Ambulatory Blood Pressure Monitoring in the Diagnosis and Management of Hypertension

A rterial hypertension is associated with an increased risk of cardiovascular morbidity and mortality.1,2 Blood pressure (BP) reduction has been shown to reduce fatal and nonfatal outcomes in hypertensive patients. 3,4 Despite the improvement in diagnostic options and therapeutic interventions, observational studies continue to show persistently low rates of BP control in the general population of hypertensive patients. 5,6 In some of these patients, hypertension is resistant to treatment and persists despite the use of a combination of drugs. Multiple previous cross-sectional studies have consistently indicated an increased frequency of cardiovascular complications in patients with resistant hypertension (RH) compared with subjects without RH. 7-10Daugherty et al 11 in a longitudinal retrospective study found a 47% higher risk for cardiovascular complications in patients with RH compared with patients with non-RH. Studies reporting on RH have shown prevalence ranging between 3% and 38%. [7][8][9][12][13][14] However, these studies differ in the definition of RH (eg, number of drug classes included, time interval with uncontrolled BP), including or ignoring pharmacological treatment dosage and adherence to treatment, data source (eg, self-reported, physician-reported, or computerized database), method of BP assessment (eg, office or ambulatory BP monitoring), and use of a single or repeated assessments of BP. The current retrospective population-based study aimed at assessing the prevalence of RH in the hypertensive population of the Maccabi Healthcare Services (MHS) using its comprehensive computerized database, including drug dispense data. Methods Study PopulationAll data were obtained from the computerized databases of MHS. The study population included all patients aged >18 years who had entered the MHS's hypertension registry before January 1, 2010. Inclusion was based on ≥2 physician's diagnoses or hospital records and ≥2 BP measurements of systolic BP (SBP) ≥140 or diastolic BP (DBP) ≥ 90 mm Hg. For cases with abnormal measurements but no diagnoses, 4 documented measurements were required where ≥50% of the measurements were SBP >160 mm Hg or DBP >90 mm Hg. Also included were patients with ≥6 dispensed medications for hypertension. Patients were eligible for the study if they had had ≥2 BP measurements during a period of ≥6 months between January 1, 2010, and December 31, 2011. The mean (SD) number of BP measurements per patient was 3.9 (5.1). Patients who left MHS Abstract-Previous assessments of the prevalence of resistant hypertension (RH) in uncontrolled blood pressure (BP) have ranged from 3% to 30%. Using real-world data, our aim was to estimate the prevalence of RH in patients belonging to the Maccabi Healthcare Services, a 2-million-member health organization in Israel. From 2010 to 2011, all hypertensive patients with ≥2 recorded BP measurements during a minimum period of 6 months were identified. Patients were considered uncontrolled if their most recent BP during the study period and their mean...

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“…22 However, most studies that evaluated the rate of RH did not use 24H ABPM for diagnosis. Goal BP according to 24H ABPM is not well defined.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Factors Associated With Resistant Hypertension in a Large Health Maintenance Organization in Israel

et al. 2014

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“…17 Patients with poor drug adherence who undergo RDN might be positively influenced by the attention which they get at follow-up and to such an extent that drug adherence may gradually improve and thereby partly explain the BP-lowering effects. 5 This phenomenon, a potential placebo effect, is not controlled for in the randomized design of Symplicity HTN-2 2 and is the rationale why an ongoing follow-up study in the United States included sham operation. 18 In a press release from Medtronic in the United States, the sponsor of the Symplicity studies, it is stated that HTN-3 did not reach its primary objective at 6 months.…”

Section: Discussionmentioning

confidence: 99%

“…Improved drug adherence would be expected during an intervention because of increased attention to measurements and management. 5 Neither placebo effect nor merely a chance finding possibly related to publication bias can be excluded. 2 Because thousands of patients worldwide have undergone RDN, a costly invasive procedure with potential damage to the renal arteries, 6 and with BP-lowering effect documented in only 1 randomized study, 2 we aimed to investigate whether RDN truly lowers BP.…”

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confidence: 99%

Adjusted Drug Treatment Is Superior to Renal Sympathetic Denervation in Patients With True Treatment-Resistant Hypertension

Elmula¹,

Hoffmann²,

Larstorp³

et al. 2014

Hypertension

187

133

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Abstract-We aimed to investigate for the first time the blood pressure (BP)-lowering effect of renal sympathetic denervation (RDN) versus clinically adjusted drug treatment in true treatment-resistant hypertension (TRH) after excluding patients with confounding poor drug adherence. Patients with apparent TRH (n=65) were referred for RDN, and those with secondary and spurious hypertension (n=26) were excluded. TRH was defined as office systolic BP (SBP) >140 mm Hg, despite maximally tolerated doses of ≥3 antihypertensive drugs including a diuretic. In addition, ambulatory daytime SBP >135 mm Hg after witnessed intake of antihypertensive drugs was required, after which 20 patients had normalized BP and were excluded. Patients with true TRH were randomized and underwent RDN (n=9) performed with Symplicity Catheter System versus clinically adjusted drug treatment (n=10

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“…In the general population, SBP and DBP, on average, decrease by 10 % or more during night time compared with that during daytime, a phenomenon which is called dipping (18) . It has been observed that subjects in whom the BP reduction during sleep is blunted have an increased risk for cardiovascular events and mortality (11,19) .…”

Section: Discussionmentioning

confidence: 99%

Effects of NWT-03, an egg-protein hydrolysate, on blood pressure in normotensive, high-normotensive and mild-hypertensive men and women: a dose-finding study

Severins

Morrison²,

Mensink

2017

Br J Nutr

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Angiotensin-converting enzyme (ACE) inhibitors are important agents in blood pressure (BP) management. It was recently shown that the egg-protein hydrolysate NWT-03 inhibited ACE in Zucker diabetic fatty rats. We therefore designed a dose-finding study to assess the effects of 1, 2 and 5 g NWT-03 on daytime, 36-h, and night-time systolic and diastolic BP (SBP and DBP) in ninety-two generally healthy subjects with normal BP (n 29), high-normal BP (n 34) or mild hypertension (n 29). The study had a cross-over design with six treatment arms (1 g NWT-03 or placebo in period 1 and placebo or 1 g NWT-03 in period 2, 2 g NTW-03 or placebo in period 1 and placebo or 2 g NWT-03 in period 2, or 5 g NTW-03 or placebo in period 1 and placebo or 5 g NTW-03 in period 2). A comparable number of subjects from each BP class were included in each study arm. Duration of both treatments in each arm was 7 d, separated by 5-d wash-out periods. BP was measured with an ambulatory BP monitor before and after the treatments. In mild-hypertensive subjects, 2 g NWT-03 significantly decreased daytime SBP (7·9 mmHg; P = 0·006), daytime DBP (4·2 mmHg; P = 0·009), 36-h SBP (6·9 mmHg; P = 0·015) and 36-h DBP (3·5 mmHg; P = 0·035) compared with placebo subjects. In addition, in mild-hypertensive subjects, 5 g NWT-03 significantly decreased night-time SBP (14·8 mmHg; P = 0·008) and night-time DBP (8·4 mmHg; P = 0·020) compared with that in placebo subjects. To conclude, we found that 2 g NWT-03 lowered daytime and 36-h BP in subjects with mild hypertension, and 5 g NWT-03 lowered night-time BP in subjects with mild hypertension. As no doseresponse relationship was evident, these results should be interpreted with care, and additional studies are needed.

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Ambulatory Blood Pressure Monitoring in the Diagnosis and Management of Hypertension

Cited by 98 publications

References 67 publications

Prevalence and Factors Associated With Resistant Hypertension in a Large Health Maintenance Organization in Israel

Prevalence and Factors Associated With Resistant Hypertension in a Large Health Maintenance Organization in Israel

Adjusted Drug Treatment Is Superior to Renal Sympathetic Denervation in Patients With True Treatment-Resistant Hypertension

Effects of NWT-03, an egg-protein hydrolysate, on blood pressure in normotensive, high-normotensive and mild-hypertensive men and women: a dose-finding study

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