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Blood pressure reduction and end-organ damage in hypertension
G Mancia1, A Frattola, A Groppelli
1Cattedra di Medicina Interna, Ospedale S. Gerardo, Monza, Italy.
Insights
Ambulatory blood pressure monitoring reveals that blood pressure variability, not just average readings, predicts hypertension-related organ damage. Optimal treatment should manage both mean blood pressure and its fluctuations over 24 hours.
Area of Science:
- Cardiovascular Medicine
- Hypertension Research
- Pharmacology
Background:
- Ambulatory blood pressure monitoring (ABPM) provides more accurate hypertension assessment than office readings.
- Average 24-hour or daytime blood pressure values correlate better with end-organ damage.
- Blood pressure variability (BPV) is increasingly recognized as a significant prognostic factor in hypertension.
Purpose of the Study:
- To highlight the prognostic significance of blood pressure variability in hypertensive patients.
- To explore the implications of BPV for antihypertensive treatment strategies.
- To discuss the role of ABPM in assessing treatment effects on BPV.
Main Methods:
- Utilizing ambulatory blood pressure monitoring (ABPM) techniques.
- Measuring 24-hour blood pressure standard deviation to assess BPV.
- Analyzing trough:peak ratio for balanced 24-hour blood pressure control.
Main Results:
- ABPM-derived average blood pressure is more strongly linked to end-organ damage than office readings.
- Higher 24-hour blood pressure standard deviation (BPV) is significantly associated with end-organ damage.
- ABPM can identify excessive blood pressure falls or uncontrolled rises, impacting treatment evaluation.
Conclusions:
- Blood pressure variability is a crucial prognostic indicator in hypertension.
- Antihypertensive drugs should aim to reduce both mean blood pressure and BPV.
- Long-acting antihypertensive medications may offer more balanced 24-hour blood pressure control and reduced variability.
Abstract:
VALUE OF AMBULATORY BLOOD PRESSURE MONITORING: Studies that have used ambulatory blood pressure monitoring techniques have shown that the average 24-h or daytime blood pressure values are more closely related to the end-organ damage associated with hypertension than are isolated office readings. IMPORTANCE OF BLOOD PRESSURE VARIABILITY IN PROGNOSIS: More recently, blood pressure variability, measured as the overall 24-h blood pressure standard deviation, has been shown to have a significant relationship to end-organ damage in hypertensive patients. The potential clinical relevance of blood pressure variability has been strengthened in a recent prospective study. The possible prognostic value of blood pressure variability has practical implications for antihypertensive treatment; it may mean, for example, that the optimal antihypertensive drug should reduce not only the mean 24-h values but also the degree of fluctuation in blood pressure. This is more likely to occur with long-acting drugs, which induce a more balanced reduction in blood pressure throughout the 24 h. USE OF THE TROUGH:PEAK RATIO: A proposed measure of a balanced 24-h blood pressure effect is the trough:peak ratio of the blood pressure fall. This ratio can be obtained by clinic blood pressure measurements but ambulatory blood pressure monitoring offers some distinct advantages. One of these advantages is that by revealing the possibility of an excessive fall in blood pressure at the time of the peak effect or an uncontrolled rise at the trough, ambulatory monitoring can also reveal the possible impact of pharmacological treatment on 24-h blood pressure variability.