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Randomized Controlled Trial
. 2017 Feb 3;6(2):e004536.
doi: 10.1161/JAHA.116.004536.

Implications of Blood Pressure Measurement Technique for Implementation of Systolic Blood Pressure Intervention Trial (SPRINT)

Rajiv Agarwal  1
Affiliations
Randomized Controlled Trial

Implications of Blood Pressure Measurement Technique for Implementation of Systolic Blood Pressure Intervention Trial (SPRINT)

Rajiv Agarwal. J Am Heart Assoc. .

Abstract

Background: Cardiovascular morbidity and mortality was reduced by 25% when blood pressure (BP) was targeted to 120 mm Hg systolic compared with 140 mm Hg systolic in Systolic Blood Pressure Intervention Trial (SPRINT); however, BP was measured using a research technique. SPRINT specified 5 minutes of seated rest in a quiet room followed by 3 oscillometric measurements without an observer in the room. The relationship of this research-grade methodology to routine BP measurements is not known.

Methods and results: Among 275 people with chronic kidney disease who had BP <140/90 mm Hg when they came to the clinic, we measured BP as in SPRINT and recorded BP on the same day without specification of seated rest. Compared with routine measurement, the research-grade systolic BP was 12.7 mm Hg lower with wide limits of agreement (-46.1 to 20.7 mm Hg). Research grade systolic BP was 7.9 mm Hg lower than daytime ambulatory systolic BP and had wide agreement limits (-33.2 to 17.4 mm Hg). Whereas the routine, research-grade, and daytime ambulatory systolic BP were all related to echocardiographic left ventricular hypertrophy, the strength of the relationship between research-grade and daytime ambulatory systolic BP to left ventricular hypertrophy was similar and stronger than the strength of the relationship between routine systolic BP and left ventricular hypertrophy.

Conclusions: Taken together, these results suggest that translation of the SPRINT results will require measurement of BP as performed in that trial. Instead of an algebraic manipulation of routine clinic measurements, the SPRINT methodology of BP measurement would be needed at minimum if implementation of the SPRINT results were to be deployed in the population at large.

Keywords: agreement; ambulatory blood pressure monitoring; blood pressure measurement; chronic kidney disease; left ventricular hypertrophy.

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Figures

Figure 1
Figure 1
Bland–Altman plot showing the mean differences between various blood pressure (BP) recordings and their limits of agreement. The top panel shows systolic BP and the bottom panel shows diastolic BP. Research‐grade BP was, on average, 12.7/12.0 mm Hg lower (bias) than routine clinic BP and had wide limits of agreement.
Figure 2
Figure 2
Relationship of odds ratio for echocardiographic left ventricular hypertrophy (LVH) and systolic blood pressure (SBP) measured using 3 different methods. Odds ratios and their 95% CIs are plotted together with the chi‐square and P values. As measured by the likelihood ratio test, the strength of the relationship between SBP and LVH was stronger for daytime ambulatory BP (ABPM) than routine SBP and LVH (P=0.032). The strength of the relationship of LVH and research‐grade SBP was stronger than that with routine SBP (P=0.005) The strength of the relationship of LVH and daytime ambulatory SBP was similar to that with research‐grade SBP (P=0.052).
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