Abnormalities in ambulatory blood pressure monitoring in hypertensive patients with diabetes

Gorostidi, Manuel; Sierra, Alejandro de la; González-Albarrán, O.; Segura, Julián; Cruz, Juan; Vinyoles, Ernest; Llisterri, J.L.; Aranda, Pedro J.; Ruilope, Luís M.; Banegas, José R.

doi:10.1038/hr.2011.100

Cited by 48 publications

(39 citation statements)

References 30 publications

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“…Corresponding data in renal and coronary heart disease patients were 72.1 and 25.8%, and 69.4 and 25.1%, respectively. 23 A relationship between the level of BP and the non-dipper pattern has also been reported, according to data from our group 21 (Table 1). Patients showing most elevated ambulatory systolic BP (4155 mm Hg) showed a prevalence of non-dippers of E70%.…”

Section: Circadian Bp Variation and Risk Categoriesmentioning

confidence: 82%

Diurnal blood pressure variation, risk categories and antihypertensive treatment

et al. 2010

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Ambulatory blood pressure (BP) monitoring is a useful tool aiding diagnostic and management decisions in patients with hypertension. Diurnal BP variation or circadian rhythm adds prognostic value to the absolute BP elevation. The Spanish ABPM Registry has collected information from 430 000 treated hypertensive patients attended by either primary care physicians or referral specialists. The analysis of BP diurnal variation has allowed the conclusion that nocturnal BP decline is related to the level of risk. Patients with blunted nocturnal dip frequently belong to high-or very high-risk categories and specifically are often older, obese, diabetics or with overt cardiovascular or renal disease. With respect to treatment, the non-dipper profile is more often observed in patients receiving several antihypertensive drug agents, but it does not correlate with the time of drug administration. Among patients receiving only one drug, non-dihydropyridine calcium channel blockers and a-blockers are associated with less nocturnal BP decline than other antihypertensive drug classes, even after adjusting for the level of risk.

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Section: Circadian Bp Variation and Risk Categoriesmentioning

confidence: 82%

Diurnal blood pressure variation, risk categories and antihypertensive treatment

et al. 2010

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“…These differences have been related, at least in part, with a wider use of antihypertensive drug combinations in the United States. Many treated patients in the Spanish ABPM Registry were receiving combinations of antihypertensive drugs, particularly high-risk hypertensives [24,25,33]. Despite a predominant use of combinations, the majority of patients had undercontrolled ambulatory BP.…”

Section: The Burden Of Uncontrolled Hypertensionmentioning

confidence: 99%

“…A series of analyses from the Spanish ABPM Registry have assessed prevalence of white-coat and masked hypertension in general treated hypertensives [17,19], untreated hypertensives [18], treated male vs. female hypertensives [20], hypertensives with coronary heart disease [21], very elderly hypertensives [22], resistant hypertensives [23], diabetics [24] and hypertensives with chronic kidney disease [25]. Prevalence of white-coat hypertension ranged from 15Á5% to 29Á2% in untreated patients, and prevalence of white-coat false resistance ranged from 24Á2% in treated males to 37Á5% in hypertensives resistant to three or more drugs.…”

Section: Prevalence Of White-coat and Masked Hypertensionmentioning

confidence: 99%

Ambulatory blood pressure monitoring in daily clinical practice – the Spanish ABPM Registry experience

Gorostidi

Banegas

Sierra

et al. 2015

Eur J Clin Investigation

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Many patients are hypertensive at the medical settings but show normal blood pressure out of the doctor's office, and are classified as white-coat hypertensives. On the other hand, many patients with controlled hypertension at the clinic show ambulatory blood pressure levels above the thresholds considered for an adequate blood pressure control, known as having masked hypertension. Using data from the Spanish Ambulatory Blood Pressure Monitoring Registry (Spanish ABPM Registry), a national program developed to promote the use of the ambulatory technique for hypertension management in daily practice, we have reviewed the main strengths of this approach, that is the ability to detect discrepancies of blood pressure status with respect to office blood pressure measurement, and to better assess accurate rates of hypertension control. White-coat hypertension within patients with elevated office blood pressure, and masked hypertension within office-controlled patients affected one of three patients in each office status. On the other hand, rates of ambulatory blood pressure control (50%) doubled those of office blood pressure control (25%), still remaining half the patients uncontrolled. We think that a systematic use of ambulatory blood pressure monitoring, and strategies to improve blood pressure control constitute key priorities in hypertension management. Keywords Ambulatory blood pressure measurement, blood pressure, blood pressure measurement, hypertension, masked hypertension, white-coat hypertension. Eur J Clin Invest 2016; 46 (1): 92-98

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“…In this issue of Hypertension Research, Gorostidi et al, 11 drawing on data from a Spanish database, describe patterns of ABPM in hypertensive patients with or without diabetes. The authors found that diabetic patients have higher BP levels and are more likely to be non-dippers; the riser pattern in particular was more frequent than in nondiabetic patients.…”

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A call for wider use of ambulatory blood pressure monitoring in patients with diabetes

Eguchi

2011

Hypertens Res

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H ypertension is one of the most important determinants of micro-and macrovascular complications in patients with diabetes. Recent guidelines on treating hypertension in diabetes patients, based on clinical evidence of protection against target organ damage, especially as demonstrated by renal outcomes, recommended that office blood pressure (BP) be lowered to 130/ 80 mmHg in these patients. 1 However, very few studies have consistently achieved BP levels as low as 130/80 mmHg in diabetic patients.A landmark report related to the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study showed that targeting a systolic BP of o120 mm Hg, as compared with o140 mm Hg, did not reduce the rate of a composite outcome of fatal and non-fatal major cardiovascular events in type 2 diabetics with at high risk for cardiovascular events. 2 As a secondary outcome, intensive BP lowering was effective in reducing total stroke (P¼0.01) and non-fatal stroke events (P¼0.03). 2 Although many observational studies support the 'the lower, the better' theory, it has not been clearly shown that the aggressive lowering of BP is indeed beneficial in the management of hypertension. The ACCORD study was a randomized control study that examined cardiovascular disease as an outcome. The extent of BP lowering in diabetes should be individualized by cardiovascular complications, microvascular complications and the severity of diabetes and hypertension. In the ACCORD subjects, 34% had experienced previous cardiovascular events, and 87% were on antihypertensive medications. The mean baseline BP was as low as 139/76 mmHg in all patients. It is not surprising that no benefit of a further reduction of BP was seen when targeting a systolic BP of o120 mm Hg. In the early stage of diabetes, aggressive control of risk factors could be effective for reducing cardiovascular outcomes. 3,4 In clinical practice, physicians occasionally hesitate to add antihypertensive medications to achieve clinic BP of 130/80 mmHg. The target BP level in patients with diabetes remains to be established. In terms of individualized BP control, ambulatory BP monitoring (ABPM) is the most useful tool for accurately evaluating BP level and variability.For the assessment and management of BP, ABPM is better than clinic BP. 5 ABPM can more reliably and easily assess actual BP levels than clinic BP and is helpful for predicting cardiovascular events, target organ damage and antihypertensive effects. Even in diabetes, we have shown that ambulatory BP levels more accurately predict future cardiovascular events. 5 An abnormal dipping pattern has been established as a risk factor, 6 and white-coat hypertension and masked hypertension have been shown to be moderate risk factors. 7,8 We showed that BP variability during sleep was a risk factor for cardiovascular disease even after adjusting for BP levels in patients with diabetes. 9 Unless ABPM is performed, it is difficult to assess these measures and to perform detailed assessments, especially of nighttime BP. In the meantime, ...

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Abnormalities in ambulatory blood pressure monitoring in hypertensive patients with diabetes

Cited by 48 publications

References 30 publications

Diurnal blood pressure variation, risk categories and antihypertensive treatment

Diurnal blood pressure variation, risk categories and antihypertensive treatment

Ambulatory blood pressure monitoring in daily clinical practice – the Spanish ABPM Registry experience

A call for wider use of ambulatory blood pressure monitoring in patients with diabetes

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