Hypertension Prevalence, Awareness, Treatment, and Control: Should 24-Hour Ambulatory Blood Pressure Monitoring be the Tool of Choice? (original) (raw)
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International Journal of Cardiovascular Sciences, 2017
Background: Arterial hypertension is an important risk factor for cardiovascular outcomes. However, in most Primary Health Care centers, blood pressure remains at inadequate control levels. Ambulatory Blood Pressure Monitoring (ABPM) is a useful tool in predicting cardiovascular morbidity and mortality. The implementation of 24-hour ABPM and evaluation of cardiovascular outcomes in Primary Health Care may be effective in improving strategies for monitoring hypertensive patients in this setting. Objective: To evaluate uncontrolled arterial hypertension detected by 24-hour ABPM as a predictor of cardiovascular outcomes in hypertensive patients from Primary Health Care in a low-resource environment. Methods: Cohort study based on primary health care centers. The study was carried out with 143 hypertensive patients, who underwent 24-hour ABPM at baseline. Therapeutic targets were based on the Eighth Joint National Committee, the Brazilian Hypertension Guideline, and the European Hypertension Guideline. Medical records of emergency care, hospital admissions, and death certificates were reviewed. Results: The sample consisted of 143 patients who met the inclusion criteria. After 4 years of follow-up, there were 17 deaths, 12 new cases of atrial fibrillation and 37 hospital admissions related to cardiovascular outcomes. During the follow-up period, the 24-hour ABPM showed a predictive result for new cases of atrial fibrillation (p = 0.015) and a combination of cardiovascular outcomes, mortality, and hospital admissions (p = 0.012). Conclusion: The 24-hour ABPM was an important predictor of cardiovascular outcomes in a hypertensive population that seeks assistance in
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...
BMJ, 2010
Background Twenty-four hour ambulatory blood pressure thresholds have been defined for the diagnosis of mild hypertension but not for its treatment or for other blood pressure thresholds used in the diagnosis of moderate to severe hypertension. We aimed to derive age and sex related ambulatory blood pressure equivalents to clinic blood pressure thresholds for diagnosis and treatment of hypertension. Methods We collated 24 hour ambulatory blood pressure data, recorded with validated devices, from 11 centres across six Australian states (n=8575). We used least product regression to assess the relation between these measurements and clinic blood pressure measured by trained staff and in a smaller cohort by doctors (n=1693). Results Mean age of participants was 56 years (SD 15) with mean body mass index 28.9 (5.5) and mean clinic systolic/diastolic blood pressure 142/82 mm Hg (19/12); 4626 (54%) were women. Average clinic measurements by trained staff were 6/3 mm Hg higher than daytime ambulatory blood pressure and 10/5 mm Hg higher than 24 hour blood pressure, but 9/7 mm Hg lower than clinic values measured by doctors. Daytime ambulatory equivalents derived from trained staff clinic measurements were 4/3 mm Hg less than the 140/90 mm Hg clinic threshold (lower limit of grade 1 hypertension), 2/2 mm Hg less than the 130/80 mm Hg threshold (target upper limit for patients with associated conditions), and 1/1 mm Hg less than the 125/75 mm Hg threshold. Equivalents were 1/2 mm Hg lower for women and 3/ 1 mm Hg lower in older people compared with the combined group. Conclusions Our study provides daytime ambulatory blood pressure thresholds that are slightly lower than equivalent clinic values. Clinic blood pressure measurements taken by doctors were considerably higher than those taken by trained staff and therefore gave inappropriate estimates of ambulatory thresholds. These results provide a framework for the diagnosis and management of hypertension using ambulatory blood pressure values.
Ambulatory blood pressure monitoring and risk of cardiovascular disease: a population based study
American journal of hypertension, 2006
Information on the relationship between ambulatory blood pressure (BP) and cardiovascular disease in the general population is sparse. Prospective study of a random sample of 1700 Danish men and women, aged 41 to 72 years, without major cardiovascular diseases. At baseline, ambulatory BP, office BP, and other risk factors were recorded. The end point was a combined end point consisting of cardiovascular mortality, ischemic heart disease, and stroke. After a mean follow-up of 9.5 years, 156 end points were recorded. In multivariate models, the relative risk (95% confidence interval) associated with increments of 10/5 mmHg of systolic/diastolic ambulatory BP were 1.35 (1.21-1.50) and 1.27 (1.16-1.39). The corresponding figures for office BP were 1.18 (1.09-1.29) and 1.11 (1.03-1.19). Compared with normotension (office BP <140/90 mm Hg; daytime BP <135/85 mm Hg) the relative risks associated with isolated office hypertension (office BP >/=140/90 mm Hg; daytime BP <135/85 mm...
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.
European journal of clinical investigation, 2015
Many patients are hypertensive at the medical settings but show normal blood pressure out of the doctor's office, and are classified as white-coat hypertensives. On the other hand, many patients with controlled hypertension at the clinic show ambulatory blood pressure levels above the thresholds considered for an adequate blood pressure control, known as having masked hypertension. Using data from the Spanish Ambulatory Blood Pressure Monitoring Registry (Spanish ABPM Registry), a national program developed to promote the use of the ambulatory technique for hypertension management in daily practice, we have reviewed the main strengths of this approach, i.e. the ability to detect discrepancies of blood pressure status with respect to office blood pressure measurement, and to better assess accurate rates of hypertension control. White-coat hypertension within patients with elevated office blood pressure, and masked hypertension within office-controlled patients affected to one of ...