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Ambulatory blood pressure during antihypertensive therapy guided by conventional pressure
1Hypertension and Cardiovascular Rehabilitation Unit, Department of Molecular and Cardiovascular Research, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium.
Insights
Elevated clinic blood pressure (CBP) may mask normal ambulatory blood pressure (ABP). Treating based on CBP alone can lower office readings but not ambulatory ones in some patients.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Trials
Background:
- Elevated clinic blood pressure (CBP) is a common finding.
- Some individuals with elevated CBP may exhibit normal ambulatory blood pressure (ABP) readings.
- The discrepancy between CBP and ABP can impact treatment decisions.
Purpose of the Study:
- To review studies investigating antihypertensive therapy guided by CBP measurements.
- To analyze the impact of CBP-guided treatment on both CBP and ABP.
- To understand the clinical implications of treating based on office readings versus 24-hour monitoring.
Main Methods:
- Systematic review of studies monitoring ABP during antihypertensive therapy initiation or intensification.
- Analysis of treatment effects on both CBP and ABP in subjects with varying ABP levels.
- Comparison of treatment outcomes based on CBP-guided versus ABP-guided strategies (implied).
Main Results:
- Antihypertensive therapy guided by elevated CBP did not significantly reduce ABP in patients with normal ABP.
- CBP readings were significantly reduced in these patients despite minimal changes in ABP.
- This suggests a potential for over-treatment based solely on office BP measurements.
Conclusions:
- Initiating or intensifying antihypertensive therapy based solely on elevated CBP may lead to unnecessary treatment in individuals with normal ABP.
- Ambulatory blood pressure monitoring provides a more comprehensive assessment of hypertension.
- Clinical guidelines should consider ABP monitoring to avoid overtreatment and its associated risks.
Abstract:
Subjects with elevated conventional clinic or office blood pressure (CBP) may have normal ambulatory blood pressure (ABP). The purpose of this review is to summarize studies in which ABP was monitored while the initiation or intensification of antihypertensive therapy was guided by CBP. These studies show that ABP does not decrease or decreases only slightly in response to treatment in subjects with elevated CBP and low ABP, whereas the CBP is significantly reduced in such patients.