured BP≥ 140/90 mmHg |
| Prevalence of 24-hour hypertension | at the time of ABPM, up to 30 days after the inclusion consultation | Proportion of patients with 24-hour high blood pressure in ABPM (24-hour systolic/diastolic BP\> 130/80 mmHg) among the patients with primary care office measured BP≥ 140/90 mmHg |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Dipping | at the time of ABPM, up to 30 days after the inclusion consultation | Proportion of nighttime mean BP fall, compared to daytime mean BP |
| Deprivation among hypertensive patients | at the time of ABPM, up to 30 days after the inclusion consultation | Deprivation status of hypertensive primary care patients, according to the French Assessment of deprivation in Health Examination Centers' (EPICES) score (deprivation if EPICES score\> 30) |
| ABPM acceptability | at the time of ABPM, up to 30 days after the inclusion consultation | Number of patients who have undergone/completed the ABPM |
| ABPM validity | at the time of ABPM, up to 30 days after the inclusion consultation | Number of patients who have had an invalid ABPM according to the criteria of the European society of cardiology |
| ABPM side effects | at the time of ABPM, up to 30 days after the inclusion consultation | Number of major side effects |
Countries
France
Outcome results
None listed