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Cuff and ambulatory blood pressure in subjects with essential hypertension
Insights
Clinic blood pressure readings may not accurately reflect true blood pressure levels. Many patients diagnosed with hypertension using cuff measurements have normal ambulatory blood pressure, indicating potential overdiagnosis.
Area of Science:
- Cardiology
- Hypertension Research
Background:
- Clinic cuff blood pressure measurements are standard for diagnosing hypertension.
- Direct ambulatory blood pressure monitoring (ABPM) provides a more comprehensive assessment.
- Discrepancies between cuff and ambulatory readings can lead to misdiagnosis and inappropriate treatment.
Purpose of the Study:
- To compare clinic cuff blood pressure measurements with mean arterial pressures obtained via ABPM.
- To identify factors that predict discrepancies between cuff and ambulatory blood pressure readings.
- To assess the clinical implications of differences between cuff and ambulatory blood pressure measurements.
Main Methods:
- Fifty-nine patients with borderline or essential hypertension underwent ABPM.
- Clinic cuff blood pressure was measured on at least three occasions.
- Patients were categorized into groups based on the agreement between cuff and ambulatory pressures.
- Clinical examination, sympathetic nerve activity, blood pressure variability, and exercise responses were assessed.
Main Results:
- In 22 patients, cuff and ambulatory pressures were similar; in 32, cuff pressures were >10 mm Hg higher.
- No reliable clinical factors distinguished patients with higher cuff pressures.
- Patients with higher cuff pressures showed less cardiovascular target organ damage and better baroreflex sensitivity.
- Twenty of 59 patients classified as hypertensive by cuff readings had normal awake ambulatory pressures (<140/90 mm Hg).
Conclusions:
- Clinic cuff blood pressure measurements may overestimate actual blood pressure in a significant proportion of hypertensive patients.
- Clinical factors and exercise responses do not reliably predict discrepancies between cuff and ambulatory blood pressure.
- ABPM is crucial for accurate hypertension diagnosis and management, especially in borderline cases.
Abstract:
Clinic cuff blood-pressure measurements, obtained on at least three occasions, were compared with mean arterial pressures in 59 patients with borderline or essential hypertension who underwent direct ambulatory monitoring of blood pressure. In 22 patients (group I) mean cuff and ambulatory pressures were similar (+/- 10 mm Hg) while in 32 subjects (group II) cuff pressures were more than 10 mm Hg higher. Groups I and II could not be distinguished on the basis of clinical examination, indices of sympathetic nerve activity, or blood-pressure variability, or by the magnitude of pressure rise during physical or mental exercise. Group II had less cardiovascular target organ damage and better baroreflex sensitivity but there was considerable overlap. There was no reliable way of telling which subjects would have lower ambulatory than cuff pressures. 20 out of 59 subjects classified as hypertensive by cuff measurements had awake ambulatory pressures or less than 140/90 mm Hg.