Diabetes Care Volume 37, February 2014
e24
Clinical Characteristics of Patients Who Report Incorrect Data of Home-Measured Blood Pressure Diabetes Care 2014;37:e24–e25 | DOI: 10.2337/dc13-1821
eLETTERS – OBSERVATIONS
Diabetic patients are at a higher risk for cardiovascular events. It is important to control dyslipidemia and blood pressure (BP) as well as to control blood glucose for the prevention of cardiovascular events. In addition, home BP (HBP) measurement has been found to have a stronger relation with target organ damage and with a risk of cardiovascular events when compared with clinic BP measurement (1–3). Therefore, the significance of HBP measurement has been widely recognized. However, there are no studies evaluating the reliability of HBP measurement in patients with type 2 diabetes. The aim of this study was to investigate the clinical characteristics in patients with the lowest quartile (quartile 1) of concordance rate between self-reported and stored HBP measurements. HBP measurements were performed in 280 patients with type 2 diabetes, regardless of the presence of hypertension, who had regularly attended the diabetes outpatient clinic at Hospital of Kyoto Prefectural University of Medicine between May 2011 and July 2012. HBP measurements were performed using an automatic device, HEM-7080IC (Omron Healthcare Co. Ltd, Kyoto, Japan), which is capable of electronically storing BP measurements. All patients used this oscillometer for the first time
and were unaware that the HBP monitor electronically stored the BP results. They were instructed to perform triplicate morning and evening measurements for 14 consecutive days. We examined the concordant rate between the logbook data, which were written by patients in their logbook, and the memory data, which were retrieved from the memory of the electronic BP device. Then we divided the patients into the upper quartiles (quartiles 2–4) and the lowest quartile (quartile 1) of concordance rate of HBP and examined the characteristics of quartile 1. The concordance rate between BP from memory and from logbook was 78.6%. The concordance rate of quartile 1 was less than 67%. Clinical characteristics of patients are shown in Table 1. Age, duration of diabetes, BMI, hemoglobin A1c, and frequencies of diabetes complications were not different between groups. Morning systolic BP was higher in quartile 1 than that in quartiles 2–4, although it did not reach statistical significance. SD of morning systolic BP, which is an index of variability of BP, was greater in quartile 1 than in quartiles 2–4. Low concordance rate of HBP was associated more with variability of BP than with BP level in HBP measurement. A limitation of this study is that the numbers of patients were relatively small, because
Shinobu Matsumoto,1 Michiaki Fukui,1 Masahide Hamaguchi,2 Emi Ushigome,1 Mayuko Kadono,1 Kanae Matsushita,1 Takuya Fukuda,1 Kazuteru Mitsuhashi,1 Saori Majima,1 Masahiro Yamazaki,1 Goji Hasegawa,1 and Naoto Nakamura1
we chose the patients who did not know the storage function of BP monitor. However, this is the first study to investigate the clinical characteristics in patients with the lowest quartile (quartile 1) of concordance rate between self-reported and stored HBP measurements. We should instruct patients to record the HBP measurement correctly, because false reporting of uncontrolled pressures may misguide physicians in the optimal medical treatment of their patients. Acknowledgments. The authors thank Naoko Higo, Machiko Hasegawa, and Terumi Kaneko (Kyoto Prefectural University of Medicine) for teaching patients how to measure their BP; Sayoko Horibe, Hiroko Kawamura, and Sanae Utena (Kyoto Prefectural University of Medicine) for their secretarial assistance; and Akane Miki (Kyoto Prefectural University) for her enormous help of data handling. Duality of Interest. No potential conflicts of interest relevant to this article were reported. Author Contributions. S.Mat. researched data and wrote the manuscript. M.F. and E.U. contributed to discussion and reviewed the manuscript. M.H. researched data and contributed to discussion. M.K., M.Y., and G.H. contributed to discussion. K.Ma., T.F., K.Mi., and S.Maj. researched data. N.N. reviewed and edited the manuscript. M.F. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
1
Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan Immunology Frontier Research Center at Osaka University, Osaka, Japan
2
Corresponding author: Michiaki Fukui, [email protected]. © 2014 by the American Diabetes Association. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
care.diabetesjournals.org
e25
References
Table 1—Clinical characteristics of patients Quartile 1
Quartiles 2–4
P value
69 30/39
211 91/120
0.9593
Age (years)
65.3 6 11.5
66.1 6 9.4
0.9426
Duration of diabetes (years)
13.7 6 10.8
12.3 6 9.8
0.5289
BMI (kg/m2)
24.0 6 3.2
23.4 6 3.6
0.0978
7.4 6 1.2
7.2 6 1.0
0.4284
n Sex (male/female)
Hemoglobin A1c (%)
57 6 13
55 6 11
0.4284
Morning SBP (mmHg)
132.9 6 18.3
129.8 6 15.5
0.2658
Morning DBP (mmHg) Evening SBP (mmHg)
73.4 6 9.7 127.8 6 18.7
72.4 6 9.7 125.6 6 14.2
0.5228 0.6404
Evening DBP (mmHg)
69.2 6 9.0
67.4 6 9.5
0.1086
SD of morning SBP (mmHg)
10.7 6 3.9
9.5 6 3.2
0.0141
Hemoglobin A1c (mmol/mol)
SD of morning DBP (mmHg)
6.1 6 3.0
5.4 6 2.6
0.0634
SD of evening SBP (mmHg)
10.3 6 4.2
10.1 6 3.4
0.6180
SD of evening DBP (mmHg)
5.8 6 2.8
Retinopathy (2/1)
57/12
5.9 6 2.4
0.7026
162/49
0.3084
Neuropathy (2/1)
44/25
157/54
0.0882
Nephropathy (2/1) Cardiovascular disease (2/1)
28/41 57/12
106/105 171/40
0.1633 0.7715
Antihypertensive drugs (2/1)
27/42
98/113
0.2887
Insulin (2/1)
60/9
167/44
0.1506
Smoking (none/past/current)
30/19/20
97/78/36
0.0959
Alcohol (never/social/everyday)
41/12/16
125/36/50
0.9736
Data are mean 6 SD or number of subjects. SBP, systolic BP; DBP, diastolic BP.
1. Tomiyama M, Horio T, Yoshii M, et al. Masked hypertension and target organ damage in treated hypertensive patients. Am J Hypertens 2006;19:880–886 2. Kamoi K, Miyakoshi M, Soda S, Kaneko S, Nakagawa O. Usefulness of home blood pressure measurement in the morning in type 2 diabetic patients. Diabetes Care 2002; 25:2218–2223 3. Ushigome E, Fukui M, Sakabe K, et al. Uncontrolled home blood pressure in the morning is associated with nephropathy in Japanese type 2 diabetes. Heart Vessels 2011;26:609–615
Copyright of Diabetes Care is the property of American Diabetes Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
e24
Clinical Characteristics of Patients Who Report Incorrect Data of Home-Measured Blood Pressure Diabetes Care 2014;37:e24–e25 | DOI: 10.2337/dc13-1821
eLETTERS – OBSERVATIONS
Diabetic patients are at a higher risk for cardiovascular events. It is important to control dyslipidemia and blood pressure (BP) as well as to control blood glucose for the prevention of cardiovascular events. In addition, home BP (HBP) measurement has been found to have a stronger relation with target organ damage and with a risk of cardiovascular events when compared with clinic BP measurement (1–3). Therefore, the significance of HBP measurement has been widely recognized. However, there are no studies evaluating the reliability of HBP measurement in patients with type 2 diabetes. The aim of this study was to investigate the clinical characteristics in patients with the lowest quartile (quartile 1) of concordance rate between self-reported and stored HBP measurements. HBP measurements were performed in 280 patients with type 2 diabetes, regardless of the presence of hypertension, who had regularly attended the diabetes outpatient clinic at Hospital of Kyoto Prefectural University of Medicine between May 2011 and July 2012. HBP measurements were performed using an automatic device, HEM-7080IC (Omron Healthcare Co. Ltd, Kyoto, Japan), which is capable of electronically storing BP measurements. All patients used this oscillometer for the first time
and were unaware that the HBP monitor electronically stored the BP results. They were instructed to perform triplicate morning and evening measurements for 14 consecutive days. We examined the concordant rate between the logbook data, which were written by patients in their logbook, and the memory data, which were retrieved from the memory of the electronic BP device. Then we divided the patients into the upper quartiles (quartiles 2–4) and the lowest quartile (quartile 1) of concordance rate of HBP and examined the characteristics of quartile 1. The concordance rate between BP from memory and from logbook was 78.6%. The concordance rate of quartile 1 was less than 67%. Clinical characteristics of patients are shown in Table 1. Age, duration of diabetes, BMI, hemoglobin A1c, and frequencies of diabetes complications were not different between groups. Morning systolic BP was higher in quartile 1 than that in quartiles 2–4, although it did not reach statistical significance. SD of morning systolic BP, which is an index of variability of BP, was greater in quartile 1 than in quartiles 2–4. Low concordance rate of HBP was associated more with variability of BP than with BP level in HBP measurement. A limitation of this study is that the numbers of patients were relatively small, because
Shinobu Matsumoto,1 Michiaki Fukui,1 Masahide Hamaguchi,2 Emi Ushigome,1 Mayuko Kadono,1 Kanae Matsushita,1 Takuya Fukuda,1 Kazuteru Mitsuhashi,1 Saori Majima,1 Masahiro Yamazaki,1 Goji Hasegawa,1 and Naoto Nakamura1
we chose the patients who did not know the storage function of BP monitor. However, this is the first study to investigate the clinical characteristics in patients with the lowest quartile (quartile 1) of concordance rate between self-reported and stored HBP measurements. We should instruct patients to record the HBP measurement correctly, because false reporting of uncontrolled pressures may misguide physicians in the optimal medical treatment of their patients. Acknowledgments. The authors thank Naoko Higo, Machiko Hasegawa, and Terumi Kaneko (Kyoto Prefectural University of Medicine) for teaching patients how to measure their BP; Sayoko Horibe, Hiroko Kawamura, and Sanae Utena (Kyoto Prefectural University of Medicine) for their secretarial assistance; and Akane Miki (Kyoto Prefectural University) for her enormous help of data handling. Duality of Interest. No potential conflicts of interest relevant to this article were reported. Author Contributions. S.Mat. researched data and wrote the manuscript. M.F. and E.U. contributed to discussion and reviewed the manuscript. M.H. researched data and contributed to discussion. M.K., M.Y., and G.H. contributed to discussion. K.Ma., T.F., K.Mi., and S.Maj. researched data. N.N. reviewed and edited the manuscript. M.F. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
1
Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan Immunology Frontier Research Center at Osaka University, Osaka, Japan
2
Corresponding author: Michiaki Fukui, [email protected]. © 2014 by the American Diabetes Association. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
care.diabetesjournals.org
e25
References
Table 1—Clinical characteristics of patients Quartile 1
Quartiles 2–4
P value
69 30/39
211 91/120
0.9593
Age (years)
65.3 6 11.5
66.1 6 9.4
0.9426
Duration of diabetes (years)
13.7 6 10.8
12.3 6 9.8
0.5289
BMI (kg/m2)
24.0 6 3.2
23.4 6 3.6
0.0978
7.4 6 1.2
7.2 6 1.0
0.4284
n Sex (male/female)
Hemoglobin A1c (%)
57 6 13
55 6 11
0.4284
Morning SBP (mmHg)
132.9 6 18.3
129.8 6 15.5
0.2658
Morning DBP (mmHg) Evening SBP (mmHg)
73.4 6 9.7 127.8 6 18.7
72.4 6 9.7 125.6 6 14.2
0.5228 0.6404
Evening DBP (mmHg)
69.2 6 9.0
67.4 6 9.5
0.1086
SD of morning SBP (mmHg)
10.7 6 3.9
9.5 6 3.2
0.0141
Hemoglobin A1c (mmol/mol)
SD of morning DBP (mmHg)
6.1 6 3.0
5.4 6 2.6
0.0634
SD of evening SBP (mmHg)
10.3 6 4.2
10.1 6 3.4
0.6180
SD of evening DBP (mmHg)
5.8 6 2.8
Retinopathy (2/1)
57/12
5.9 6 2.4
0.7026
162/49
0.3084
Neuropathy (2/1)
44/25
157/54
0.0882
Nephropathy (2/1) Cardiovascular disease (2/1)
28/41 57/12
106/105 171/40
0.1633 0.7715
Antihypertensive drugs (2/1)
27/42
98/113
0.2887
Insulin (2/1)
60/9
167/44
0.1506
Smoking (none/past/current)
30/19/20
97/78/36
0.0959
Alcohol (never/social/everyday)
41/12/16
125/36/50
0.9736
Data are mean 6 SD or number of subjects. SBP, systolic BP; DBP, diastolic BP.
1. Tomiyama M, Horio T, Yoshii M, et al. Masked hypertension and target organ damage in treated hypertensive patients. Am J Hypertens 2006;19:880–886 2. Kamoi K, Miyakoshi M, Soda S, Kaneko S, Nakagawa O. Usefulness of home blood pressure measurement in the morning in type 2 diabetic patients. Diabetes Care 2002; 25:2218–2223 3. Ushigome E, Fukui M, Sakabe K, et al. Uncontrolled home blood pressure in the morning is associated with nephropathy in Japanese type 2 diabetes. Heart Vessels 2011;26:609–615
Copyright of Diabetes Care is the property of American Diabetes Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
