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CLINICAL REVIEW: Richard J McManus, Paul Glasziou, Andrew Hayen, Jonathan Mant, Paul Padfield, John Potter, Emma P Bray, and David Mant Blood pressure self monitoring: questions and answers from a national conference BMJ 2008; 337: a2732 [Full text]

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Self Blood Pressure Measurement in computation of 10-year Cardiovascular Risk

Mario Bo, Marco Astengo, Chiara Merlo   (12 January 2009)

Self Blood Pressure Measurement in computation of 10-year Cardiovascular Risk 12 January 2009
Mario Bo, MD, PhD Department of Geriatrics, Ospedale San Giovanni Battista, Corso Bramante 88, 10126, Torino, Italy, Marco Astengo, Chiara Merlo Send response to journal: Re: Self Blood Pressure Measurement in computation of 10-year Cardiovascular Risk	Dear Editor, we really appreciated the clinical review by McManus et al. (BMJ 2008; 337: a2732) about the clinical impact of self home blood pressure measurement. However, with regard to the statement “we found no studies that looked at the potential differences in calculated risk of cardiovascular disease when using office versus home blood pressure measurements” we would like to mention the results of our study, published on Atherosclerosis (2008; 197: 904-909). Among subjects free of previous cardiovascular (CV) disease, attending for a first visit at a lipid clinic, we evaluated prevalence and severity of white-coat effect (WCE) by comparing physician's and nurse’s office blood pressure (BP) readings with home self BP measurements (SBPM), and how the difference between office BP measurements and SBPM affected the individual 10-year CV risk, calculated according to current national guidelines (http://www.cuore.iss.it), including age, gender, current smoking habit, systolic BP value, total and high-density lipoprotein cholesterol. Prevalence of WCE was 60.3% during the physician's visit; mean home self-measured systolic and diastolic BP values were 16.7 and 11.2 mmHg lower than office readings, respectively (p<0.001). Compared with mean SBPM, either physician’s and nurse’s systolic BP measurements resulted in higher risk estimation (p=.000) (Figure). Using conventional risk stratification (<5% low; 5-20% moderate; >20% high), inclusion in the prediction model of physician's and nurse’s (before and after the visit) systolic BP measurements determined a higher CV risk-strata allocation in 16.5%, 8.5% and 9.4% of patients, respectively, compared to inclusion of SBPM. Clinical and economic implications of risk overestimation are particularly relevant in the primary prevention setting, in which drug treatment on top of lifestyle changes should be reserved to subjects deemed at high risk. Competing interests: None declared