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Defining normal ambulatory blood pressure in relation to target organ damage and prognosis
1Hypertension Unit, General Hospital R. Silvestrini, Perugia PG, Italy.
Insights
Defining normal ambulatory blood pressure (ABP) is crucial for identifying hypertension risks. Studies suggest specific ABP levels may indicate lower cardiovascular risk, even in treated patients.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Measurement
Background:
- Establishing definitive normal ranges for ambulatory blood pressure (ABP) is challenging.
- The prognostic significance of 'white coat hypertension' (normal ABP in a clinical setting) remains unclear regarding cardiovascular (CV) morbidity.
- Current understanding lacks consensus on whether antihypertensive drug treatment offers benefits over placebo for white coat hypertension.
Purpose of the Study:
- To propose a working definition for normal ambulatory blood pressure (ABP).
- To test hypotheses regarding CV morbidity in white coat hypertension compared to higher ABP levels.
- To evaluate the efficacy of drug treatment versus placebo in white coat hypertension.
Main Methods:
- Utilizing echocardiographic left ventricular (LV) mass as a surrogate outcome measure.
- Analyzing mean daytime ABP levels to identify subgroups of hypertensive subjects.
- Comparing LV mass and left ventricular hypertrophy (LVH) prevalence against healthy normotensive controls.
Main Results:
- A subgroup of clinically hypertensive subjects with mean daytime ABP < 134/90 mm Hg (or < 136/87 mm Hg in men, < 131/86 mm Hg in women) showed LV mass and LVH prevalence similar to healthy normotensive individuals.
- This suggests a potential definition for identifying hypertensive patients at lower future CV risk.
Conclusions:
- The proposed ABP thresholds may help identify a subgroup of hypertensive patients with a lower risk profile.
- Further research is needed to confirm the prognostic implications of these ABP levels and the role of treatment in white coat hypertension.
Abstract:
It is premature to state that ambulatory blood pressure (ABP) values below a given level should be considered normal, and those above it abnormal, in terms of prognostic implications on cardiovascular (CV) morbidity. We do not know whether CV morbidity in hypertensive subjects with apparently normal ABP (white coat hypertension) is less than that in patients with higher ABP levels and similar to that of healthy normotensive subjects, or whether the effects of antihypertensive drug treatment on CV morbidity are superior to placebo in white coat hypertension. It is important to achieve agreement on a temporary working definition of normal ABP to be used to test two main hypotheses: 1) in subjects with white coat hypertension, CV morbidity is less than that in patients with higher ABP levels; and 2) drug treatment is not superior to placebo in reducing CV morbidity in white coat hypertension. Normal ABP values can be derived empirically from population based samples, in selected groups of healthy subjects, or from meta-analyses. However, the significance of the definition of a normal ABP range is the identification of clinically hypertensive patients at low risk of future CV morbid events. Using echocardiographic left ventricular (LV) mass as a surrogate outcome measure, we found that the coexistence of mean daytime ABP levels < 134 mm Hg systolic and < 90 mm Hg diastolic, regardless of gender (< 136/87 mm Hg in men and 131/86 mm Hg in women) identifies a subgroup of clinically hypertensive subjects with echocardiographic LV mass, and associated prevalence of left ventricular hypertrophy (LVH) similar to those found in healthy normotensive control subjects.(ABSTRACT TRUNCATED AT 250 WORDS)