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Barbosa ECD, Farina GS, Basso CS, Camafort M, Coca A, Nadruz W. Seasonal variation in blood pressure: what is still missing? Front Cardiovasc Med 2023; 10:1233325. [PMID: 37663410 PMCID: PMC10469506 DOI: 10.3389/fcvm.2023.1233325] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/01/2023] [Indexed: 09/05/2023] Open
Abstract
Seasonal variation of blood pressure (BP) is a topic in cardiology that has gained more attention throughout the years. Although it is extensively documented that BP increases in seasons coupled with lower temperatures, there are still many gaps in this knowledge field that need to be explored. Notably, seasonal variation of BP phenotypes, such as masked and white coat hypertension, and the impact of air pollution, latitude, and altitude on seasonal variation of BP are still poorly described in the literature, and the levels of the existing evidence are low. Therefore, further investigations on these topics are needed to provide robust evidence that can be used in clinical practice.
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Affiliation(s)
- Eduardo Costa Duarte Barbosa
- Hypertension Leagueof Porto Alegre, Porto Alegre, Brazil
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, Campinas, Brazil
- Department of Hypertension and Cardiometabolism, São Francisco Hospital, Santa Casa de Misericórdia de Porto Alegre, Feevale University, Porto Alegre, Brazil
| | - Giovani Schulte Farina
- Hypertension Leagueof Porto Alegre, Porto Alegre, Brazil
- Center for Clinical Research and Management Education, Division of Health Care Sciences, Dresden International University, Dresden, Germany
| | - Carolina Souza Basso
- Hypertension Leagueof Porto Alegre, Porto Alegre, Brazil
- School of Medicine, Lutheran University of Brazil, Canoas, Brazil
| | - Miguel Camafort
- Hypertension and Vascular Risk Unit, Hospital Clínic (IDIBAPS), Department of Internal Medicine, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Hospital Clínic (IDIBAPS), Department of Internal Medicine, University of Barcelona, Barcelona, Spain
| | - Wilson Nadruz
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, Campinas, Brazil
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Alves MAM, Feitosa ADM, Mota-Gomes MA, Paiva AMG, Barroso WS, Miranda RD, Barbosa ECD, Brandão AA, Diniz PGS, Berwanger O, Lima-Filho JL, Sposito AC, Coca A, Nadruz W. Accuracy of screening strategies for masked hypertension: a large-scale nationwide study based on home blood pressure monitoring. Hypertens Res 2023; 46:742-750. [PMID: 36380200 DOI: 10.1038/s41440-022-01103-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/26/2022] [Accepted: 10/30/2022] [Indexed: 11/16/2022]
Abstract
This study compared the ability of guideline-proposed office blood pressure (OBP) screening thresholds [European Society of Hypertension (ESH) guidelines: 130/85 mmHg for individuals with an OBP < 140/90 mmHg; American College of Cardiology/American Heart Association (ACC/AHA) guidelines: 120/75 mmHg for individuals with an OBP < 130/80 mmHg] and novel screening scores to identify normotensive individuals at high risk of having masked hypertension (MH) in an office setting. We cross-sectionally evaluated untreated participants with an OBP < 140/90 mmHg (n = 22,266) and an OBP < 130/80 mmHg (n = 10,005) who underwent home blood pressure monitoring (HBPM) (derivation cohort) from 686 Brazilian sites. MH was defined according to criteria suggested by the ESH (OBP < 140/90 mmHg; HBPM ≥ 135/85 mmHg), Brazilian Society of Cardiology (BSC) (OBP < 140/90 mmHg; HBPM ≥ 130/80 mmHg) and ACC/AHA (OBP < 130/80 mmHg; HBPM ≥ 130/80 mmHg). Scores were generated from multivariable logistic regression coefficients between MH and clinical variables (OBP, age, sex, and BMI). Considering the ESH, BSC, and ACC/AHA criteria, 17.2%, 38.5%, and 21.2% of the participants had MH, respectively. Guideline-proposed OBP screening thresholds yielded area under curve (AUC) values of 0.640 (for ESH criteria), 0.641 (for BSC criteria), and 0.619 (for ACC/AHA criteria) for predicting MH, while scores presented as continuous variables or quartiles yielded AUC values of 0.700 and 0.688 (for ESH criteria), 0.720 and 0.709 (for BSC criteria), and 0.671 and 0.661 (for ACC/AHA criteria), respectively. Further analyses performed with alternative untreated participants (validation cohort; n = 2807 with an OBP < 140/90 mmHg; n = 1269 with an OBP < 130/80 mmHg) yielded similar AUC values. In conclusion, the accuracy of guideline-proposed OBP screening thresholds in identifying individuals at high risk of having MH in an office setting is limited and is inferior to that yielded by scores derived from simple clinical variables.
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Affiliation(s)
- Marco A M Alves
- Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, PE, Brazil
| | - Audes D M Feitosa
- Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, PE, Brazil.,Pronto Socorro Cardiológico de Pernambuco (PROCAPE), University of Pernambuco, Recife, PE, Brazil.,UNICAP Clinical Research Institute, Recife, PE, Brazil
| | | | | | - Weimar S Barroso
- Hypertension League, Cardiovascular Section, Federal University of Goiás, Goiânia, GO, Brazil
| | - Roberto D Miranda
- Cardiovascular Section, Geriatrics Division, Paulista School of Medicine, Federal University of São Paulo, São Paulo, SP, Brazil.,Hospital Israelita Albert Eistein, São Paulo, SP, Brazil
| | - Eduardo C D Barbosa
- Department of Hypertension and Cardiometabolism, São Francisco Hospital - Santa Casa de Porto Alegre, Porto Alegre, Brazil
| | - Andréa A Brandão
- School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Paulo G S Diniz
- Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, PE, Brazil
| | - Otavio Berwanger
- Academic Research Organization (ARO), Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - José L Lima-Filho
- Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, PE, Brazil
| | - Andrei C Sposito
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, SP Paulo, Brazil
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Wilson Nadruz
- Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, PE, Brazil. .,Department of Internal Medicine, School of Medical Sciences, State University of Campinas, SP Paulo, Brazil.
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Brandão AA, Barroso WKS, Feitosa A, Barbosa ECD, Miranda RD, Vitorino PVDO, Pozzan R, Ribeiro LP, Epelman A, Saraiva GA, Silveira FS, Braga AA, Gomes MM. Home Blood Pressure Monitoring and Blood Pressure Control in Treated Hypertensives. Arq Bras Cardiol 2022; 119:353-357. [PMID: 35946699 PMCID: PMC9363073 DOI: 10.36660/abc.20220038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 05/11/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
| | | | | | | | - Roberto Dischinger Miranda
- Universidade Federal de São Paulo, São Paulo, SP - Brasil.,Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
| | | | - Roberto Pozzan
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ - Brasil
| | | | | | - Giovanni Alves Saraiva
- Prevencor, Recife, PE - Brasil.,Imedi, Recife, PE - Brasil.,Icordis, Recife, PE - Brasil
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Feitosa FGAM, Feitosa ADM, Paiva AMG, Mota-Gomes MA, Barroso WS, Miranda RD, Barbosa ECD, Brandão AA, Lima-Filho JL, Sposito AC, Coca A, Nadruz W. Impact of the COVID-19 pandemic on blood pressure control: a nationwide home blood pressure monitoring study. Hypertens Res 2021; 45:364-368. [PMID: 34857897 PMCID: PMC8636576 DOI: 10.1038/s41440-021-00784-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/15/2021] [Accepted: 09/30/2021] [Indexed: 01/08/2023]
Abstract
There are concerns that hypertension control may decrease during the COVID-19 pandemic. This study evaluated the impact of the COVID-19 pandemic on office blood pressure (OBP) and home blood pressure monitoring (HBPM) control in a large Brazilian nationwide sample. The results of an adjusted spline analysis evaluating the trajectory of OBP and HBPM control from 01/Jan/2019 to 31/Dec/2020 among independent participants who were untreated (n = 24,227) or treated (n = 27,699) with antihypertensive medications showed a modest and transient improvement in OBP control among treated individuals, which was restricted to the early months following the COVID-19 pandemic outbreak. Furthermore, slight reductions in OBP and HBPM values were detected in the early months following the COVID-19 pandemic outbreak among treated (n = 987) participants for whom blood pressure measurements before and during the pandemic were available, but not among untreated (n = 495) participants. In conclusion, we found no major adverse influence of the COVID-19 pandemic on OBP and HBPM control in a large nationwide sample.
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Affiliation(s)
- Fabiana G A M Feitosa
- Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, PE, Brazil.,Pronto Socorro Cardiológico de Pernambuco (PROCAPE), University of Pernambuco, Recife, PE, Brazil.,University Hospital Oswaldo Cruz, University of Pernambuco, Recife, PE, Brazil
| | - Audes D M Feitosa
- Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, PE, Brazil.,Pronto Socorro Cardiológico de Pernambuco (PROCAPE), University of Pernambuco, Recife, PE, Brazil.,UNICAP Clinical Research Institute, Recife, PE, Brazil
| | | | | | - Weimar S Barroso
- Hypertension League, Federal University of Goiás, Goiânia, GO, Brazil
| | - Roberto D Miranda
- Cardiovascular Section, Geriatrics Division, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Eduardo C D Barbosa
- Department of Hypertension and Cardiometabolism, São Francisco Hospital - Santa Casa de Porto Alegre, Porto Alegre, Brazil
| | - Andréa A Brandão
- School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - José L Lima-Filho
- Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, PE, Brazil
| | - Andrei C Sposito
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, SP Paulo, Brazil
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Wilson Nadruz
- Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, PE, Brazil. .,Department of Internal Medicine, School of Medical Sciences, State University of Campinas, SP Paulo, Brazil.
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