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Blood pressure control in anticoagulated hypertensive patients
Feza Guzet1, Atilla Bitigen, Can Yücel Karabay
1aDepartment of Cardiology, Istanbul Surp Pırgic Armenian Foundation Hospital bDepartment of Cardiology, Medikalpark Fatih Hospital Affiliation of İstanbul Kemerburgaz University cDepartment Cardiology, Süreyyapaşa Chest and Chest Surgery Center, Istanbul, Turkey.
Insights
Office blood pressure (BP) measurements may overestimate BP control in anticoagulated patients. Ambulatory blood pressure monitoring (ABPM) is crucial for accurate BP assessment and preventing complications like intracranial bleeding.
Area of Science:
- Cardiology
- Hypertension Management
- Clinical Trials
Background:
- Anticoagulated patients with hypertension require precise blood pressure (BP) monitoring.
- Office BP measurements may not accurately reflect true BP control in this population.
- Atrial fibrillation necessitates warfarin therapy, increasing bleeding risks if BP is poorly controlled.
Purpose of the Study:
- To compare office BP measurements with 24-hour ambulatory blood pressure monitoring (ABPM).
- To determine the accuracy of office BP in assessing optimal BP control in hypertensive anticoagulated patients.
- To evaluate the predictive values of office BP versus ABPM for cardiovascular outcomes.
Main Methods:
- Seventy-eight hypertensive patients on warfarin and antihypertensive drugs were enrolled.
- 24-hour ABPM was performed on all participants.
- Office BP measurements were compared with ABPM, categorizing patients into 'good' and 'poor' control groups based on systolic BP (SBP) thresholds.
Main Results:
- Office BP classified 56.9% as 'good control,' but ABPM revealed significant discrepancies.
- Based on ABPM, 'true good control' was observed in only 25.5% (daytime) and 19.6% (night-time) of patients.
- Office BP measurements showed low sensitivity and specificity when compared to ABPM, particularly for daytime SBP.
Conclusions:
- Office BP measurements can lead to a false sense of security regarding BP control in anticoagulated patients.
- Poorly controlled BP, even if appearing controlled in-office, poses a risk for fatal events like intracranial bleeding.
- ABPM is essential for accurate BP assessment and management in patients on anticoagulant therapy.
Objective:
To compare the methods of office blood pressure (BP) measurement and ambulatory blood pressure monitoring (ABPM) to ensure optimal BP control in hypertensive anticoagulated patients.
Patients And Methods:
Seventy-eight patients who were receiving antihypertensive drugs and warfarin in a dose-adjusted approach to achieve therapeutic international normalized ratio because of the association of atrial fibrillation were enrolled in the study. Twenty-four hour ABPM was applied to all patients. For the assessment of optimal BP control, office BP measurements were compared with ABPM recordings. All patients were divided into 'good control' and 'poor control' groups with a cut-off level of 140 mmHg systolic blood pressure (SBP). The groups of patients with 'good control' and 'poor control' were further subdivided into four groups according to the cardiovascular outcome on the basis of ABPM reference threshold levels: 'true good control' or 'seemingly good control' and 'true poor control' or 'seemingly poor control' (white coat effect). Positive and negative predictive values of the office BP measurement method versus ABPM were estimated.
Results:
According to office measurements, 56.9% of all cases were in the 'good control' group and 43.1% were in the 'poor control' group. When we reclassified patients according to daytime and night-time mean SBP, we realized that they were in 'true good control', 'seemingly good control', 'true poor control', and 'seemingly poor control' groups with ratios of 25.5, 31.4, 21.6, and 21.6% on the basis of daytime systolic mean values and 19.6, 37.3, 35.3, and 7.8% on the basis of night-time systolic mean values, respectively. When we considered ABPM as a reference method, sensitivity, specificity, and positive and negative predictive values of office SBP measurements were 40.74, 54.17, 50.00, and 44.83% for daytime SBP mean values and 48.65, 71.43, 81.82, and 34.48% for night-time SBP mean values, respectively.
Conclusion:
Poor control of SBP in patients with anticoagulant therapy may result in fatal events such as intracranial bleeding; thus, they are still under significant risk, although they are considered to have controlled BP with office measurements. ABPM is an essential method for accurate BP control in contrast to office BP measurement in anticoagulated patients.
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