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BP Measurement in Clinical Practice: Time to SPRINT to Guideline-Recommended Protocols
1Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis, Minnesota; and draw0003@umn.edu.
Insights
Intensive blood pressure (BP) lowering in the SPRINT trial reduced cardiovascular risks. However, standardized BP measurement techniques are crucial for translating these findings into routine clinical practice for hypertension management.
Area of Science:
- Nephrology
- Cardiology
- Clinical Trials
Background:
- Hypertension is a major global health risk and highly prevalent in Chronic Kidney Disease (CKD) patients.
- The Systolic BP Intervention Trial (SPRINT) demonstrated benefits of intensive systolic blood pressure (BP) lowering (<120 mm Hg) versus standard (<140 mm Hg).
- Concerns exist regarding the generalizability of SPRINT findings due to its automated, unobserved BP measurement method compared to less standardized clinical practice.
Purpose of the Study:
- To review BP measurement techniques in major hypertension studies.
- To evaluate the impact of measurement techniques on BP readings.
- To explore how SPRINT's ambulatory BP data can inform clinical practice.
Main Methods:
- Review of BP measurement techniques in observational studies and clinical trials.
- Evaluation of measurement technique effects on BP readings.
- Analysis of ambulatory BP data from the SPRINT trial.
Main Results:
- SPRINT showed intensive BP control significantly reduced cardiovascular events and mortality.
- Variability in BP measurement techniques across studies may affect reported outcomes.
- Ambulatory BP monitoring offers insights into real-world BP control.
Conclusions:
- Standardized BP measurement is vital for accurate hypertension assessment.
- Implementing guideline-recommended BP measurement techniques is essential for clinical practice.
- Translating trial results like SPRINT requires careful consideration of measurement methodology.
Abstract:
Hypertension is the leading chronic disease risk factor in the world and is especially important in patients with CKD, nearly 90% of whom have hypertension. Recently, in the Systolic BP Intervention Trial (SPRINT), intensive lowering of clinic systolic BP to a target <120 mm Hg, compared with a standard BP target of <140 mm Hg, reduced risk for cardiovascular disease and all-cause mortality. However, because BP was measured unobserved using an automated device, some investigators have questioned the ability to translate SPRINT results into routine clinical practice, in which measurement of BP is typically less standardized. In this review, we discuss the BP measurement techniques used in major observational studies and clinical trials that form the evidence base for our current approach to treating hypertension, evaluate the effect of measurement technique on BP readings, and explore how ambulatory BP data from the SPRINT trial may inform this discussion. We conclude by arguing for implementation of guideline-recommended BP measurement techniques in routine clinical practice.
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01:17Measurement of Blood Pressure
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Prepare for the Procedure: