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Ambulatory blood pressure monitoring. A tool for more comprehensive assessment
1Department of Community Health Sciences, Lund University, Dalby, Sweden.
Insights
Comprehensive blood pressure monitoring aids hypertension evaluation. While office blood pressure is adequate for diagnosis, daily life measurements offer valuable insights for treatment adjustments.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Trials
Background:
- Hypertension diagnosis and treatment traditionally rely on office blood pressure measurements.
- The utility of more comprehensive, out-of-office blood pressure monitoring in clinical practice remains an area of investigation.
Purpose of the Study:
- To assess the value of ambulatory blood pressure (amb-BP) and self-blood pressure (self-BP) measurements in diagnosing and managing hypertension.
- To compare the efficacy of different antihypertensive medications (atenolol, enalapril, lisinopril) under various conditions.
Main Methods:
- Screening of middle-aged individuals in Sweden for blood pressure classification.
- Recording of amb-BP in normotensive, borderline hypertensive, and untreated hypertensive subjects.
- Self-blood pressure (self-BP) measurements in a subgroup of borderline hypertensives.
- Comparative study of atenolol vs. enalapril and enalapril vs. lisinopril efficacy at rest, during 24 hours, and during exercise.
Main Results:
- Ambulatory blood pressure (amb-BP) differentiated normotensives from hypertensives effectively.
- Self-blood pressure (self-BP) and office blood pressure (office-BP) showed similar classification accuracy; combining them offered minimal additional benefit.
- Atenolol demonstrated superior blood pressure reduction during dynamic exercise compared to enalapril.
- No significant difference in efficacy was observed between enalapril and lisinopril, even 18-24 hours post-dose.
Conclusions:
- Comprehensive blood pressure measurements, including ambulatory monitoring, should be considered in the overall evaluation of hypertension treatment.
- Standard office blood pressure measurements remain a sufficiently reliable tool for the initial diagnosis of hypertension.
Aims:
To investigate the usefulness of more comprehensive blood pressure measurements, made during daily life, in the diagnosis and treatment of hypertension.
Methods:
A blood pressure screening was carried out in middle-aged men and women in Kävlinge, a municipality in southern Sweden. Subjects were classified according to Swedish standard criteria. Ambulatory blood pressure (amb-BP) was recorded in a random sample of normotensives and borderline hypertensives as well as in all the untreated hypertensives identified at screening and willing to participate. A subgroup of borderline hypertensives also carried out self-measurements of blood pressure (self-BP) both at work and at home. The blood pressure lowering efficacy of atenolol 50 mg o.d. and enalapril 20 mg o.d. was compared in hypertensives at rest, during 24 hours, and during dynamic and isometric exercise. The efficacy of enalapril and lisinopril (two ACE inhibitors with different durations of action) were also compared, with special focus on the early morning hours.
Results:
Men and women classified as normotensives clearly differed from those with hypertension, also when blood pressure was recorded with ambulatory technique. The number of correctly classified subjects did not differ between self-BP and office-BP; combining the two added little. Atenolol reduced blood pressure better during dynamic exercise than did enalapril, while there was no significant difference in effect between enalapril and lisinopril, not even 18-24 hours post-dose.
Conclusion:
More comprehensive blood pressure measurements should be considered in the evaluation of hypertension treatment. Office BP, however, seems a reasonably good tool for diagnosing hypertension.