Guiding antihypertensive treatment decisions using ambulatory blood pressure monitoring

Abstract

Compared with isolated clinic measurements, ambulatory blood pressure monitoring (ABPM) provides an insight into blood pressure (BP) changes in everyday life and an estimate of the overall BP load exerted on the cardiovascular system over 24 hours. Cross-sectional evidence suggests a direct and significant relationship between ambulatory BP and organ damage. There is also longitudinal evidence for a superior predictive value of 24-hour BP in relation to the risk for cardiovascular morbidity and mortality as opposed to clinic BP. The usefulness of ABPM in pharmacologic studies aimed at evaluating the 24-hour antihypertensive efficacy of different drugs and drug combinations is now acknowledged. Among the mathematical indices available to explore 24-hour BP coverage by treatment, the ABPM-derived smoothness index provides a superior measure of the homogeneity of BP control compared with trough:peak ratios. The main applications of clinical practice should be in identifying patients with isolated office hypertension and those who are nonresponders to treatment, in assessing coverage of the 24-hour BP profile in high-risk patients and in diagnosing suspected treatment-related hypotension.

Ambulatory blood pressure and cardiovascular risk in chronic kidney disease

“…A body of evidence shows that a nondipping nocturnal pattern is associated with more pronounced target-organ involvement and is a risk factor for cardiovascular mortality [6•,7]. In addition, a blunted BP fall at night suggests the presence of secondary hypertension [4]. ABPM can provide more than 100 measurements throughout 24 hours, which allows the calculation of short-term variability.…”

“…Several longitudinal studies suggest that ABPM is a more sensitive predictor of cardiovascular outcome than conventional measurement [4]. In addition, the clinical use of ABPM has enabled the identification of parameters other than the 24-hour average that might be useful for improving the prognostic precision.…”

Protective effects of renin–angiotensin blockade beyond blood pressure control

“…However, it is now well established that the effects of antihypertensive drug treatment on out-of-office blood pressure values may be quite different. 1 The European Lacidipine Study on Atherosclerosis (ELSA) examined the effects of a 4-year treatment with lacidipine or atenolol in 2334 patients with hypertension, in whom blood pressure was measured at yearly intervals both by clinic and 24-h monitoring. 2,3 In the pre-randomization state there were marked differences between these two blood pressure values.…”

Ambulatory Blood Pressure Monitoring: An Invaluable Tool Comes of Age for Patients with Chronic Kidney Disease

“…This is largely attributed to ABPM providing information on factors such as non-dipping status and BP variability, which have been shown to predict target-organ damage, but cannot be captured with clinic BP readings [16] . Current evidence derived from numerous observational studies in a wide range of populations (such as patients with essential hypertension, type 2 diabetes mellitus, and the elderly) clearly suggests the higher prognostic value of ABPM also for renal outcomes, including progression of albuminuria, decline of estimated glomerular function (eGFR), and incident ESRD, as recently summarized elsewhere [17] .…”