Randomized trial of guiding hypertension management using central aortic blood pressure compared with best-practice care: principal findings of the BP GUIDE study

Sharman, James E., Marwick, Thomas H., Gilroy, Deborah, Otahal, Petr, Abhayaratna, Walter P. and Stowasser, Michael (2013) Randomized trial of guiding hypertension management using central aortic blood pressure compared with best-practice care: principal findings of the BP GUIDE study. Hypertension, 62 6: 1138-1145. doi:10.1161/HYPERTENSIONAHA.113.02001


Author Sharman, James E.
Marwick, Thomas H.
Gilroy, Deborah
Otahal, Petr
Abhayaratna, Walter P.
Stowasser, Michael
Title Randomized trial of guiding hypertension management using central aortic blood pressure compared with best-practice care: principal findings of the BP GUIDE study
Journal name Hypertension   Check publisher's open access policy
ISSN 0194-911X
1524-4563
Publication date 2013-12-01
Sub-type Article (original research)
DOI 10.1161/HYPERTENSIONAHA.113.02001
Volume 62
Issue 6
Start page 1138
End page 1145
Total pages 8
Place of publication Philadelphia, PA, United States
Publisher Lippincott Williams & Wilkins
Language eng
Abstract Arm cuff blood pressure (BP) may overestimate cardiovascular risk. Central aortic BP predicts mortality and could be a better method for patient management. We sought to determine the usefulness of central BP to guide hypertension management. This was a prospective, open-label, blinded-end point study in 286 patients with hypertension randomized to treatment decisions guided by best-practice usual care (n=142; using office, home, and 24-hour ambulatory BP) or, in addition, by central BP intervention (n=144; using SphygmoCor). Therapy was reviewed every 3 months for 12 months, and recommendations were provided to each patient and his/her doctor on antihypertensive medication titration. Outcome measures were as follows: medication quantity (daily defined dose), quality of life, and left ventricular mass (3-dimensional echocardiography). There was 92% compliance with recommendations on medication titration, and quality of life improved in both groups (post hoc P<0.05). For usual care, there was no change in daily defined dose (all P>0.10), but with intervention there was a significant stepwise decrease in daily defined dose from baseline to 3 months (P=0.008) and each subsequent visit (all P<0.001). Intervention was associated with cessation of medication in 23 (16%) patients versus 3 (2%) in usual care (P<0.001). Despite this, there were no differences between groups in left ventricular mass index, 24-hour ambulatory BP, home systolic BP, or aortic stiffness (all P>0.05). We conclude that guidance of hypertension management with central BP results in a significantly different therapeutic pathway than conventional cuff BP, with less use of medication to achieve BP control and no adverse effects on left ventricular mass, aortic stiffness, or quality of life.
Keyword Aorta
Clinical trial
Heart ventricles
Hemodynamics
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Originally published online: 23 September 2013.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
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