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24-hour blood pressure monitoring in hypertension
G Mancia1, R Casadei, A Groppelli
1Cattedra di Semeiotic Medica and Istituto di Clinica Medica Generale e Terapia Medica, Università di Milano, Italy.
Insights
Continuous 24-hour blood pressure monitoring reveals that both higher average blood pressure and increased variability are linked to greater target-organ damage in hypertension. Effective hypertension treatment requires full 24-hour blood pressure control.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Medicine
Background:
- Blood pressure exhibits significant 24-hour variability.
- 24-hour ambulatory blood pressure monitoring (ABPM) correlates better with target-organ damage than traditional sphygmomanometry.
- Hypertension-related morbidity and mortality are influenced by various blood pressure parameters, including diurnal patterns and variability.
Purpose of the Study:
- To investigate the significance of blood pressure variability and mean values over a 24-hour period in relation to target-organ damage.
- To determine the importance of nighttime blood pressure in hypertensive patients.
- To assess the correlation between different blood pressure metrics and the extent of hypertension-related target-organ damage.
Main Methods:
- Utilized 24-hour ambulatory blood pressure monitoring (ABPM) in hypertensive and normotensive subjects.
- Analyzed mean 24-hour, daytime, and nighttime blood pressure values.
- Correlated blood pressure metrics with the extent and severity of target-organ damage.
Main Results:
- Mean nighttime blood pressure in hypertensive patients remained elevated compared to normotensive subjects and correlated closely with target-organ damage.
- Higher mean 24-hour blood pressure was directly associated with increased target-organ involvement.
- Greater blood pressure variability during the 24-hour monitoring period correlated with more extensive target-organ damage, even with comparable mean 24-hour blood pressure.
Conclusions:
- Both the mean 24-hour blood pressure and its variability are critical factors in hypertension-related target-organ damage.
- Effective hypertension management necessitates achieving blood pressure control over the entire 24-hour period.
- Ambulatory blood pressure monitoring is essential for confirming comprehensive blood pressure control in hypertensive patients.
Abstract:
It has been recognized for some time that blood pressure is highly variable over a 24-h period. A number of studies have demonstrated that the extent and severity of target-organ damage associated with hypertension can be correlated more closely with blood pressure values monitored continuously for 24 h than with individual values recorded sphygmomanometrically. A great deal of interest is focused on whether absolute values of diastolic or systolic blood pressure, values during the day or night, or the rate of change of blood pressure such as the rapid increase that occurs in the early morning are more or less important factors contributing to the mortality and morbidity associated with hypertension. Work from our own unit provides evidence of the importance of two features in the variability of blood pressure. Blood pressure decreases during the night, but remains higher in hypertensive patients than in normotensive subjects. The mean nighttime blood pressure was shown to correlate with hypertension-related target-organ damage almost as closely as the mean daytime blood pressure. Using 24-h blood pressure monitoring, we have shown that the higher the mean 24-h blood pressure, the greater the extent and severity of target-organ involvement. In addition, for patients with comparable mean 24-h blood pressure values, larger degrees of blood pressure variability throughout the monitoring period were associated with more target-organ damage. Taking the available evidence into account, it is probably important that treatments used for hypertension should provide control of blood pressure for a full 24-h period confirmed by ambulatory blood pressure monitoring.
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