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Importance of aggressive blood pressure lowering when it may matter most
1Division of Hypertension and Clinical Pharmacology, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut 06032-3940, USA. wwhite@nsol.uchc.edu
Insights
Ambulatory blood pressure monitoring (ABPM) offers superior cardiovascular risk prediction compared to clinic readings. This method aids in managing hypertension and evaluating real-world antihypertensive therapy effectiveness.
Area of Science:
- Cardiology
- Hypertension Research
- Circadian Rhythms
Background:
- Blood pressure exhibits a daily circadian pattern, with surges in the morning.
- Cardiovascular events often peak during the early morning, coinciding with blood pressure increases.
- 24-hour ambulatory blood pressure monitoring (ABPM) predicts cardiovascular events better than clinic measurements.
Purpose of the Study:
- To highlight the clinical utility of ABPM in identifying cardiovascular risk.
- To emphasize ABPM's role in optimizing antihypertensive treatment strategies.
- To explore the feasibility of ABPM in real-world, community-based settings.
Main Methods:
- Utilizing ambulatory blood pressure monitoring (ABPM) for continuous 24-hour blood pressure assessment.
- Comparing ABPM data with clinic blood pressure readings for predictive accuracy.
- Conducting community-based trials to assess ABPM in non-research environments.
- Analyzing pre- and post-awakening blood pressure data to evaluate early-morning control.
Main Results:
- ABPM is superior to clinic blood pressure in predicting future cardiovascular events.
- ABPM facilitates the evaluation of antihypertensive therapies for 24-hour efficacy.
- Community-based ABPM studies demonstrate feasibility and provide real-world treatment insights.
- ABPM allows for detailed assessment of early-morning blood pressure control.
Conclusions:
- ABPM is a valuable tool for improving hypertension management and cardiovascular risk stratification.
- Real-world ABPM studies enhance understanding of antihypertensive efficacy in routine clinical practice.
- Focusing on early-morning blood pressure control via ABPM can optimize patient outcomes.
Abstract:
Variation in blood pressure levels follows a reproducible circadian pattern, characterized by low levels during sleep and a rapid increase during the early-morning period. The incidence of cardiovascular events displays a similar circadian variation, with peak occurrence coinciding with the early-morning blood pressure surge. Numerous prospective studies have shown that blood pressure measured over a 24-hour period is superior to clinic blood pressure in predicting future cardiovascular events. Thus, the use of ambulatory blood pressure monitoring (ABPM) to identify patients at risk of cardiovascular events could improve the management of the patient with hypertension. ABPM has also become widely adopted to evaluate antihypertensive therapeutic options that might provide blood pressure reduction throughout the 24-hour dosing interval. Recently, community-based trials have shown that it is feasible to perform ABPM-oriented research in nonresearch environments. This allows us to better understand the efficacy of antihypertensive therapies in a "real-world" setting. Studies of this nature can even assess blood pressure control in the early-morning period by sequestering data before and after awakening.
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