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Digital health for chronic disease management
Published in Ben Y.F. Fong, Martin C.S. Wong, The Routledge Handbook of Public Health and the Community, 2021
Kelvin K.F. Tsoi, Martin C.S. Wong
In scaling up to all-rounded care, home-based monitoring is of paramount importance apart from clinic-based and community-based monitoring. Masked hypertension, reported with a prevalence ranging from 15% to 30% worldwide (Peacock et al., 2014), is a condition in which individuals show normal office blood pressure records, but their blood pressure might be elevated in out-of-office setting, such as home monitoring or even in 24-hour ambulatory blood pressure monitoring. Masked hypertension, in fact, is a major hurdle to confirm clinical diagnosis if the decision is purely based on blood pressure readings observed in clinical setting. Home blood pressure monitoring with mobile technology can help identify masked hypertension, and therefore home blood pressure readings are increasingly used in cardiovascular risk and mortality prediction, particularly for stroke and coronary events (Sega et al., 2005).
Athletes with Chronic Conditions Hypertension
Published in Flavia Meyer, Zbigniew Szygula, Boguslaw Wilk, Fluid Balance, Hydration, and Athletic Performance, 2016
Masked hypertension that is defined as a normal office BP in the presence of an elevated BP during the ambulatory 24-h BP measurement presents nearly similar risk of cardiovascular morbidity as classical hypertension (Trachsel et al. 2015). A recent prospective study, in middle-aged endurance competitive athletes, reported a 38% prevalence of masked hypertension. This prevalence was similar to that of professional football players (Berge et al. 2013a) but higher than in general population (<20%). This prevalence may be partly increased by the definition criterion of 24-h or daytime BP used. As discussed before, masked hypertension was associated with a lower diastolic function and a higher left ventricular mass/volume ratio, indicating predominantly concentric myocardial remodeling.
Eclampsia and Pre-Eclampsia with Severe Features
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Malik Goonewardene
White-coat hypertension is hypertension that is evident only at clinic visits, and although considered a benign condition, it carries an increased risk of pre-eclampsia. Masked hypertension is a form of chronic hypertension that is characterised by a BP that is considered normal in the clinic, but with evidence of target organ damage that suggests that the BP may be elevated at other times. The diagnosis of transient gestational hypertension, gestational hypertension or pre-eclampsia implies that the BP must have been normal before pregnancy or during the first trimester of pregnancy. A normal BP after 12 weeks of gestation does not exclude preexisting hypertension, because the blood pressure may decrease to normal levels even if it has been high before this time due to the physiological changes that occur during pregnancy. Gestational hypertension occurs de novo after 20 weeks in the absence of the features of pre-eclampsia. Although the outcome in gestational hypertension is generally good, about a quarter of women with gestational hypertension, especially those who develop the disease early, could progress into pre-eclampsia, in which case the outcome is poor. It is important to monitor even cases in which the BP is transiently elevated for the first time during pregnancy after 20 weeks, i.e. transient gestational hypertension, as there is an approximately 40% risk of developing true gestational hypertension or pre-eclampsia. About a quarter of women with chronic hypertension develop pre-eclampsia. Eclampsia is defined as the new onset of generalised tonic-clonic seizures in a woman with pre-eclampsia.
Determinants of reverse dipping blood pressure in normotensive, non-diabetic population with an office measurement below 130/85mmHg
Published in Clinical and Experimental Hypertension, 2021
Ali Çoner, Ertan Akbay, Sinan Akıncı, Gökhan Özyıldız, Gültekin Gençtoy, Haldun Müderrisoğlu
Awake and asleep blood pressure measurements were averaged and calculated at the last 24-hour follow-up. A > 10% decrement in nighttime systolic blood pressure compared to daytime systolic blood pressure was defined as a dipping pattern. If the nighttime systolic blood pressure decrease was lower than 10% compared to daytime, it was defined as a non-dipping pattern. The diurnal blood pressure pattern was defined as reverse dipping, if the average nighttime systolic blood pressure was higher than the daytime. The study population was divided into three groups depending on their circadian systolic blood pressure measurements as Group-1 (dipping), Group-2 (non-dipping) and Group-3 (reverse dipping). Participants with ABPM sessions consistent with masked hypertension were excluded from statistical analysis. Masked hypertension was defined as the average of 24-hour blood pressure measurement ≥130/80 mmHg.
Blood pressure phenotypes based on ambulatory monitoring in a general middle-aged population
Published in Blood Pressure, 2021
Yi-Ting Lin, Erik Lampa, Tove Fall, Gunnar Engström, Johan Sundström
In accordance with the European society of hypertension (ESH) guidelines, ambulatory hypertension was defined as a mean 24-h BP ≥130/80 mmHg, mean day-time BP ≥135/85 mmHg, and/or mean night-time BP ≥120/70 mmHg [6]. Office hypertension was defined as office BP ≥140/90 mmHg [26]. In the presence of an elevated office BP (≥140/90 mmHg), we defined participants with a normal mean ambulatory day-time BP (<135/85 mmHg) as having day-time white coat hypertension [4,27]; those with normal mean night-time BP (<120/70 mmHg) as having nocturnal white coat hypertension [26], and those with normal mean 24-h BP (<130/80 mmHg) as having 24-h white coat hypertension [26,28]. In the presence of a normal office BP (<140/90 mmHg), we defined those with an increased mean day-time BP (≥135/85 mmHg) as having day-time masked hypertension [26,28], those with an increased mean night-time BP (≥120/70 mmHg) as having nocturnal masked hypertension [26], and those with an increased mean 24-h BP (≥130/80 mmHg) as having 24-h masked hypertension [26,28]. Although ‘masked uncontrolled hypertension’ has been used for masked hypertension among individuals under anti-hypertensive treatment, we used ‘masked hypertension’ for individuals with or without anti-hypertensive treatment for consistency. Individuals with both elevated office and ABPM BPs were defined as having sustained hypertension, and those with both non-elevated office and ABPM BPs were defined as having sustained normotension [29].
Increased rate of any retinopathy risk in patients with masked hypertension
Published in Clinical and Experimental Hypertension, 2020
Timuçin Yıldırım, Selçuk Özkan, Ömer Çağlar Yılmaz, Bunyamin Yavuz
Masked hypertension is diagnosed when the patients whose blood pressure values are under 140/90 mmHg in-office measurements, but the average of ambulatory blood pressure is higher than any of the normal values described above. Patients with blood pressure levels in the normal range in all three different groups of measurements were considered as the normotensive group. Blood pressure values recorded by the device were interpreted with the aid of the computer software of the device and measurements were recorded. Patients were also recommended to measure their own blood pressure at home by themselves, four times a day (with 1–2-min intervals, 2 times in the morning and 2 times in the evening, after 10 min of rest and without using caffeine products or smoking previously). The arithmetic average of home blood pressure measurements was recorded.