Comparison of community pharmacy-measured blood pressure and ambulatory blood pressure monitoring: A pilot study

IF 1.3 Q4 PHARMACOLOGY & PHARMACY Journal of the American College of Clinical Pharmacy : JACCP Pub Date : 2024-06-26 DOI:10.1002/jac5.2004
Christine Tran BA, Ibrahim S. Alhomoud Pharm.D., Kristi Taylor B.S., Tana Kaefer Pharm.D., Roy Sabo Ph.D., Dave L. Dixon Pharm.D., FCCP
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Abstract

Introduction

Blood pressure (BP) measured by 24-h ambulatory blood pressure monitoring (ABPM) is a better predictor of hypertension (HTN)-related end-organ damage than office BP; however, it is not always available nor tolerated by patients. Community pharmacy-measured blood pressure (CPBP) could serve as a potential alternative, although it is unknown whether CPBP is equivalent to BP measured using ABPM.

Objectives

The primary objective of this pilot study was to explore the equivalency of CPBP compared with awake ABPM.

Methods

This was a pilot, single-arm, equivalency study of adults ≥21 years with HTN, taking ≥1 antihypertensive with no changes in the prior 2 weeks. Exclusion criteria included night shift workers, sleep apnoea, arrhythmia, on dialysis, pregnancy or an arm circumference > 50 cm. Three unattended seated BP measurements were obtained in both arms at a community pharmacy and followed by 24-h ABPM. At the return visit, seated BP measurements were repeated; the mean across both visits served as the CPBP. The primary outcome was the equivalency of systolic BP measured at the community pharmacy to awake BP measured using ABPM. The continuous outcome (BP) was modelled against a binary fixed effect for the measurement device (CPBP vs. ABPM) and a subject-level random effect to account for the multiple BP readings arising from the same individuals.

Results

The 25 participants had a mean (standard deviation [SD]) age of 65 (15) years, 80% were female, and 36% identified as Black or Latino. The mean (SD) systolic BP was 128.0 (20.2) and 129.1 (15.8) mmHg for CPBP and awake ABPM, respectively (p = 0.8409). No significant differences were found between the mean diastolic BP or heart rate for CPBP vs. 24-h ABPM or CPBP vs. daytime ABPM.

Conclusion

The difference between CPBP and ABPM was not statistically significant; however, we cannot claim equivalence between the two approaches.

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社区药房测量血压与门诊血压监测的比较:试点研究
导言:与诊室血压相比,通过 24 小时动态血压监测(ABPM)测量的血压能更好地预测与高血压(HTN)相关的终末器官损害;但是,患者并不总能获得或耐受动态血压监测。社区药物测量血压 (CPBP) 可作为一种潜在的替代方法,但 CPBP 是否等同于 ABPM 测量的血压尚不得而知。 目标 本试验研究的主要目的是探讨 CPBP 与清醒 ABPM 相比是否具有同等效果。 方法 这是一项单臂等效性试验研究,研究对象为年龄≥21 岁、服用≥1 种降压药且在前 2 周内未更换过降压药的成人高血压患者。排除标准包括夜班工作者、睡眠呼吸暂停、心律失常、透析患者、怀孕或臂围超过 50 厘米。在社区药房进行三次无人值守的双臂坐位血压测量,然后进行 24 小时 ABPM。回访时,再次进行坐位血压测量;两次测量的平均值作为 CPBP。主要结果是社区药房测量的收缩压与使用 ABPM 测量的清醒血压的等效性。连续结果(血压)与测量设备(CPBP 与 ABPM)的二元固定效应和受试者水平随机效应建立了模型,以考虑来自同一人的多个血压读数。 结果 25 名参与者的平均(标准差 [SD])年龄为 65(15)岁,80% 为女性,36% 为黑人或拉丁裔。CPBP 和清醒 ABPM 的收缩压平均值(标准差)分别为 128.0 (20.2) mmHg 和 129.1 (15.8) mmHg (p = 0.8409)。CPBP 与 24 小时 ABPM 或 CPBP 与日间 ABPM 的平均舒张压或心率之间没有发现明显差异。 结论 CPBP 和 ABPM 之间的差异无统计学意义;但是,我们不能断言这两种方法之间具有等效性。
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