US Pharm. 2023;48(12):32-35.

Blood pressure (BP) is one of the most routinely measured clinical parameters, and its values affect many therapeutic decisions. In the United States, hypertension accounts for approximately $131 billion in medical expenditure each year, averaged over 12 years from 2003 to 2014.^1,2 The American College of Cardiology and American Heart Association (ACC/AHA) hypertension guidelines classify BP into four categories: normal (<120 systolic and <80 mmHg diastolic), elevated (120-129 systolic and <80 mmHg diastolic), stage 1 hypertension (130-139 systolic or 80-89 mmHg diastolic), and stage 2 hypertension (≥140 systolic or ≥90 mmHg diastolic).³ The higher the BP, the greater the risk for other health problems such as heart disease and strokes, which are the leading causes of death in the U.S.

In individuals aged 40 to 69 years, a 20-mmHg rise of systolic BP or a 10-mmHg rise of diastolic BP is associated with greater than two times the risk for stroke or ischemic heart disease mortality. A systolic BP reduction of 5 mmHg can decrease stroke and cardiovascular mortality by 14% and 9%, respectively.⁴ BP can be assessed in the doctor’s office or out-of-office with self-monitoring devices. The ACC/AHA recommends that individuals with hypertension monitor their pressure at home. The advantages of out-of-office BP monitoring include increasing early diagnosis, keeping track of treatment progress, cutting healthcare costs, and evaluating whether BP readings differ outside of the office due to potential white coat syndrome.³ The Omron HeartGuide is one of the most recent options for at-home BP monitoring.⁵

Epidemiology

According to the World Health Organization, about 1.1 billion people worldwide have hypertension, with two-thirds of them residing in lower-income countries.⁶ In the U.S., 108 million people live with hypertension, and only 25% of them have controlled BP. In contrast, 33% of Americans are unaware that they have hypertension and remain untreated. In 2018, hypertension was the primary or leading cause of mortality, accounting for approximately 500,000 deaths. Statistics demonstrate that men are at a slightly higher risk for developing hypertension compared with women. Additionally, hypertension is more common in African American adults, with about 54% affected, followed by non-Hispanic white adults with 46%, Asians with 39% of adults, and Hispanic adults at 36%.⁴

Etiology

Hypertension may be categorized as either essential or secondary. Primary (essential hypertension) is hypertension diagnosed in the absence of an identifiable secondary cause. It is estimated that 90% to 95% of adults with hypertension have primary hypertension. Although the cause is unknown, many risk factors can influence BP, such as family history, diet components (e.g., excessive sodium intake), physical inactivity, alcoholism, diabetes, and dyslipidemia. The Framingham Heart Study has consistently identified a direct relationship between hypertension and BMI, suggesting that obesity may be responsible for hypertension in 78% of men and 68% of women.⁷

Secondary hypertension accounts for 5% to 10% of hypertensive cases. Secondary hypertension is hypertension that is caused by medical conditions such as autoimmune disorders (systemic lupus erythematosus), cardiovascular diseases (coarctation of the aorta), endocrine disorders (hypothyroidism or hyperthyroidism), or hematologic diseases (sickle cell disease).^4,7

Furthermore, secondary hypertension can be caused by renal disease and primary aldosteronism. Aldosterone is a hormone that controls salt and potassium levels in the blood. Overproduction of aldosterone causes the body to retain more sodium and excrete potassium, which leads to elevated BP.⁸ Chronic kidney disease risk factors affect BP through the increased activity of the renin-angiotensin-aldosterone system and activation of the sympathetic nervous system, leading to increased levels of neurohormones that can also increase BP.⁵ Obstructive sleep apnea may lead to increases in BP and strain the cardiovascular system.⁹ Secondary hypertension can also be caused by illicit drugs, alcohol induction, or pharmaceuticals, including acetaminophen, amphetamines, and antidepressants.¹⁰

Diagnosis

Hypertension has been called the “silent killer” because it usually does not present with any warning signs or symptoms.¹ According to the ACC/AHA guidelines, the individual must have at least two in-office elevated readings on two separate occasions to be diagnosed with hypertension. In addition, the guidelines recommend using out-of-office BP measurements to confirm the diagnosis by self-monitoring with about two to three readings in the morning and evening before meals and medications. These are ideal options for receiving the patient’s BP history, as readings in clinical offices may be higher, resulting in incorrect treatment due to white coat syndrome.³

Management, Safety Precautions, Prevention

In adults, the ACC/AHA guidelines recommend a plethora of nonpharmacologic interventions. Nonpharmacologic interventions can be accomplished by employing lifestyle modifications, such as weight loss management (1-kg weight loss results in approximately 1-mmHg reduction of systolic and diastolic BP); incorporating a heart-healthy diet (e.g., DASH diet composed of fruits, vegetables, whole grains, low-fat dairy products, reduced saturated fats and total fats); sodium reduction (goal <1,500 mg/d); potassium supplementation (goal 3,500 to 5,000 mg/d); increased physical activity; and limitation of alcohol consumption. Each of these interventions has a suggested approximate impact on systolic BP. According to the guidelines, the effect is a 5-mmHg decrease for weight loss, an 11-mmHg decrease for diet, a 5- to 6-mmHg decrease for reduced dietary sodium intake, a 4- to 5-mmHg decrease for enhanced intake of dietary potassium, a 4- to 8-mmHg decrease for physical activity, and a 4-mmHg decrease for moderation in alcohol consumption.³

Additionally, there are several medications utilized for the management of hypertension. The primary drug classes utilized for the management of hypertension include thiazide diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and calcium channel blockers. Initial therapy is based on patient-specific factors, such as race and ethnicity, pregnancy status, age, and the presence of other comorbidities, such as heart disease, heart failure, chronic kidney disease, ischemic stroke, or diabetes mellitus. The relative risk reduction for cardiovascular prevention and the use of BP-lowering medication is consistent in varying groups that differ in cardiovascular risks. These groups include but are not limited to sex, age, BMI, and the presence or absence of diabetes mellitus, atrial fibrillation, and chronic kidney disease.³ The overall goal of hypertension management is to reduce BP and prevent cardiovascular-related events.¹

Omron HeartGuide

On January 8, 2019, the HeartGuide received 510K FDA clearance and was released for consumer consumption by Omron Healthcare. This noninvasive oscillometric BP monitor is the world’s first FDA-approved fitness watch to provide accurate and automatic BP monitoring.⁵ Similar to traditional BP monitors, to measure arterial BP, the HeartGuide utilizes an air pump located within the watch band to sense arterial wall vibrations.¹¹ Oscillometric measurement is recognized as the only FDA standard for noninvasive BP monitoring at home.¹²

The Omron HeartGuide is a user-friendly, nontouchscreen device with approximately three buttons to access and navigate its features. The device is available in medium and large wrist sizes to accommodate different patients and ensure the accuracy of readings. Users can expect to charge the device two to three times per week, depending on the frequency and features utilized. The Omron HeartGuide wristwatch can store up to 100 BP readings.¹³ These BP readings can be transferred and accessed on Omron connect US/CAN app, which is a free mobile application available to both android and IOS consumers. Clinicians can review the data through the VitalSight remote patient-monitoring program. This mobile health platform allows real-time data collection and storage of BP readings to provide an accurate understanding of BP changes and aid doctors in developing evidence-based treatment plans for patients. The Omron HeartGuide is being sold for $499 on the Omron Healthcare website.¹⁶

Compared with other BP monitors, oscillometric BP monitoring in a smartwatch design offers several advantages. This device records and archives heart rate, number of steps, aerobic or high-impact steps, distance traveled, and calories burned. Coupled with these functions, the HeartGuide has the functionality of a traditional smartwatch, such as the ability to receive text messages, calls, and email notifications.¹⁵ An additional feature is the monitoring of sleep quality, which is essential, as people are more likely to experience cardiac emergencies such as heart attack or stroke during the morning and last stage of sleep.^14,17 For this reason, Omron aims to reduce the incidence of stroke and heart attack.¹¹

Traditionally, the upper arm has been preferred to measure BP. According to the AHA, arm BP monitors are the most accurate, while wrist monitors are not preferred; however, these devices can yield accurate results if used appropriately.^15,22 When used in a home environment, the HeartGuide requires recalibration every 2 years to ensure the accuracy of readings.¹² A study was conducted to evaluate the use of an arm monitor, the Omron M6, and a wrist monitor, the Omron R7, in 33 participants using the European Society of Hypertension protocol methodology. For both devices, the readings differed by less than 15 mmHg, thereby validating the International Protocol’s recommendations.¹⁸

Another study evaluated the accuracy of three automated electronic oscillometric BP measuring devices in 33 elderly participants. The devices that underwent evaluation were the Omron M5-I (home-use upper arm monitor), R5-I (home-use wrist monitor), and HEM-907 (professional-use upper arm monitor). The results determined that the home-use upper arm monitor was more precise than the home-use wrist monitor and professional-use upper arm monitor. However, all three devices fulfilled the validations recommended by the International Protocol. Although limited, these results suggest that wrist BP monitors are a reliable alternative to the upper arm monitor.²⁰ Additionally, a study compared the HeartGuide with a conventional ambulatory BP monitor on in-office and out-of-office settings in 50 participants. The results concluded that the difference between the HeartGuide and the conventional ambulatory BP monitor device was acceptable in and out of the office.^19,21

Although the Omron HeartGuide is arguably convenient and aesthetically appealing, limitations do exist. The HeartGuide costs $499, thereby having little economic appeal.¹¹ On average, many top-rated BP monitors cost between $50 and $100.¹⁷ Hypertension predominantly plagues low- to middle-class African American populations.²¹ Therefore, the cost of the HeartGuide and the lack of insurance coverage for wrist monitors make this device inaccessible to the individuals who would benefit from it the most.

Additionally, this device has a built-in heart zone indicator that must be appropriately positioned to achieve an accurate reading.^12,13 Variations in user size and body type can result in measurement errors. BP readings should not be taken more frequently than necessary in older adults because bruising can occur due to blood flow interference. For the best results, proper preparation before each BP reading should be followed.¹⁵

Conclusion

BP is one of the most screened clinical parameters. At-home BP monitoring can aid in the reduction of cardiovascular events such as stroke and heart attack, denote whether the prescribed antihypertensive medication is effective, and provide both the doctor and patient with a patient-specific understanding of the impact of the patient’s lifestyle on the heart. The Omron HeartGuide is a wrist BP monitor used to provide accurate on-the-go BP measurements throughout the day. Although limitations include cost and increased likelihood of user error if the instructions are not strictly followed, the device’s strengths include the ability to record BP readings on the go and measure heart rate and sleep quality. This device is wearable and allows access to real-time BP readings. For more information regarding the HeartGuide wearable BP monitor, visit https://omronhealthcare.com/products/heartguide-wearable-blood-pressure-monitor-bp8000m/.

REFERENCES

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