Chief findings from IHS at CSI 2018 by Dr. Sundeep Mishra
M3 India Newsdesk Dec 04, 2018
Prof. Dr. Sundeep Mishra summarises the India Heart Study, presented at this year's Annual CSI (Cardiology Society of India) Meeting.
Prof. Mishra: The diagnosis of hypertension based on office blood pressure measurement alone can be fallacious. The home measurement of BP is genuinely crucial.
Chief findings of IHS
Even after repeated office measurement, the prevalence of white-coat and masked hypertension were found to be 10% and 9% respectively, indicating “Out of Office” measurement as the ideal method of Hypertension measurement.
Many global studies have established Heart rate as an independent risk factor for a cardiac event, but Indian data on heart rate was very limited.
The IHS- interim analysis revealed:
- Average heart rate of 8551 subjects was found to be 82
- Elevated heart rate (>80 bpm) was observed in 51% of the subjects
It is important because as resting heart rate goes up by 10 bpm (as is observed in the IHS), the association with cardiovascular death increases by 14% and that with all-cause mortality increases by 20%.
This year, Prof. Upendra Kaul presented an interim analysis of the India Heart Study on the sidelines of the CSI Annual Meeting held in Mumbai 2018.
The India Heart study
Background
Numerous studies have suggested that India is becoming the hypertension capital of the world. Accurate blood pressure measurement is crucial for treatment but data about hypertension measurement in India demonstrate large heterogeneity in blood pressure measurement methods.
The most followed blood pressure measurement method in India i.e. office blood pressure measurement has serious limitations. Hence the India Heart Study (IHS) was conceptualized with the aim to identify:
- Whether the diagnosis of hypertension based on home measurement of blood pressure (HBPM) differs from the diagnosis based on the office blood pressure measurement (OBPM)
- Prevalence of white coat hypertension and masked hypertension
- Prevalence of elevated heart rate in the Indian subjects
Methods
The India Heart Study aimed to screen 30,000 drug-naïve (anti-hypertensive) subjects to be screened at 2000 consulting physician practices. The design of the study included:
Visit 1:
- Office reading (as per current practice of clinician)
- Home measurement: Home blood pressure monitoring for 7 days
Visit 2:
- Office reading (as per current practice of clinician after 7 days of HBPM)
Results
The interim analysis of 9600 subjects from over 1300 clinics was carried out and the results were striking. Data from 8551 subjects (as per inclusion/exclusion criteria) reflected that:
- In 30% of cases, over two visits, there was a significant discrepancy in office BP measurements and thereby in the diagnosis of hypertension.
- On the basis of only one office-based reading (visit-1), the prevalence of white coat Hypertension was found to be 25% while the prevalence of masked Hypertension was found to be 14%.
- The number of white coat hypertensives in the second visit were lesser than the first visit while that of masked hypertension was higher in the second visit.
In clinical practice, this is of prime importance as many people are unnecessarily exposed to drugs (as is the case with white coat hypertension) while many hypertensives are untreated and predisposed to cardiovascular events (as is the case with masked hypertension).
Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.
The writer, Dr. Sundeep Mishra is a Professor of Cardiology.
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