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Ambulatory blood pressure monitoring in hypertension
1Cattedra di Medicina Interna, Università di Milano, Italy.
Insights
Ambulatory blood pressure monitoring offers insights into daily cardiovascular control and hypertension management. While 24-hour readings better reflect organ damage, further studies are needed to confirm its prognostic value for widespread clinical use.
Area of Science:
- Cardiology
- Hypertension research
- Clinical diagnostics
Background:
- Ambulatory blood pressure monitoring (ABPM) is gaining interest for studying daily cardiovascular control.
- Its potential applications include improving hypertension diagnosis, risk assessment, and treatment efficacy evaluation.
Purpose of the Study:
- To discuss the evidence, pros, and cons of ABPM for hypertension diagnosis, risk estimation, and treatment assessment.
- To evaluate the correlation of 24-hour blood pressure with end-organ damage.
Main Methods:
- Review of existing evidence on ambulatory blood pressure monitoring.
- Comparison of 24-hour blood pressure values with clinic blood pressure measurements.
- Discussion of the need for longitudinal studies and population-based normality definitions.
Main Results:
- 24-hour blood pressure values show closer correlation with hypertension-related end-organ damage compared to clinic blood pressure.
- ABPM may better reflect the cardiovascular consequences of hypertension.
Conclusions:
- Wider clinical adoption of ABPM requires further demonstration of its prognostic importance through morbidity and mortality studies.
- Clear definitions of normal ABPM values are needed.
- Currently, ABPM is best used for specific issues like identifying white coat hypertension and non-response to treatment.
Abstract:
Ambulatory blood pressure monitoring generates a greater interest among investigators and clinicians because of its potential to 1) study the mechanisms involved in cardiovascular control in daily life (particularly if monitoring is performed on a beat-to-beat basis) and 2) improve the diagnosis of hypertension, the estimate of the patient's risk and the assessment of the efficacy of antihypertensive treatment. This paper will discuss the evidence pros and cons the latter indications of this approach. It will be shown that 24 hour blood pressure values correlate more closely than clinic blood pressure with various measures of the end organ damage of hypertension, suggesting that it may reflect better than traditional blood pressure measurements the cardiovascular consequences of this condition. Wider use of ambulatory blood pressure monitoring in the medical practice, however, must await a more clear demonstration of its prognostic importance, by longitudinal studies based on cardiovascular morbidity and mortality or on surrogate end points with undisputable clinical significance (e.g. left ventricular hypertrophy). It must also await clear definition of ambulatory blood pressure normality based on population studies. Until then ambulatory blood pressure monitoring should be employed to resolve special problems, e.g. identification of white coat hypertension and false non response to treatment.