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Prognostic value of ambulatory blood pressure : current evidence and clinical implications
1Ospedale R. Silvestrini, Dipartimento di Scienze Cardiologiche, Perugia PG, Italy. verdec@tin.it
Insights
Ambulatory blood pressure (ABP) monitoring significantly enhances cardiovascular risk assessment beyond traditional methods. It is particularly valuable for refining risk in untreated hypertension and resistant hypertension cases.
Area of Science:
- Cardiology
- Hypertension Research
- Preventive Medicine
Background:
- Office blood pressure (BP) is a standard cardiovascular risk factor.
- Ambulatory blood pressure (ABP) monitoring offers a more comprehensive assessment.
- Existing evidence on ABP's prognostic value requires critical review.
Purpose of the Study:
- To critically review the prognostic value of ambulatory blood pressure (ABP).
- To assess ABP's ability to improve cardiovascular risk stratification.
- To identify specific patient populations benefiting most from ABP monitoring.
Main Methods:
- Review of event-based cohort studies on ABP.
- Analysis of ABP as a continuous variable and with risk categories.
- Comparison of ABP with office BP and traditional risk factors.
Main Results:
- ABP improves cardiovascular risk stratification beyond office BP.
- Higher ABP (systolic, diastolic, pulse) is independently associated with increased risk.
- Reduced nocturnal BP dipping is linked to worse outcomes, irrespective of 24-hour ABP levels.
Conclusions:
- ABP monitoring refines cardiovascular risk stratification, especially in untreated and resistant hypertension.
- Further intervention studies targeting ABP are warranted.
- ABP provides critical insights into cardiovascular risk beyond conventional measurements.
Abstract:
This article is a critical review of the available evidence on the prognostic value of ambulatory blood pressure (ABP). Several event-based cohort studies have shown that ABP improves cardiovascular risk stratification over and beyond traditional risk factors, including office BP. Most of these studies have been conducted in subjects with essential hypertension who were untreated at the time of execution of ABP monitoring; other studies have been conducted in subjects who were poorly controlled with treatment or in the general population. In these studies, ABP was examined as a continuous variable or with operational risk categories. Cardiovascular risk showed a direct and independent association with the observed ABP (systolic, diastolic, and pulse) and an inverse association with the degree of BP reduction from day to night. Cardiovascular risk was also directly associated with the difference between the observed value of ABP and that predicted from the office BP. White-coat hypertension versus ambulatory hypertension and dippers versus nondippers are 2 classifications based on arbitrary operational risk categories. A blunted or absent BP reduction from day to night, defined with ABP as a continuous variable or with operational thresholds, was also associated with a worse outcome regardless of the average value of ABP during the 24 hours. Overall, these studies indicate that ABP monitoring is particularly valuable to refine cardiovascular risk stratification in untreated subjects with office hypertension and in those with resistant hypertension. Intervention studies targeted at ABP are now needed.