scholarly journals Ambulatory Blood Pressure Monitoring to Diagnose and Manage Hypertension

Hypertension ◽  
2021 ◽  
Vol 77 (2) ◽  
pp. 254-264
Author(s):  
Qi-Fang Huang ◽  
Wen-Yi Yang ◽  
Kei Asayama ◽  
Zhen-Yu Zhang ◽  
Lutgarde Thijs ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ambulatory Blood Pressure ◽  
Randomized Clinical Trials ◽  
Antihypertensive Drugs ◽  
Blood Pressure Monitoring ◽  
Cardiovascular Complications ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Clinical Implementation ◽  
Ambulatory Bp Monitoring

This review portrays how ambulatory blood pressure (BP) monitoring was established and recommended as the method of choice for the assessment of BP and for the rational use of antihypertensive drugs. To establish much-needed diagnostic ambulatory BP thresholds, initial statistical approaches evolved into longitudinal studies of patients and populations, which demonstrated that cardiovascular complications are more closely associated with 24-hour and nighttime BP than with office BP. Studies cross-classifying individuals based on ambulatory and office BP thresholds identified white-coat hypertension, an elevated office BP in the presence of ambulatory normotension as a low-risk condition, whereas its counterpart, masked hypertension, carries a hazard almost as high as ambulatory combined with office hypertension. What clinically matters most is the level of the 24-hour and the nighttime BP, while other BP indexes derived from 24-hour ambulatory BP recordings, on top of the 24-hour and nighttime BP level, add little to risk stratification or hypertension management. Ambulatory BP monitoring is cost-effective. Ambulatory and home BP monitoring are complimentary approaches. Their interchangeability provides great versatility in the clinical implementation of out-of-office BP measurement. We are still waiting for evidence from randomized clinical trials to prove that out-of-office BP monitoring is superior to office BP in adjusting antihypertensive drug treatment and in the prevention of cardiovascular complications. A starting research line, the development of a standardized validation protocol for wearable BP monitoring devices, might facilitate the clinical applicability of ambulatory BP monitoring.

Applications of ambulatory blood pressure monitoring in clinical practice

1991 ◽  
Vol 37 (10) ◽  
pp. 1880-1884 ◽  
Author(s):  
M A Weber ◽  
D H Smith ◽  
J M Neutel ◽  
D G Cheung
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Ambulatory Blood Pressure Monitoring ◽  
Ambulatory Blood Pressure ◽  
Antihypertensive Drugs ◽  
Blood Pressure Monitoring ◽  
Ambulatory Monitoring ◽  
White Coat Hypertension ◽  
Portable Devices ◽  
Pressure Monitoring

Abstract Traditionally, blood pressure has been measured by the sphygmomanometer in the medical office. There is growing evidence, however, that office blood pressures may not be typical of values throughout the day. Between 20% and 30% of patients diagnosed with hypertension in the office actually are normotensive at other times. Ambulatory blood pressure monitoring with small, portable devices that automatically measure blood pressure every few minutes throughout the day appears to be an appropriate tool when "white-coat" hypertension is suspected--i.e., for individuals whose hypertension in the physician's office is not associated with other physical or historical evidence for cardiovascular disease or with other risk factors. Used prudently, ambulatory monitoring is a cost-effective technique that potentially can prevent unnecessary treatment of patients. Moreover, whole-day measurements may correlate more closely than office measurements may correlate more closely than office measurements do with findings of cardiovascular disease. This new approach also has highlighted the circadian pattern of blood pressure, especially the sharp early to mid-morning increase that coincides with an increased tendency to major cardiovascular events. This has focused attention on directing antihypertensive therapy towards the morning hours. Ambulatory monitoring is now used routinely in studies of antihypertensive drugs. This technique has no placebo effect and takes fewer patients to assess drug efficacy than do conventional methods.

scholarly journals Ambulatory blood pressure monitoring in young adults with different levels of office blood pressure

2018 ◽  
Vol 24 (4) ◽  
pp. 427-434
Author(s):  
N. T. Vatutin ◽  
E. V. Sklyannaya
Keyword(s):  
Blood Pressure ◽  
Young People ◽  
Ambulatory Blood Pressure Monitoring ◽  
Ambulatory Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Office Blood Pressure ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Pressure Monitoring ◽  
Group 2

Objectiveof our study was to assess the ambulatory blood pressure monitoring (ABPM) in young people with different office blood pressure (BP).Design and methods. We included 981 students of a medical university at the age of 20–29 years (536 men, 445 women). ABPM was performed using the device “Kardiotekhnika 4000” (Inkart, Russia), the data were processed using the program “KT Result2” (Inkart, Russia).Results. The optimal BP during office measurement was recorded in 220 patients (22,4 %, group 1), normal — in 488 (49,8 %, group 2), high normal — in 134 (13,6 %, group 3), hypertension (HTN) 139 (14,2 %, group 4). The proportion of males was significantly higher in groups 3 and 4 (96,6 % and 85,6 %) compared with groups 1 and 2 (47,7 % and 40,2 %, respectively, p < 0,001). The median systolic BP (SBP) was 123 (110; 126) mm Hg, diastolic BP (DBP) — 85 (84; 87) mm Hg. According to the ABPM, the parameters of SBP and DBP correlated with the corresponding office BP parameters. A strong direct correlation was found for both SBP (rs= 0,87) and DBP (rs= 0,85). Daytime variability of SBP was significantly higher in individuals with high normal BP and HTN (15,9 ± 2,6 and 17,2 ± 4,2 mm Hg) compared to groups 1 and 2 (9,2 ± 4,4 and 9,9 ± 3,0, respectively, p < 0,05). The majority of young people had normal BP decrease at night (dipper), non-dipper profile was also frequent. Over-dipper and night-peaker profiles were rarely recorded. In the groups 3 and 4, a larger number of non-dipper patients were observed compared with groups 1 and 2 (23,9 % and 34,6 %, compared with 10,0 % and 11,1 %, respectively, p < 0,001). The prevalence of white-coat hypertension (WCH) among the young people was 0,31 % (95 % CI 0,06–0,75 %), among subjects with office HTN 2,2 % (95 % CI 0,4–5,3 %). The prevalence of masked hypertension (MHTN) in the studied population was 1,4 % (95 % CI 0,8–2,3 %), among normotensive subjects — 1,7 % (95 % CI 0,9–2,6 %), among subjects with high normal BP — 10,4 % (95 % CI 5,8–16,2 %).Conclusions. ABPM in young hypertensive patients is characterized by higher variability of daytime SBP. The majority (56,1 %)of HTN subjects had normal BP decrease at night. The prevalence of WCH among young people is 0,31 % (95 % CI 0,06–0,75 %). The prevalence of MHTN among young people is 1,4 % (95 % CI 0,8–2,3 %).

scholarly journals Office and Ambulatory Arterial Hypertension in Highlanders

Hypertension ◽  
2020 ◽  
Vol 76 (6) ◽  
pp. 1962-1970
Author(s):  
Grzegorz Bilo ◽  
Lorenzo Acone ◽  
Cecilia Anza-Ramírez ◽  
José Luis Macarlupú ◽  
Davide Soranna ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ambulatory Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Blood Pressure Measurement ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Blood Oxygen Saturation ◽  
Chronic Mountain Sickness ◽  
Nocturnal Hypertension ◽  
Mountain Sickness

Millions of people worldwide live at high altitude, being chronically exposed to hypobaric hypoxia. Hypertension is a major cardiovascular risk factor but data on its prevalence and determinants in highlanders are limited, and systematic studies with ambulatory blood pressure monitoring are not available. Aim of this study was to assess the prevalence of clinic and ambulatory hypertension and the associated factors in a sample of Andean highlanders. Hypertension prevalence and phenotypes were assessed with office and ambulatory blood pressure measurement in a sample of adults living in Cerro de Pasco, Peru (altitude 4340 m). Basic clinical data, blood oxygen saturation, hematocrit, and Qinghai Chronic Mountain Sickness score were obtained. Participants were classified according to the presence of excessive erythrocytosis and chronic mountain sickness diagnosis. Data of 289 participants (143 women, 146 men, mean age 38.3 years) were analyzed. Office hypertension was present in 20 (7%) participants, while ambulatory hypertension was found in 58 (20%) participants. Masked hypertension was common (15%), and white coat hypertension was rare (2%). Among participants with ambulatory hypertension, the most prevalent phenotypes included isolated nocturnal hypertension, isolated diastolic hypertension, and systodiastolic hypertension. Ambulatory hypertension was associated with male gender, age, overweight/obesity, 24-hour heart rate, and excessive erythrocytosis. Prevalence of hypertension among Andean highlanders may be significantly underestimated when based on conventional blood pressure measurements, due to the high prevalence of masked hypertension. In highlanders, ambulatory hypertension may be independently associated with excessive erythrocytosis.

Ambulatory Blood Pressure Monitoring: Measurement Implications for Research

2001 ◽  
Vol 9 (1) ◽  
pp. 49-59 ◽  
Author(s):  
Carolyn B. Yucha
Keyword(s):  
Blood Pressure ◽  
Ambulatory Blood Pressure Monitoring ◽  
Ambulatory Blood Pressure ◽  
Antihypertensive Drugs ◽  
Blood Pressure Monitoring ◽  
Computer Software ◽  
Research Assistant ◽  
Pressure Monitoring ◽  
Ambulatory Bp Monitoring ◽  
The Cost

Although blood pressure (BP) is a frequently used variable in nursing studies, measurements are likely to be inaccurate for a variety of reasons: incorrect technique, operator error, and environmental factors. Ambulatory BP monitoring (ABPM) reduces measurement error, is relatively easy to use, and yields many more BP parameters than do clinic BP measurements. The cost of equipment for ABPM ranges from $2,500 to $5,000 per monitor and from $2,000 to $3,000 for computer software. A research assistant can easily be trained to follow a standardized procedure. Researchers have used ABPM to study normal BP patterns, complications of hypertension, effects of antihypertensive drugs, and the prognosis of cardiovascular events. This article provides the nurse researcher with an introduction to this technology and an overview of information gained from ambulatory blood pressure monitoring.

Abstract P206: Ambulatory Blood Pressure Monitoring Phenotypes Among Individuals With and Without Diabetes: The Jackson Heart Study

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Samantha G Bromfield ◽  
Daichi Shimbo ◽  
Alain Bertoni ◽  
Mario Sims ◽  
April P Carson ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ambulatory Blood Pressure Monitoring ◽  
Ambulatory Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Prevalence Ratio ◽  
White Coat ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Pressure Monitoring ◽  
Heart Study

Several ambulatory blood pressure monitoring (ABPM) phenotypes including masked hypertension are associated with an increased risk for cardiovascular disease (CVD). Diabetes is associated with CVD risk as well as a higher prevalence of hypertension. However, little is known about whether ABPM phenotypes differ between individuals with versus without diabetes. We evaluated the association between diabetes and ABPM phenotypes including clinic hypertension, awake hypertension, sustained hypertension, nocturnal hypertension, non-dipping pattern, white coat hypertension, and masked hypertension in the Jackson Heart Study (JHS). Baseline data collection included two clinic blood pressure measurements using standardized protocols. ABPM measurements were taken in the 24 hours following the baseline visit. Diabetes was defined as fasting glucose ≥126 mg/dL, hemoglobin A1c ≥6.5%, or use of diabetes medications. Of the 1,032 JHS participants with valid ABPM data (67.7% female, mean age 59.2 years), 253 (24.5%) had diabetes. The prevalence of clinic hypertension was similar for participants with and without diabetes (Table 1). After multivariable adjustment, diabetes was associated with an increased prevalence ratio of awake, sustained, and masked hypertension and a lower prevalence ratio of white coat hypertension compared with individuals without diabetes. In summary, there was an increased prevalence of adverse blood pressure phenotypes among individuals with versus those without diabetes that was not captured in the clinic setting alone. The role of ABPM for identifying high risk individuals with diabetes should be further investigated.

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