Larissa Rangel Nascimento

Reprodutibilidade da pressao arterial medida no ELSA-Brasil com a monitorizacao pressorica de 24h

OBJECTIVE To determine the reproducibility of casual arterial pressure measurement and to confirm pressure diagnosis by monitoring of participants in the ELSA-Brasil (Estudo Longitudinal de Saúde do Adulto - Brazilian Longitudinal Study for Adult Health). METHODS Casual blood pressure was measured with an oscilometric device. A sub-sample of participants (N = 255) from Espírito Santo state (Southeastern Brazil) was reevaluated using the same methodology following one to ten weeks and, in addition, underwent arterial blood pressure monitoring. Diagnosis of hypertension used cut off points of 140/90 mmHg for casual pressure and 130/80 mmHg for arterial blood pressure monitoring. White coat hypertension was defined as the presence of hypertension in casual blood pressure and normal arterial blood pressure monitoring, and converse findings characterized masked hypertension. RESULTS Data are from 230 participants that on the two occasions were free from antihypertensive medication (N1 = 153) or under the same antihypertensive regimen (N2 = 77). Normotension was confirmed by arterial blood pressure monitoring in 120 out of 134 participants of the N1 group. In N2, blood pressure control was confirmed by arterial blood pressure monitoring in 43 of 54 participants with controlled hypertension per casual blood pressure. Overall diagnostic concordance between casual blood pressure and arterial blood pressure monitoring was 78% (kappa = 0.44). In the N1 group, six subjects (4%) presented white coat hypertension, and 23 subjects (25%) presented with masked hypertension. CONCLUSIONS Diagnostic concordance between casual blood pressure and arterial blood pressure monitoring was moderate. The rigorous standardization of casual blood pressure measurement adopted in the ELSA-Brasil study was able to reduce white coat hypertension. The high frequency of masked hypertension may suggest that pressure values obtained by arterial blood pressure monitoring indicate an elevated degree of stress at work.OBJECTIVE: To determine the reproducibility of casual arterial pressure measurement and to confirm pressure diagnosis by monitoring of participants in the ELSA-Brasil (Estudo Longitudinal de Saude do Adulto - Brazilian Longitudinal Study for Adult Health). METHODS: Casual blood pressure was measured with an oscilometric device. A sub-sample of participants (N = 255) from Espirito Santo state (Southeastern Brazil) was reevaluated using the same methodology following one to ten weeks and, in addition, underwent arterial blood pressure monitoring. Diagnosis of hypertension used cut off points of 140/90 mmHg for casual pressure and 130/80 mmHg for arterial blood pressure monitoring. White coat hypertension was defined as the presence of hypertension in casual blood pressure and normal arterial blood pressure monitoring, and converse findings characterized masked hypertension. RESULTS: Data are from 230 participants that on the two occasions were free from antihypertensive medication (N1 = 153) or under the same antihypertensive regimen (N2 = 77). Normotension was confirmed by arterial blood pressure monitoring in120 out of 134 participants of the N1 group. In N2, blood pressure control was confirmed by arterial blood pressure monitoring in 43 of 54 participants with controlled hypertension per casual blood pressure. Overall diagnostic concordance between casual blood pressure and arterial blood pressure monitoring was 78% (kappa = 0.44). In the N1 group, six subjects (4%) presented white coat hypertension, and 23 subjects (25%) presented with masked hypertension. CONCLUSIONS: Diagnostic concordance between casual blood pressure and arterial blood pressure monitoring was moderate. The rigorous standardization of casual blood pressure measurement adopted in the ELSA-Brasil study was able to reduce white coat hypertension. The high frequency of masked hypertension may suggest that pressure values obtained by arterial blood pressure monitoring indicate an elevated degree of stress at work.

Reproducibility of arterial pressure measured in the ELSA-Brasil with 24-hour pressure monitoring

OBJECTIVE To determine the reproducibility of casual arterial pressure measurement and to confirm pressure diagnosis by monitoring of participants in the ELSA-Brasil (Estudo Longitudinal de Saúde do Adulto - Brazilian Longitudinal Study for Adult Health). METHODS Casual blood pressure was measured with an oscilometric device. A sub-sample of participants (N = 255) from Espírito Santo state (Southeastern Brazil) was reevaluated using the same methodology following one to ten weeks and, in addition, underwent arterial blood pressure monitoring. Diagnosis of hypertension used cut off points of 140/90 mmHg for casual pressure and 130/80 mmHg for arterial blood pressure monitoring. White coat hypertension was defined as the presence of hypertension in casual blood pressure and normal arterial blood pressure monitoring, and converse findings characterized masked hypertension. RESULTS Data are from 230 participants that on the two occasions were free from antihypertensive medication (N1 = 153) or under the same antihypertensive regimen (N2 = 77). Normotension was confirmed by arterial blood pressure monitoring in 120 out of 134 participants of the N1 group. In N2, blood pressure control was confirmed by arterial blood pressure monitoring in 43 of 54 participants with controlled hypertension per casual blood pressure. Overall diagnostic concordance between casual blood pressure and arterial blood pressure monitoring was 78% (kappa = 0.44). In the N1 group, six subjects (4%) presented white coat hypertension, and 23 subjects (25%) presented with masked hypertension. CONCLUSIONS Diagnostic concordance between casual blood pressure and arterial blood pressure monitoring was moderate. The rigorous standardization of casual blood pressure measurement adopted in the ELSA-Brasil study was able to reduce white coat hypertension. The high frequency of masked hypertension may suggest that pressure values obtained by arterial blood pressure monitoring indicate an elevated degree of stress at work.OBJECTIVE: To determine the reproducibility of casual arterial pressure measurement and to confirm pressure diagnosis by monitoring of participants in the ELSA-Brasil (Estudo Longitudinal de Saude do Adulto - Brazilian Longitudinal Study for Adult Health). METHODS: Casual blood pressure was measured with an oscilometric device. A sub-sample of participants (N = 255) from Espirito Santo state (Southeastern Brazil) was reevaluated using the same methodology following one to ten weeks and, in addition, underwent arterial blood pressure monitoring. Diagnosis of hypertension used cut off points of 140/90 mmHg for casual pressure and 130/80 mmHg for arterial blood pressure monitoring. White coat hypertension was defined as the presence of hypertension in casual blood pressure and normal arterial blood pressure monitoring, and converse findings characterized masked hypertension. RESULTS: Data are from 230 participants that on the two occasions were free from antihypertensive medication (N1 = 153) or under the same antihypertensive regimen (N2 = 77). Normotension was confirmed by arterial blood pressure monitoring in120 out of 134 participants of the N1 group. In N2, blood pressure control was confirmed by arterial blood pressure monitoring in 43 of 54 participants with controlled hypertension per casual blood pressure. Overall diagnostic concordance between casual blood pressure and arterial blood pressure monitoring was 78% (kappa = 0.44). In the N1 group, six subjects (4%) presented white coat hypertension, and 23 subjects (25%) presented with masked hypertension. CONCLUSIONS: Diagnostic concordance between casual blood pressure and arterial blood pressure monitoring was moderate. The rigorous standardization of casual blood pressure measurement adopted in the ELSA-Brasil study was able to reduce white coat hypertension. The high frequency of masked hypertension may suggest that pressure values obtained by arterial blood pressure monitoring indicate an elevated degree of stress at work.

Sensitivity and specificity in the diagnosis of hypertension with different methods

OBJETIVO: Avaliar a sensibilidade e a especificidade de diferentes protocolos de medida da pressao arterial para o diagnostico da hipertensao em adultos. METODOS: Estudo transversal com amostra nao probabilistica de 250 funcionarios de ambos os sexos de instituicao publica na faixa etaria de 35 a 74 anos em Vitoria, ES, entre 2008 e 2010. Os participantes tiveram suas pressoes arteriais aferidas por tres metodos: medida clinica, automedida e medida ambulatorial por 24 horas. Foram coletados dados antropometricos (peso, estatura e circunferencias) e realizada entrevista. Os metodos foram confrontados e analisados em relacao a medida ambulatorial 24 h (padrao-ouro). Foram calculadas as medidas de desempenho diagnostico: sensibilidade, especificidade, valores preditivos positivos e negativos e acuracia. A metodologia de Bland & Altman foi utilizada para verificar a concordância entre a variabilidade pressorica na medida ambulatorial (desvio-padrao relativo ao periodo diurno) e a variabilidade pressorica na automedida (desvio-padrao das quatro medidas). Adotou-se nivel de significância de 5% para todos os testes. RESULTADOS: A automedida apresentou maior sensibilidade (S = 84%; IC95%: 75;93) e acuracia global (0,817; p < 0,001) no diagnostico da hipertensao que a medida clinica (S = 79%; IC95%: 73;86 e AG = 0,815; p < 0,001). Apesar da forte correlacao com o metodo de medida ambulatorial durante a vigilia (r = 0,843; p = 0,000), a automedida nao mostrou boa concordância com o referido metodo para a medida sistolica (vies = 5,82; IC95%: 4,49;7,15). Foram identificados sete (2,8%) individuos com hipertensao do avental branco, 26 (10,4%) com hipertensao mascarada e 46 (18,4%) com efeito do avental branco. CONCLUSOES: Os resultados sugerem que a automedida apresenta sensibilidade superior a medida clinica para identificar verdadeiros hipertensos na populacao. Os valores de predicao negativa encontrados confirmam a superioridade da automedida em relacao a medida clinica no que tange a capacidade do teste em apontar os individuos verdadeiramente normotensos. Contudo, nao pode substituir a medida clinica, que ainda e o metodo mais fidedigno.OBJECTIVE To evaluate sensitivity and specificity of different protocols for blood pressure measurement for the diagnosis of hypertension in adults. METHODS Cross-sectional study conducted in a non-probabilistic sample of 250 public servants of both sexes aged 35 to 74 years in Vitória, southeastern Brazil, between 2008 and 2010. The participants had their blood pressure measured using three different methods: clinic measurement, self-measured and 24-hour ambulatory measurement. They were all interviewed to obtain sociodemographic information and had their anthropometric data (weight, height, waist circumference) collected. Clinic measurement and self-measured were analyzed against the gold standard ambulatory measurement. Measures of diagnostic performance (sensitivity, specificity, accuracy and positive and negative predictive values) were calculated. The Bland & Altman method was used to evaluate agreement between ambulatory measurement (standard deviation for daytime measurements) and self-measured (standard deviation of four measurements). A 5% significance level was used for all analyses. RESULTS Self-measured blood pressure showed higher sensitivity (S=84%, 95%CI 75;93) and overall accuracy (0.817, p<0.001) in the diagnosis of hypertension than clinic measurement (S=79%, 95%CI 73;86, and overall accuracy=0.815, p<0.001). Despite the strong correlation with daytime ambulatory measurement values (r=0.843, p<0.001), self-measured values did not show good agreement with daytime systolic ambulatory values (bias=5.82, 95%CI 4.49;7.15). Seven (2.8%) cases of white coat hypertension, 26 (10.4%) of masked hypertension and 46 (18.4%) of white-coat effect were identified. CONCLUSIONS The study shows that self-measured blood pressure has higher sensitivity than clinic measurement to identify true hypertension. The negative predictive values found confirm the superiority of self-measured when compared to clinic in identifying truly normotensive individuals. However, clinic measurement cannot be replaced with self-measured, as it is still the most reliable method for the diagnosis of hypertension.

Sensibilidade e especificidade no diagnóstico de hipertensão por diferentes métodos

OBJETIVO: Avaliar a sensibilidade e a especificidade de diferentes protocolos de medida da pressao arterial para o diagnostico da hipertensao em adultos. METODOS: Estudo transversal com amostra nao probabilistica de 250 funcionarios de ambos os sexos de instituicao publica na faixa etaria de 35 a 74 anos em Vitoria, ES, entre 2008 e 2010. Os participantes tiveram suas pressoes arteriais aferidas por tres metodos: medida clinica, automedida e medida ambulatorial por 24 horas. Foram coletados dados antropometricos (peso, estatura e circunferencias) e realizada entrevista. Os metodos foram confrontados e analisados em relacao a medida ambulatorial 24 h (padrao-ouro). Foram calculadas as medidas de desempenho diagnostico: sensibilidade, especificidade, valores preditivos positivos e negativos e acuracia. A metodologia de Bland & Altman foi utilizada para verificar a concordância entre a variabilidade pressorica na medida ambulatorial (desvio-padrao relativo ao periodo diurno) e a variabilidade pressorica na automedida (desvio-padrao das quatro medidas). Adotou-se nivel de significância de 5% para todos os testes. RESULTADOS: A automedida apresentou maior sensibilidade (S = 84%; IC95%: 75;93) e acuracia global (0,817; p < 0,001) no diagnostico da hipertensao que a medida clinica (S = 79%; IC95%: 73;86 e AG = 0,815; p < 0,001). Apesar da forte correlacao com o metodo de medida ambulatorial durante a vigilia (r = 0,843; p = 0,000), a automedida nao mostrou boa concordância com o referido metodo para a medida sistolica (vies = 5,82; IC95%: 4,49;7,15). Foram identificados sete (2,8%) individuos com hipertensao do avental branco, 26 (10,4%) com hipertensao mascarada e 46 (18,4%) com efeito do avental branco. CONCLUSOES: Os resultados sugerem que a automedida apresenta sensibilidade superior a medida clinica para identificar verdadeiros hipertensos na populacao. Os valores de predicao negativa encontrados confirmam a superioridade da automedida em relacao a medida clinica no que tange a capacidade do teste em apontar os individuos verdadeiramente normotensos. Contudo, nao pode substituir a medida clinica, que ainda e o metodo mais fidedigno.OBJECTIVE To evaluate sensitivity and specificity of different protocols for blood pressure measurement for the diagnosis of hypertension in adults. METHODS Cross-sectional study conducted in a non-probabilistic sample of 250 public servants of both sexes aged 35 to 74 years in Vitória, southeastern Brazil, between 2008 and 2010. The participants had their blood pressure measured using three different methods: clinic measurement, self-measured and 24-hour ambulatory measurement. They were all interviewed to obtain sociodemographic information and had their anthropometric data (weight, height, waist circumference) collected. Clinic measurement and self-measured were analyzed against the gold standard ambulatory measurement. Measures of diagnostic performance (sensitivity, specificity, accuracy and positive and negative predictive values) were calculated. The Bland & Altman method was used to evaluate agreement between ambulatory measurement (standard deviation for daytime measurements) and self-measured (standard deviation of four measurements). A 5% significance level was used for all analyses. RESULTS Self-measured blood pressure showed higher sensitivity (S=84%, 95%CI 75;93) and overall accuracy (0.817, p<0.001) in the diagnosis of hypertension than clinic measurement (S=79%, 95%CI 73;86, and overall accuracy=0.815, p<0.001). Despite the strong correlation with daytime ambulatory measurement values (r=0.843, p<0.001), self-measured values did not show good agreement with daytime systolic ambulatory values (bias=5.82, 95%CI 4.49;7.15). Seven (2.8%) cases of white coat hypertension, 26 (10.4%) of masked hypertension and 46 (18.4%) of white-coat effect were identified. CONCLUSIONS The study shows that self-measured blood pressure has higher sensitivity than clinic measurement to identify true hypertension. The negative predictive values found confirm the superiority of self-measured when compared to clinic in identifying truly normotensive individuals. However, clinic measurement cannot be replaced with self-measured, as it is still the most reliable method for the diagnosis of hypertension.

Reproducibilidad de la presion arterial medida en el ELSA con el monitoreo de las medidas presoricas de 24h

OBJECTIVE To determine the reproducibility of casual arterial pressure measurement and to confirm pressure diagnosis by monitoring of participants in the ELSA-Brasil (Estudo Longitudinal de Saúde do Adulto - Brazilian Longitudinal Study for Adult Health). METHODS Casual blood pressure was measured with an oscilometric device. A sub-sample of participants (N = 255) from Espírito Santo state (Southeastern Brazil) was reevaluated using the same methodology following one to ten weeks and, in addition, underwent arterial blood pressure monitoring. Diagnosis of hypertension used cut off points of 140/90 mmHg for casual pressure and 130/80 mmHg for arterial blood pressure monitoring. White coat hypertension was defined as the presence of hypertension in casual blood pressure and normal arterial blood pressure monitoring, and converse findings characterized masked hypertension. RESULTS Data are from 230 participants that on the two occasions were free from antihypertensive medication (N1 = 153) or under the same antihypertensive regimen (N2 = 77). Normotension was confirmed by arterial blood pressure monitoring in 120 out of 134 participants of the N1 group. In N2, blood pressure control was confirmed by arterial blood pressure monitoring in 43 of 54 participants with controlled hypertension per casual blood pressure. Overall diagnostic concordance between casual blood pressure and arterial blood pressure monitoring was 78% (kappa = 0.44). In the N1 group, six subjects (4%) presented white coat hypertension, and 23 subjects (25%) presented with masked hypertension. CONCLUSIONS Diagnostic concordance between casual blood pressure and arterial blood pressure monitoring was moderate. The rigorous standardization of casual blood pressure measurement adopted in the ELSA-Brasil study was able to reduce white coat hypertension. The high frequency of masked hypertension may suggest that pressure values obtained by arterial blood pressure monitoring indicate an elevated degree of stress at work.OBJECTIVE: To determine the reproducibility of casual arterial pressure measurement and to confirm pressure diagnosis by monitoring of participants in the ELSA-Brasil (Estudo Longitudinal de Saude do Adulto - Brazilian Longitudinal Study for Adult Health). METHODS: Casual blood pressure was measured with an oscilometric device. A sub-sample of participants (N = 255) from Espirito Santo state (Southeastern Brazil) was reevaluated using the same methodology following one to ten weeks and, in addition, underwent arterial blood pressure monitoring. Diagnosis of hypertension used cut off points of 140/90 mmHg for casual pressure and 130/80 mmHg for arterial blood pressure monitoring. White coat hypertension was defined as the presence of hypertension in casual blood pressure and normal arterial blood pressure monitoring, and converse findings characterized masked hypertension. RESULTS: Data are from 230 participants that on the two occasions were free from antihypertensive medication (N1 = 153) or under the same antihypertensive regimen (N2 = 77). Normotension was confirmed by arterial blood pressure monitoring in120 out of 134 participants of the N1 group. In N2, blood pressure control was confirmed by arterial blood pressure monitoring in 43 of 54 participants with controlled hypertension per casual blood pressure. Overall diagnostic concordance between casual blood pressure and arterial blood pressure monitoring was 78% (kappa = 0.44). In the N1 group, six subjects (4%) presented white coat hypertension, and 23 subjects (25%) presented with masked hypertension. CONCLUSIONS: Diagnostic concordance between casual blood pressure and arterial blood pressure monitoring was moderate. The rigorous standardization of casual blood pressure measurement adopted in the ELSA-Brasil study was able to reduce white coat hypertension. The high frequency of masked hypertension may suggest that pressure values obtained by arterial blood pressure monitoring indicate an elevated degree of stress at work.

Sensibilidad y especificidad en el diagnóstico de hipertensión por diferentes métodos

OBJETIVO: Avaliar a sensibilidade e a especificidade de diferentes protocolos de medida da pressao arterial para o diagnostico da hipertensao em adultos. METODOS: Estudo transversal com amostra nao probabilistica de 250 funcionarios de ambos os sexos de instituicao publica na faixa etaria de 35 a 74 anos em Vitoria, ES, entre 2008 e 2010. Os participantes tiveram suas pressoes arteriais aferidas por tres metodos: medida clinica, automedida e medida ambulatorial por 24 horas. Foram coletados dados antropometricos (peso, estatura e circunferencias) e realizada entrevista. Os metodos foram confrontados e analisados em relacao a medida ambulatorial 24 h (padrao-ouro). Foram calculadas as medidas de desempenho diagnostico: sensibilidade, especificidade, valores preditivos positivos e negativos e acuracia. A metodologia de Bland & Altman foi utilizada para verificar a concordância entre a variabilidade pressorica na medida ambulatorial (desvio-padrao relativo ao periodo diurno) e a variabilidade pressorica na automedida (desvio-padrao das quatro medidas). Adotou-se nivel de significância de 5% para todos os testes. RESULTADOS: A automedida apresentou maior sensibilidade (S = 84%; IC95%: 75;93) e acuracia global (0,817; p < 0,001) no diagnostico da hipertensao que a medida clinica (S = 79%; IC95%: 73;86 e AG = 0,815; p < 0,001). Apesar da forte correlacao com o metodo de medida ambulatorial durante a vigilia (r = 0,843; p = 0,000), a automedida nao mostrou boa concordância com o referido metodo para a medida sistolica (vies = 5,82; IC95%: 4,49;7,15). Foram identificados sete (2,8%) individuos com hipertensao do avental branco, 26 (10,4%) com hipertensao mascarada e 46 (18,4%) com efeito do avental branco. CONCLUSOES: Os resultados sugerem que a automedida apresenta sensibilidade superior a medida clinica para identificar verdadeiros hipertensos na populacao. Os valores de predicao negativa encontrados confirmam a superioridade da automedida em relacao a medida clinica no que tange a capacidade do teste em apontar os individuos verdadeiramente normotensos. Contudo, nao pode substituir a medida clinica, que ainda e o metodo mais fidedigno.OBJECTIVE To evaluate sensitivity and specificity of different protocols for blood pressure measurement for the diagnosis of hypertension in adults. METHODS Cross-sectional study conducted in a non-probabilistic sample of 250 public servants of both sexes aged 35 to 74 years in Vitória, southeastern Brazil, between 2008 and 2010. The participants had their blood pressure measured using three different methods: clinic measurement, self-measured and 24-hour ambulatory measurement. They were all interviewed to obtain sociodemographic information and had their anthropometric data (weight, height, waist circumference) collected. Clinic measurement and self-measured were analyzed against the gold standard ambulatory measurement. Measures of diagnostic performance (sensitivity, specificity, accuracy and positive and negative predictive values) were calculated. The Bland & Altman method was used to evaluate agreement between ambulatory measurement (standard deviation for daytime measurements) and self-measured (standard deviation of four measurements). A 5% significance level was used for all analyses. RESULTS Self-measured blood pressure showed higher sensitivity (S=84%, 95%CI 75;93) and overall accuracy (0.817, p<0.001) in the diagnosis of hypertension than clinic measurement (S=79%, 95%CI 73;86, and overall accuracy=0.815, p<0.001). Despite the strong correlation with daytime ambulatory measurement values (r=0.843, p<0.001), self-measured values did not show good agreement with daytime systolic ambulatory values (bias=5.82, 95%CI 4.49;7.15). Seven (2.8%) cases of white coat hypertension, 26 (10.4%) of masked hypertension and 46 (18.4%) of white-coat effect were identified. CONCLUSIONS The study shows that self-measured blood pressure has higher sensitivity than clinic measurement to identify true hypertension. The negative predictive values found confirm the superiority of self-measured when compared to clinic in identifying truly normotensive individuals. However, clinic measurement cannot be replaced with self-measured, as it is still the most reliable method for the diagnosis of hypertension.