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Normal ambulatory blood pressure: a clinical-practice-based analysis of recent American Heart Association

Iddo Z Ben-Dov1, Liora Ben-Arie, Judith Mekler

  • 1Department of Internal Medicine, Hadassah-Hebrew University Medical Center, Mount-Scopus Campus, Jerusalem, Israel. vp02292@netvision.net.il

The American Journal of Medicine
|January 25, 2006
PubMed

Insights

New guidelines for blood pressure measurement show good agreement, but some individuals are classified as hypertensive by only one method. This discrepancy is more common with awake-sleep blood pressure readings.

Area of Science:

  • Cardiology
  • Hypertension Research

Background:

  • The American Heart Association Council on High Blood Pressure Research established new recommendations for blood pressure measurement.
  • Normal 24-hour ambulatory blood pressure is <130/80 mm Hg, normal daytime is <135/85 mm Hg, and normal nighttime is <120/70 mm Hg.

Purpose of the Study:

  • To evaluate the compatibility of these new blood pressure cutoffs in clinical practice.
  • To assess the agreement between 24-hour, daytime, and nighttime blood pressure measurements.

Main Methods:

  • Analysis of 4121 ambulatory blood pressure measurement sessions.
  • Classification of subjects based on 24-hour (<130/80 mm Hg) and awake-sleep (<135/85 mm Hg and <120/70 mm Hg) blood pressure criteria.

Main Results:

  • A high concordance (92%, kappa=0.77) was observed between the different blood pressure measurement criteria.
  • A small percentage of subjects (8%) showed discordant classifications.
  • Discordance was more frequent for awake-sleep criteria (7%) than for 24-hour criteria (1%).

Conclusions:

  • The new ambulatory blood pressure normality suggestions demonstrate good agreement in real-world clinical settings.
  • A subset of patients may be classified as hypertensive based on only one measurement method, particularly the awake-sleep criteria.
  • This discordance has implications for large-scale clinical blood pressure monitoring and patient management.
Abstract

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