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The clinical value of circadian variations of blood pressure
1Area Omogenea di Cardiologia e Medicina, Ospedale 'R. Silvestrini', Perugia, Italy.
Insights
Investigating the diurnal rhythm of blood pressure using 24-hour ambulatory monitoring (ABPM) is crucial for clinical practice. However, methodological challenges and balanced interpretation of findings are essential for accurate cardiovascular risk assessment.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Measurement
Background:
- The clinical significance of the diurnal blood pressure rhythm is debated.
- 24-hour ambulatory blood pressure monitoring (ABPM) is the standard method for assessing this rhythm.
- Physician and regulatory acceptance of ABPM hinges on recognizing the clinical value of day and night blood pressure data.
Purpose of the Study:
- To critically evaluate the clinical relevance of diurnal blood pressure variations.
- To address methodological challenges in defining and measuring daytime and night-time blood pressure.
- To present a balanced perspective on the association between blood pressure patterns and cardiovascular damage.
Main Methods:
- The study involves a review and discussion of existing research on diurnal blood pressure rhythms.
- It highlights the role of 24-hour ambulatory blood pressure monitoring (ABPM).
- Contributions from active research groups using ABPM are incorporated.
Main Results:
- ABPM is essential for understanding diurnal blood pressure patterns.
- A blunted day-night blood pressure difference has been linked to cardiovascular damage.
- Methodological aspects of ABPM require careful consideration for reproducibility and definition.
Conclusions:
- The clinical utility of diurnal blood pressure rhythm assessment via ABPM is significant but requires careful interpretation.
- Addressing methodological issues in ABPM is critical for reliable clinical application.
- A balanced approach is needed to weigh positive and negative evidence regarding diurnal blood pressure and cardiovascular outcomes.
Abstract:
Writing an editorial on the clinical relevance of the diurnal rhythm of blood pressure bears a two-sided risk. There is little doubt that 24 h ambulatory monitoring (ABPM) is the only practical way to investigate the diurnal rhythm of blood pressure and that acceptance of ABPM by physicians and regulatory authorities is largely dependent upon acceptance of the concept that knowledge of blood pressure values during day and night is clinically valuable information. However, underestimation of the many open methodological aspects regarding definition and reproducibility of daytime and night-time blood pressure and emphasis on positive reports showing an association between a blunted day-night blood pressure difference and cardiovascular damage would bear the risk of one being perceived as an uncritical reviewer of a hypothesis fitting with one's personal data [1-6]. At the opposite extreme, the exigency of neutrality could lead one to place excessive emphasis on the less positive or frankly negative evidence in this field (for a review, see [7]). In this issue of the Journal, several groups that are actively involved in clinical research projects with ABPM provide detailed and balanced contributions on several topics related to the diurnal changes in blood pressure.