Ambulatory Blood Pressure Monitoring in Resistant Hypertension (original) (raw)
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How to use ambulatory blood pressure monitoring in resistant hypertension
Hypertension Research, 2013
Resistant hypertension is defined as an uncontrolled office blood pressure (BP) despite the use of at least three antihypertensive drugs, in adequate doses and combinations, preferentially including one diuretic. It is a clinical diagnosis based on office BP measurements. Ambulatory BP monitoring (ABPM) is the cornerstone in the management of patients with resistant hypertension, as it is mandatory for diagnosis, treatment, follow-up and prognosis. In relation to diagnosis, ABPM measurements have classified patients with resistant hypertension into four subgroups: true, white-coat, controlled and masked resistant hypertension. This classification largely defines the therapeutic approach and the follow-up for each group. In this way, the target of antihypertensive treatment is ambulatory BP control and not office BP control. Chronotherapy based on ABPM values might frequently lead to a more rational treatment regimen. In relation to prognosis, uncontrolled ambulatory BP levels at baseline identify a subgroup of patients with a very high cardiovascular risk profile and a significantly worse prognosis. ABPM parameters can provide a better cardiovascular risk stratification than other traditional risk factors and office BPs.
Twenty-four hour ambulatory blood pressure monitoring pattern of resistant hypertension
Blood Pressure Monitoring, 2003
Background Due to large beat-to-beat blood pressure variation the use of 24-h ambulatory blood pressure monitoring in patients with atrial fibrillation has been questioned. Methods Repeatability and variability of 24-h ambulatory blood pressure (Accutraccer II or Diasys Integra), and daily blood pressure variation was examined in 42 patients aged 51-81 (median 73.5) years admitted for elective electrocardioversion of atrial fibrillation. Results Before cardioversion 24-h ambulatory systolic blood pressure was slightly lower and nocturnal blood pressure reduction was larger in the group of patients who achieved sinus rhythm than in the group who maintained atrial fibrillation (11.5/10.5 versus 4.1/4.7 mmHg; P o 0.05). No statistically significant change was observed in ambulatory blood pressure after cardioversion in any of the two groups. Blood pressure variability (SD/mean) was 10-14% both in patients with and without conversion to sinus rhythm. Coefficient of repeatability (2 SD of difference) was 13.6 mmHg (16.6%) for diastolic blood pressure and 30.2 mmHg (24.7%) for systolic blood pressure in patients with normalized heart rhythm and 17.0 and 29.0 mmHg (21.5 and 22.4%) in patients with maintained atrial fibrillation, respectively. Conclusion Ambulatory blood pressure monitoring provides data with similar variability and repeatability in patients with atrial fibrillation as in subjects with normal cardiac rhythm. Twenty-four-hour ambulatory blood pressure measurement is applicable in atrial fibrillation in the same way as during sinus rhythm. Blood Press Monit 7: 149-156 & 2002 Lippincott Williams & Wilkins.
AMBULATORY BLOOD PRESSURE MONITORING IN INTREATED HYPERTENSIVES: WHAT ARE THE TARGET PARAMETERS
2017
Ambulatory blood pressure monitoring (ABPM) as out-of-office method of evaluation blood pressure (BP) is recommended in guidelines for the practical clinical use of the diagnosis and management of hypertension. However, there is poor information about the algorithm of ABPM analysis strategy in treated cohort individuals. To this purpose, we analyzed 150 ABPM records in hypertensive individuals with essential hypertension. We have selected ABPM data in 150 patients conducted ABPM with a bifunctional recorder (Incart, S.-P., RF) using an oscillometric method. For analyzing matter, we defined awake and asleep periods as the fixed periods of time (from 9:00 AM to 9:00 PM as day time and from 01:00 to 06:00 AM as a nighttime period). We have also calculated BP averages for systolic BP (SBP), diastolic BP (DBP) and pulse pressure (PP) for 24-h, day and nighttime periods. Moreover, we calculated sleep-through morning surge as the average morning SBP minus moving lowest nocturnal SBP [5], a dipping status and SBPnight variability. Results. The age of participants was 61 (10,4) yrs, 54 % was male. We found average SBPday < 135 mmHg and/or average DBPday< 85 mmHg in 53 cases. In that subgroup SBPnight variability < 12.2 mmHg, average PBP24 < 53 mmHg, sleep-through morning surge < 37mmHg and a dipping status was found in 11 cases. Conclusion. In this retrospective study 35 % of hypertensive subjects achieve target level of ABPM component basis on a day-time BP and only 7 % of subjects in the same hypertensive population reach target level of five ambulatory BP parameters as pulse presse, morning surge, dipping status and SBP variability in night period.
Hypertension, 2012
Resistant hypertension is defined as uncontrolled office blood pressure, despite the use of ≥3 antihypertensive drugs. Ambulatory blood pressure monitoring (ABPM) is mandatory to diagnose 2 different groups, those with true and white-coat resistant hypertension. Patients are found to change categories between controlled/uncontrolled ambulatory pressures without changing their office blood pressures. In this way, ABPM should be periodically repeated. The aim of this study was to evaluate the most appropriate time interval to repeat ABPM to assure sustained blood pressure control in patients with white-coat resistant hypertension. This prospective study enrolled 198 patients (69% women; mean age: 68.9±9.9 years) diagnosed as white-coat resistant hypertension on ABPM. Patients were submitted to a second confirmatory examination 3 months later and repeated twice at 6-month intervals. Statistical analyses included Bland-Altman repeatability coefficients and multivariate logistic regressi...
2016
Abstract—Resistant hypertension is defined as uncontrolled office blood pressure, despite the use of 3 antihypertensive drugs. Ambulatory blood pressure monitoring (ABPM) is mandatory to diagnose 2 different groups, those with true and white-coat resistant hypertension. Patients are found to change categories between controlled/uncontrolled ambulatory pressures without changing their office blood pressures. In this way, ABPM should be periodically repeated. The aim of this study was to evaluate the most appropriate time interval to repeat ABPM to assure sustained blood pressure control in patients with white-coat resistant hypertension. This prospective study enrolled 198 patients (69 % women; mean age: 68.99.9 years) diagnosed as white-coat resistant hypertension on ABPM. Patients were submitted to a second confirmatory examination 3 months later and repeated twice at 6-month intervals. Statistical analyses included Bland-Altman repeatability coefficients and multivariate logistic ...
Is home blood pressure monitoring useful in the management of patients with resistant hypertension?
American journal of hypertension, 2015
Ambulatory blood pressure (BP) monitoring (ABPM) is a cornerstone in resistant hypertension (RHT) management. However, it has higher cost and lower patients' acceptance than home BP monitoring (HBPM). Our objective was to evaluate HBPM usefulness in the management of patients with RHT. A total of 240 patients were submitted to 24-hour ABPM and 5-day HBPM (triplicate morning and evening measurements). Patients with uncontrolled office BP (≥140/90mm Hg) were classified as true RHT (daytime or home BP ≥135/85mm Hg) or white-coat RHT (daytime or home BP <135/85mm Hg), and patients with controlled office BP were classified as masked RHT (daytime or home BP ≥135/85mm Hg) or controlled RHT (daytime or home BP <135/85mm Hg). Sensitivity, specificity, predictive values, and likelihood ratios for HBPM were calculated. Agreement between the procedures was evaluated using kappa coefficients and the Bland-Altman method. Mean office BP was 157±26/84±16mm Hg, mean daytime BP was 134±18/7...
Ambulatory blood pressure monitoring: from old concepts to novel insights
International Urology and Nephrology, 2012
Ambulatory blood pressure monitoring (ABPM) is an out-of-office technique for the assessment of 24-h blood pressure measurements. ABPM is indicated to diagnose many conditions, including white-coat hypertension, resistant hypertension, episodic hypertension, nocturnal hypertension, autonomic dysfunction, hypotension secondary to excessive usage of antihypertensive medication, and masked hypertension. ABPM gives a better prediction of clinical outcomes in patients with hypertension and cardiovascular diseases when compared to office blood pressure measurements. Recently, several new indices have been introduced with the aim of predicting various clinical end-points in several patient populations. In this review, we aimed to determine the clinical utility of 24-h ABPM and its potential implications for the management of hypertension in patients with a high risk of cardiovascular mortality and morbidity, as well as various novel indices that can predict clinical end-points in different patient populations.