Clinical Value of Ambulatory Blood Pressure

Abstract

This article reviews the clinical value of ambulatory blood pressure (BP) vis-à-vis the traditional BP measurements taken in the physician's office or in the hospital. Mention is initially made that longitudinal studies conducted in the general population or in hypertensive cohorts have shown that ambulatory BP provides a more accurate prediction of outcome than office BP. Namely, that (1) the risk of cardiovascular events increases in a less steep fashion with office than with 24-hour mean BP, (2) the 24-hour BP-dependent prediction is maintained after adjustment for office BP values, and (3) among individuals with normal office BP, those with increased ambulatory BP (masked hypertension) have an increased prevalence of organ damage, a more frequent unfavorable metabolic profile and a higher risk of new onset sustained hypertension, diabetes mellitus, and cardiovascular events than those with normal ambulatory BP. It is further mentioned, however, that more recently similar observations have been made for individuals with high office but normal ambulatory BP (white coat hypertension) suggesting a complementary role of out-of-office and office BP values in the determination of patients' prognosis. The evidence in favor of an independent prognostic value also of some within 24-hour BP phenomena (night BP reduction or absolute values, short-term BP variations, and morning BP surge) is then critically appraised for its elements of strength and weakness. Finally, whether the clinical advantages of ambulatory BP make this approach necessary for all patients with hypertension is discussed. The conclusion is that this is at present still premature because crucial evidence pro or against routine use of this approach in untreated and treated hypertensives is not yet available. It will be crucial for future studies to determine whether, compared with a treatment guided by office BP, a treatment tailored on ambulatory BP allows to improve prevention or regression of organ damage as well as protection from major cardiovascular complications to a degree that justifies the complexity and cost of the procedure.

Impact of Empagliflozin on Blood Pressure in Patients With Type 2 Diabetes Mellitus and Hypertension by Background Antihypertensive Medication

“…En comparación con la PA de consultorio, la MAPA de 24 horas tiene reproducibilidad superior y es un factor predictivo más sensible de resultados cardiovasculares. 24 Si bien la reducción de la PA después del tratamiento con empagliflozina tendió a ser más baja durante la noche que durante el día (una consecuencia previsible de la PA nocturna más baja), la empagliflozina redujo los valores de PA en uno u otro perío-do. 20 Más aún, la reducción se mantuvo durante todo el período de 24 horas, aun en las horas más alejadas de la administración de empagliflozina.…”

“…Compared with office BP, 24-hour ABPM has superior reproducibility and is a more sensitive predictor of cardiovascular outcomes. 24 Although BP reduction after treatment with empagliflozin tended to be lower during the nighttime than during the daytime (an expected consequence of lower nighttime BP), BP values were reduced by empagliflozin in either period. 20 Furthermore, the reduction was maintained throughout the 24-hour period, even in the hours farthest from empagliflozin administration.…”

Use of Biomarkers in the Evaluation and Treatment of Hypertensive Patients

“…In recent years the role of out-of-office blood pressure readings in the form of ambulatory blood pressure monitoring (ABPM) and home (self) blood pressure monitoring has been recognised [9].…”

Utilizing proteomics to understand and define hypertension: where are we and where do we go?

“…This complexity has implications for the definition of ‘normal’ and ‘high’ blood pressure where clearly an isolated reading at a random time of the day cannot be used to establish the diagnosis ‘hypertension’ [4]. In fact, hypertension is different from many other clinical conditions whose definition is primarily based on the underlying pathology, possibly combined with diagnostic criteria based on symptoms and test results.…”