Ambulatory Blood Pressure Monitoring for the Effective Management of Antihypertensive Drug Treatment

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Hypertension is an important public health issue because of its association with a number of significant diseases and adverse outcomes. However, there are important ethnic differences in the pathogenesis and cardio-/cerebrovascular consequences of hypertension. Given the large populations and rapidly aging demographic in Asian regions, optimal strategies to diagnose and manage hypertension are of high importance. Ambulatory | 1251 KARIO et Al.

Section: Resultsmentioning

confidence: 99%

Expert panel consensus recommendations for ambulatory blood pressure monitoring in Asia: The HOPE Asia Network

Kario

Shin

Chen³

et al. 2019

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167

“…In one study, only 12% of patients achieved target BP with office BP compared with more than one third of patients with ABPM. Furthermore, 38% of patients had a change in their medication as a result of ABPM, 32% had a new medication started, and 14% of untreated patients with elevated office BP, who were candidates for drug treatment, were not started on medication because ABPM values were normal . In one Spanish database, 700 000 elderly individuals would have been spared medication if ABPM, instead of office BP, had been performed .…”

Section: Abpm To Determine Efficacy Of Treatmentmentioning

confidence: 99%

“…Furthermore, 38% of patients had a change in their medication as a result of ABPM, 32% had a new medication started, and 14% of untreated patients with elevated office BP, who were candidates for drug treatment, were not started on medication because ABPM values were normal. 14,15 In one Spanish database, 700 000 elderly individuals would have been spared medication if ABPM, instead of office BP, had been performed. 5 On the other hand, the percentage of patients considered eligible for treatment increased by 6% with ABPM, which amounted to 350 000 elderly patients.…”

Section: Ab Pm To De Termine Effic Ac Y Of Tre Atmentmentioning

confidence: 99%

Ambulatory blood pressure monitoring in the 21st century

O’Brien

White

Parati

et al. 2018

Self Cite

In clinical practice, ambulatory blood pressure monitoring (ABPM) tends to be used solely for diagnosing hypertension, especially to identify white-coat and masked hypertension. However, ABPM can provide additional information to guide the management and drug treatment of hypertension. In this brief review, the general principles governing the use of ABPM in clinical practice, such as the devices and software, recording requirements, the thresholds for the day, night and 24-hour periods and how often to repeat ABPM are summarized. The use of ABPM for diagnosing, determining the efficacy of treatment, and assessing the long-term control of hypertension are discussed.

“…This study showed that ABPM identified the patients for whom medication was needed and resulted in an overall reduction in the number of patients treated for hypertension. The conclusion was that ABPM can save money and that the extra costs of providing the technique were more than offset by cost savings from better targeted treatment …”

Section: Abpm To Determine Efficacy Of Treatmentmentioning

confidence: 99%

How should ambulatory blood pressure measurement be used in general practice?

O’Brien

2016

Self Cite

| INTRODUCTIONCurrent guidelines on hypertension now accept that ambulatory blood pressure (BP) measurement (ABPM) is the measurement method of choice for diagnosing hypertension. The technique has been shown to be more accurate and more cost effective than office BP (OBPM) or self-measurement of BP (SBPM). The diagnostic superiority of ABPM derives mainly from the ability of the technique to identify sustained hypertension by allowing for the exclusion of white-coat hypertension and by demonstrating the presence of masked hypertension. ABPM also offers diagnostic insights into nocturnal patterns of BP, and, despite less attention being given to nighttime BP in clinical practice, the increased risk of stroke with elevated nocturnal BP makes it important to assess the response to BP-lowering medication during sleep. Surprisingly, although current guidelines give detailed recommendations on the diagnostic potential and use of ABPM, there are scant recommendations on the benefits and application of the technique for the initiation of BP-lowering therapy in clinical practice and virtually no recommendations as to how it might be used to assess the efficacy of drug treatment and guide the prescribing physician on the most appropriate drug administration and dosage over time. Furthermore, the limited availability of ABPM to date has confined its use to the diagnosis of hypertension, rather than applying the technique to gauging more reliably the response to treatment, especially in patients at high risk, who may be taking a number of BP-lowering drugs. The increasing approval of ABPM for reimbursement in many countries is an overdue and welcome initiative, which, although incurring substantial initial short-term costs, will lead to improved BP control in the longer term and substantial savings in the prevention of the cardiovascular (CV) consequences of hypertension, most especially the prevention of stroke. However, we are now faced with a responsibility to use ABPM to achieve the maximum benefit, without applying the technique excessively. | ABPM FOR THE DIAGNOSIS OF HYPERTENSIONThe US Preventive Services Task Force, with out-of-office measurement is sustained and not due to a whitecoat reaction, as may occur in some 25% of patients. 5 Therefore, there is no disagreement but that ABPM should be offered to all patients before prescribing BP-lowering medication. | ABPM TO DETERMINE EFFICACY OF TREATMENTWe now move into uncharted waters as none of the guidelines make definitive recommendations regarding how to use ABPM to initiate and assess the response to antihypertensive drug treatment in spite of there being sound evidence that ABPM can be extremely helpful in this regard. The largest study to date on the use of ABPM to guide treatment in primary care comes from Spain, where a nationwide project to promote the use of ABPM in primary care settings was established a decade ago. 6 This study showed that ABPM identified the patients for whom medication was needed and resulted in an overall reduction in the number of pa...