HYPERTENSION WATCH

Pharmacy Times, Volume 0, 0

AM Surge Detection MayHelp Diabetes

Patients with type 2 diabetes who have consistent elevatedblood pressure (BP) in the morning are more prone to kidneydisease, eye disease, heart disease, and stroke. In the study, theresearchers examined 170 patients with diabetes to determinehow well regular home BP predicted complications related totheir disease, compared with BP readings taken at a clinic.

The findings, reported in Diabetes Care (December 2002),showed no major differences in the occurrence of diseasesamong patients whose BP measured high at the clinic. Patientswhose morning readings revealed higher BP were more proneto have diabetes-linked complications and heart disease, however.The findings underscore the need for patients with diabetesto monitor their BP at home. For more information onmorning hypertension, visit www.morningbp.com/pt3.

Home Monitoring Improves BP

An analysis of 18 blood pressure (BP) monitoring studiesfound that individuals who monitor their BP at homehave better control over their condition. The findings,presented at the 14th European Society of Hypertensionmeeting (June 2004), included 1359 patients who monitoredtheir BP at home and 1355 patients who had theirBP monitored by clinicians. The researchers discoveredthat BP was lower in patients who conducted homemonitoring, compared with patients seen in the healthcare system. They found that home BP monitoring wasassociated with better BP values and improved controlof hypertension, compared with traditional BP monitoringin clinics.

The researchers concluded that home BP monitoringwill help to involve patients in the management of theirown BP and help to determine if they are at risk formorning hypertension. For more information on morninghypertension, visit www.morningbp.com/pt6.

Early BP Problems May Leadto Heart Trouble

A study of young individuals in 13 American Indian communitieswith high blood pressure (BP) showed that they are at risk ofhaving an abnormally large heart. Of the participants, 294 hadhypertension and 675 had prehypertension.

A diagnosis of hypertension or prehypertension was associatedwith a greater risk of having changes in the heart structureassociated with increased heart risk, including a higher rate ofleft ventricular hypertrophy. The frequency of left ventricularhypertrophy was 3 times higher among the hypertension groupand 2 times higher among the prehypertension group, accordingto the findings reported in Circulation (January 16, 2007).

The findings emphasized the need for increased preventivemeasures, and regular home monitoring of BP. For more informationon morning hypertension, visit www.morningbp.com/pt5.

Caution: Morning BP May ImpactStroke Risk

During the first few hours of the morning, patients with high bloodpressure (BP) may experience morning hypertension. This morningsurge puts patients at risk for stroke.

In an editorial in the March 18, 2003, issue of Circulation, NormanKaplan, MD, summarizes Kazoumi Kario, MD, PhD, and colleagues'findings, which indicated that early morning hypertension increasedthe risk of stroke in seniors with high BP. For the study, 519 seniorswere studied with ambulatory BP monitoring. During 41 months offollow-up, 44 strokes were reported.

The study found that patients with the highest early morning BP(within 2 hours of rising) had a greater risk of multiple silent infarctsat baseline magnetic resonance imaging (57% vs 33%), and almost a3-fold higher stroke incidence during follow-up (19% vs 7.3%). Thefindings reiterate the need for hypertensive patients to learn how tomonitor their BP at home to help prevent stroke and other cardiovascularevents. For more information on morning hypertension, visitwww.morningbp.com/pt4.

Self-monitoring Can Guide BP Treatment

Blood pressure (BP) measured at home is as precise as 24-hour ambulatory monitoring, so either can be used to modifymedication taken to lower BP, according to findings reported inthe American Journal of Hypertension (May 2006).

For the study, 98 patients with untreated hypertension wererandomly assigned to routine home monitoring or ambulatorymonitoring.At 6-week periods, average home BP measurementor one 24-hour period of ambulatory monitoring was used toadjust their antihypertensive treatment. The researchersreported that, during 6 months of follow-up, BP decreased considerablyin both groups, and the changes were not dramaticallydifferent between the 2 methods.

Lead researcher Teemu J. Niiranen commented that "homeblood pressure measurement can be used effectively for guidingantihypertensive treatment."In an accompanying editorial,George S. Stergiou, MD, added that the home approach "ismore convenient and better accepted by the patients for long-termuse and also less costly, compared to ambulatory monitoring."For more information on morning hypertension, visitwww.morningbp.com/pt7.