BP Measurement in Clinical Practice: Time to SPRINT to Guideline-Recommended Protocols

Hypertension is the leading chronic disease risk factor in the world and is especially important in patients with CKD, nearly 90% of whom have hypertension. Recently, in the Systolic BP Intervention Trial (SPRINT), intensive lowering of clinic systolic BP to a target <120 mm Hg, compared with a standard BP target of <140 mm Hg, reduced risk for cardiovascular disease and all-cause mortality. However, because BP was measured unobserved using an automated device, some investigators have questioned the ability to translate SPRINT results into routine clinical practice, in which measurement of BP is typically less standardized. In this review, we discuss the BP measurement techniques used in major observational studies and clinical trials that form the evidence base for our current approach to treating hypertension, evaluate the effect of measurement technique on BP readings, and explore how ambulatory BP data from the SPRINT trial may inform this discussion. We conclude by arguing for implementation of guideline-recommended BP measurement techniques in routine clinical practice.

Low fruit and vegetable consumption in Mozambique: results from a WHO STEPwise approach to chronic disease risk factor surveillance

Monitoring food consumption and its determinants over time is essential for defining and implementing health promotion strategies, but surveillance is scarce in Africa. The present study aimed to describe fruit and vegetable consumption in Mozambique according to socio-demographic characteristics and place of residence (urban/rural). A national representative sample (n 3323) of subjects aged 25–64 years was evaluated in 2005 following the WHO Stepwise Approach to Chronic Disease Risk Factor Surveillance, which included an assessment of usual fruit and vegetable consumption (frequency and quantity). Crude prevalence and age-, education- and family income-adjusted prevalence ratios (PR) with 95 % CI were computed. Less than 5 % of the subjects reported an intake of five or more daily servings of fruits/vegetables. Both fruits and vegetables were more often consumed by women and in rural settings. In urban areas, the prevalence of fruit intake ( ≥ 2 servings/d) increased with education ( ≥ 6 years v. < 1 year: women, adjusted PR = 3·11, 95 % CI 1·27, 7·58; men, adjusted PR = 3·63, 95 % CI 1·22, 10·81), but not with income. Conversely, vegetable consumption ( ≥ 2 servings/d) was less frequent in more educated urban men ( ≥ 6 years v. < 1 year: adjusted PR = 0·30, 95 % CI 0·10, 0·94) and more affluent rural women ( ≥ $801 US dollars (USD) v. $0–64: adjusted PR = 0·32, 95 % CI 0·13, 0·81). The very low intake of these foods in this setting supports the need for fruit and vegetable promotion programmes that target the whole population, despite the different socio-demographic determinants of fruit and vegetable intake.