Value of Ambulatory Blood Pressure Monitoring in Evaluation of Blood Pressure Control in Patients on Antihypertensive Treatment (original) (raw)
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JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2018
Introduction: Regular monitoring of blood pressure in chronic hypertensive patients on antihypertensive therapy is essential to assess cardiovascular events and to prevant target organ damage. Aim: The present study was undertaken as an attempt to correlate the relation between random blood pressure monitoring and 24 hour Ambulatory blood pressure monitoring in chronic hypertensive patients on therapy and to assess the efficacy of antihypertensive medication in chronic hypertensive patients. Materials and Methods: The study was undertaken as a prospective cross-sectional study among 100 patients during the period of June 2015 to June 2016 using convenient sampling technique. As per Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High blood Pressure (JNC 7) guidelines, cases of diagnosed hypertension on regular medication and on follow-up in the outpatient department of General Medicine in a tertiary care hospital were included in the study. Blood pressure was recorded using a mercury sphygmomanometer or aneroid or electronic device as per JNC guidelines. After that Ambulatory Blood Pressure Monitoring (ABPM) device was attached on a belt connected to a standard cuff in the upper arm which uses an oscillometry technique to detect systolic, diastolic and Mean Arterial Blood Pressure (MAP). Descriptive statistics was expressed by means and proportions. Paired t-test was used to find statistically significant difference in related sample observations. A p-value <0.05 was considered statistically significant. Results: Majority of the study participants were males and were in the age group of 31-40 years. There was a significant difference between random (clinic) blood pressure and ambulatory blood pressure recordings. It was observed that 36 patients (36%) were dippers, 54 patients (54%) were nondippers, 10 patients (10%) were reverse dippers independent of clinical blood pressure readings. Conclusion: Ambulatory blood pressure monitoring gives a true estimate of 24 hour readings rather than a single clinic blood pressure which can be influenced by so many factors. It also gives an estimate of other variables like morning surge and nocturnal dip.
Role of ambulatory blood pressure measurement in diagnosis and control of hypertension
Medical Journal Armed Forces India, 2002
Oftice blood pressure (BP) measurements by sphygmomanometer are not necessarUy representative of patient's usual blood pressure. In contrast, ambulatory blood pressure measurements (ABPM) represent a large number of readJngs and may reOeet the actual BP status of an iadivtduaJ. ID this study, ISO individuals were studied in 2 groups. 110 patients (group A) bad stage I & n, hypertensJon based on casual BP readings. 26 (23.6%) of them were found to be normootens.ive~per existing ABPM standard. There were 40 patients with poorly controlled hypertension on multiple drugs (group B). The trougb/peak ratio of >50% was seen in 12.5% of these patients at start of study. Thk increased to 84.8% after modification of drugs~per the profile on ABPM, thus indicating usefuloess in acl1ievlng a smoother co.trot MJAFI2002; 58 : 307-309
Hypertension is a very common disease, and office measurements of blood pressure are frequently inaccurate. Ambulatory Blood Pressure Monitoring (ABPM) offers a more accurate diagnosis, more detailed readings of average blood pressures, better blood pressure measurement during sleep, fewer false positives by detecting more white-coat hypertension, and fewer false negatives by detecting more masked hypertension. ABPM offers better management of clinical outcomes. For example, based on more accurate measurements of blood pressure variability, ABPM demonstrates that taking anti-hypertensive medication at night leads to better controlled nocturnal blood pressure, which translates into less end organ damage and fewer clinical complications of hyper-tension. For these reasons, albeit some shortcomings which were discussed, ABPM should be considered as a first-line tool for diagnosing and managing hypertension.
Sultan Qaboos University medical journal, 2010
Blood pressure (BP) measurements taken in a physician's clinic do not represent readings throughout the day. Ambulatory blood pressure monitoring (ABPM) overcomes this problem by providing multiple readings with minimal interference with the patient's daily activities. The purpose of our study was to evaluate the value of ABPM in risk assessment and management of hypertension compared to office measurements. A total of 104 consecutive hypertensive patients were retrospectively studied from January 2007 to December 2009. The following data were gathered: 1) clinic BP measurements; 2) routine blood test results; 3) electrocardiography, echocardiography, and 4) 24-hour ABPM. The mean age of patients was 41.1 ± 8.6 years and 51.9% of them male. Indications for ABPM were: suspected "white coat" hypertension (10.6%), de novo hypertension (18.2%), resistant hypertension (27.9%) and others (43.3%). Mean daytime and nighttime BP were 134/82 and 124/73 mmHg respectively. A n...
Hypertension, 1999
Previous studies have reported results on 24-hour ambulatory blood pressure (ABP) in Europe and Japan, but no data exists from South America. In this study, we conducted a population survey to identify reference values and to compare ambulatory blood pressure with clinic, home, and self-measured values. A random sample of 2650 adults was selected among 190 000 people covered by our prepaid healthcare institution. Clinic (physician and nurse) and home (nurse) blood pressure measurements were performed 3 times each, with semiautomatic electronic equipment. Self-measurements were performed by the subjects manually activating the ambulatory device. We analyzed 1573 individuals who were not receiving antihypertensive therapy from 1921 participants. Self-measurement was available in a subgroup of 577 participants younger than the whole sample. Normal ambulatory blood pressure limits were estimated as those that best correlated with 140/90 mm Hg at clinic. Estimated values were 125/80 mm Hg for 24-hour ambulatory (range: 122 to 128 and 77 to 83 mm Hg) and 129/84 mm Hg for daytime ambulatory (range: 127 to 132 and 81 to 86) blood pressure, depending on gender and age. Ambulatory and clinic blood pressures increased with age. The age-dependent increase in ABP was similar in women and men. Average blood pressure at clinic was 124/79 mm Hg by physician and 123/78 mm Hg by nurse. Nurse measurement at home was 125/78 mm Hg, daytime ambulatory was 121/77 mm Hg, and 24-hour ambulatory was 118/74 mm Hg. The values of the subgroup with self-measurement were physician 119/77 mm Hg; nurse at clinic 118/77 mm Hg; nurse at home 121/78 mm Hg; self-measured 115/72 mm Hg; daytime ambulatory 119/77 mm Hg; and 24-hour ambulatory 115/73 mm Hg. This study shows that a 24-hour ABP average value of 125/80 mm Hg and a daytime ABP average value of 129/84 mm Hg are suitable upper limits for normality. Higher limits would yield an artificially higher prevalence of white coat hypertension. Most subjects showed higher blood pressure levels when measurements were performed by healthcare personnel at a clinic or at home than when self-measured at home.
Ambulatory blood pressure measurement in the diagnosis and management of hypertension
Journal of human hypertension, 1991
Before the diagnostic potential of 24-hour non-invasive BP measurement can be assessed, the accuracy of ambulatory recorders must be established, and normal reference values determined. The accuracy criteria of four ambulatory BP measuring systems (the SpaceLabs 90207, the Novecor DIASYS 200, the Takeda TM-2420 and the Del Mar Avionics Pressurometer IV) have been assessed according to the British Hypertension Society (BHS) protocol, and the Medilog, Suntech Accutracker II and the SpaceLabs 90202 according to the standard of the Association for the Advancement of Medical Instrumentation (AAMI). The SpaceLabs 90202 and 90207, the DIASYS 200 and the Medilog fulfilled the AAMI criteria. The best devices with the BHS grading system are the SpaceLabs 90207 and the DIASYS 200. Normal reference values for daytime, night-time and 24-hour ambulatory BP have been provided by the Allied Irish Bank study of 815 healthy individuals, which showed clear age and sex differences. The mean 24-hour amb...
Ambulatory Blood Pressure Monitoring: How Reproducible Is It
American Journal of Hypertension, 1997
We tested the reproducibility of ambulatory blood pressure monitoring (ABPM) by the use of agreement plots. Thirty-two normotensive volunteers underwent ABPM on four separate days (interval 28 days), on the same typical weekday. Sleeping time was restricted to the ABPM nighttime subperiod from 11:00 PM to 7:00 AM. Twenty-four-hour average values-both systolic and diastolic-daytime average values, and nighttime average values, as well as standard deviation (SD) values, were analyzed for differences (analysis of variance). Adaptation occurred from the first to the fourth ABPM, ie, average 24 h, daytime, and nighttime values were lower (؊1 to ؊3 mm Hg) during the fourth recording than the first (P < .05 to P < .01). The agreement analysis showed a surprisingly high agreement among the four data sets (ie, differences from ؎2.54 to ؎5.92 mm Hg; ؎2 SD of the distribution). We concluded that reproducibility of ABPM seems excellent, but adaptation may occur, even in normotensive volunteers under research conditions. Caution must be paid before labeling a patient as hypertensive, because initial ABPM may yield higher values than later monitorings. Am J Hypertens 1997;10:936 -939