Office compared with ambulatory blood pressure in assessing response to antihypertensive treatment

Mancia, Giuseppe; Parati, Gianfranco

doi:10.1097/00004872-200403000-00001

Cited by 193 publications

(129 citation statements)

References 66 publications

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“…33 We could not evaluate the effects of diuretics on dipping status, 34,35 because 85% of patients were using diuretics at baseline. Third, it has been noted that antihypertensive therapy can have differential affects on day and night BP 36 ; however, the magnitude of the difference is small and unlikely to explain the high prevalence of nondipping in our study. Finally, because the analyses are cross-sectional, we cannot draw causal links between any BP index and target organ damage.…”

Section: Discussioncontrasting

confidence: 57%

Disparate Estimates of Hypertension Control From Ambulatory and Clinic Blood Pressure Measurements in Hypertensive Kidney Disease

et al. 2009

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Abstract-Ambulatory blood pressure (ABP) monitoring provides unique information about day-night patterns of blood pressure (BP). The objectives of this article were to describe ABP patterns in African Americans with hypertensive kidney disease, to examine the joint distribution of clinic BP and ABP, and to determine associations of hypertensive target organ damage with clinic BP and ABP. This study is a cross-sectional analysis of baseline data from the African American Study of Kidney Disease Cohort Study. Masked hypertension was defined by elevated daytime (Ն135/ 85 mm Hg) or elevated nighttime (Ն120/70 mm Hg) ABP in those with controlled clinic BP (Ͻ140/90 mm Hg); nondipping was defined by a Յ10% decrease in mean nighttime systolic BP; reverse dipping was defined by a higher nighttime than daytime systolic BP. Of the 617 participants (mean age: 60.2 years; 62% male; mean estimated glomerular filtration rate: 43.8 mL/min per 1.73 m 2 ) with both clinic BP and ABP, 498 participants (80%) had a nondipping or reverse dipping profile. Of the 377 participants with controlled clinic BP (61%), 70% had masked hypertension. Compared with those with controlled clinic BP or white-coat hypertension, target organ damage (proteinuria and left ventricular hypertrophy) was more common in those with elevated nighttime BP, masked hypertension, or sustained hypertension. In conclusion, clinic BP provides an incomplete and potentially misleading assessment of the severity of hypertension in African Americans with hypertensive kidney disease, in large part because of increased nighttime BP. Whether lowering nighttime BP improves clinical outcomes is unknown but should be tested given the substantial burden of BP-related morbidity in this population.

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Section: Discussioncontrasting

confidence: 57%

Disparate Estimates of Hypertension Control From Ambulatory and Clinic Blood Pressure Measurements in Hypertensive Kidney Disease

et al. 2009

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“…In a meta-analysis of studies analyzing the effect of antihypertensive drugs on both office and 24-hour ambulatory BP, the effect on the reduction of 24-hour ambulatory BP was smaller than that in the office because of substantially less reduction in nighttime as compared with daytime BP. 30 Patients in HTN-Japan had a lower body mass index and, perhaps related to this, were less likely to have a history of obstructive sleep apnea compared with patients in SYMPLICITY HTN-3. Asian patients on average have a lower body mass index and have different associations between body mass index, body fat percentage, and health risks compared with an American population.…”

Section: P=0004mentioning

confidence: 96%

Effect of Catheter-Based Renal Denervation on Morning and Nocturnal Blood Pressure

et al. 2015

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U ncontrolled hypertension is associated with an increasing incidence of stroke, cardiovascular events such as myocardial infarction, peripheral artery disease, and end-stage renal disease across all ages, and ethnicities. [1][2][3][4][5] Detailed studies of blood pressure (BP) variability over 24 hours have further described an increased risk of cardiovascular events and stroke with elevated BP during the nighttime 6,7 and early morning hours. 8,9The sympathetic nervous system plays an active role in the modulation of BP, and its overactivation can lead to hypertension.10,11 Percutaneous catheter-based renal denervation (RDN) by radiofrequency ablation of the renal artery nerves has been shown to reduce central sympathetic activity 12,13 and BP in patients with uncontrolled hypertension. Although recently reported results from the Renal Denervation in Patients With Uncontrolled Hypertension (SYMPLICITY HTN-3) 14 and SYMPLICITY HTN-Japan (HTN-Japan) 15 clinical trials did not demonstrate superiority of RDN over pharmacological management of hypertension based on superiority analyses of office BP or 24-hour ambulatory BP measurements (ABPM), 14,15 further evaluation of the SYMPLICITY HTN-3 trial identified several potential confounding factors that may have impacted the overall results, including insufficient ablation attempts, insufficient 4-quadrant ablations, and antihypertensive medication changes. 16In contrast to the results of SYMPLICITY HTN-3, the recently reported prospective Renal Denervation for Hypertension (DENER HTN) 17 trial reported small but statistically significant reductions in ambulatory BP (though not office or home BP) in denervated patients compared with a nonblinded, randomized control group of patients with resistant hypertension treated with a stepped-care pharmacological strategy. These reductions included greater decreases in both daytime and nighttime ambulatory systolic BP in the denervated group.Abstract-High nighttime and early morning blood pressure (BP) have been associated with greater risk for cardiovascular events than high clinic or daytime BP. BP is typically highest in the rising hours, when morning activities typically begin. We examined the effect of renal denervation on morning (6:00-8:59 AM), daytime (9:00 AM-8:59 PM), and nighttime ( P=0.28), but the classes prescribed and changes in prescription varied by study. Among patients treated with renal denervation, although the number of ablation treatments were similar in both studies (11.2±2.8 versus 11.5±1.9, P=0.55), patients in SYMPLICITY HTN-3 were less likely to receive at least 1 four-quadrant ablation treatment (25% versus 82%, P<0.001). In SYMPLICITY HTN-3, compared with controls (n=159), patients treated with renal denervation (n=325) experienced a significantly greater change in morning (−7.3±19.8 mm Hg, P<0.001) and nighttime (−6.1±18.2 versus −1.6±19.7 mm Hg, P=0.02) but not daytime systolic BP (−7.2±16.2 versus −6.4±18.6 mm Hg, P=0.67). This same trend was observed in the pooled analysis with HTN-Japan. Re...

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“…The genetics of ambulatory BP (ABP) may differ, however, because it is unaffected by the "white-coat" effect. 6 The added value of ABP measurements is best illustrated by studies showing that ABP is a better predictor of target organ damage, 7 cardiovascular morbidity, and mortality 8,9 than conventional office BP.To date, only 4 twin studies 10 -13 and 1 family study 14 reported heritability estimates for daytime or 24-hour ABP. Estimates ranged from 22% to 62% for systolic blood pressure (SBP) and from 38% to 63% for diastolic blood pressure (DBP).…”

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confidence: 99%

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confidence: 99%

Heritability of Daytime Ambulatory Blood Pressure in an Extended Twin Design

et al. 2005

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Abstract-The present study estimated the genetic influences on ambulatory systolic and diastolic blood pressure, and on hypertensive status derived from ambulatory levels, in a family sample of 535 twins and 257 singleton siblings. This "extended twin design" was used to explicitly test the possibility that results obtained in singleton siblings are different from those obtained in twins. To examine the effects of excluding (medicated) hypertensive subjects, the genetic analyses were first performed under strict exclusion (medication and/or blood pressure Ͼ135/85 mm Hg), then without the medicated subjects, and, finally, without any exclusion. For the latter analysis, the untreated blood pressure values in subjects using antihypertensive medication were estimated by augmenting the observed blood pressure by the published efficacy of the specific antihypertensive medication used. No evidence was found for differential means, variances, or covariances of ambulatory blood pressure in singletons compared with twins. This indicates that estimates of heritability of ambulatory blood pressure from twin studies can be generalized to the singleton population. Heritability of hypertension, defined as a mean daytime blood pressure Ͼ135/85 mm Hg or antihypertensive medication use, was 61%. Genetic contribution to ambulatory blood pressure was highest when all subjects were included (systolic, 44% to 57%; diastolic, 46% to 63%) and lowest under strict exclusion (systolic, 32% to 50%; diastolic, 31% to 55%). We conclude that exclusion of (medicated) Most of these studies have based their genetic analyses on conventional office BP measurements. The genetics of ambulatory BP (ABP) may differ, however, because it is unaffected by the "white-coat" effect. 6 The added value of ABP measurements is best illustrated by studies showing that ABP is a better predictor of target organ damage, 7 cardiovascular morbidity, and mortality 8,9 than conventional office BP.To date, only 4 twin studies 10 -13 and 1 family study 14 reported heritability estimates for daytime or 24-hour ABP. Estimates ranged from 22% to 62% for systolic blood pressure (SBP) and from 38% to 63% for diastolic blood pressure (DBP). With the exception of studies by Vinck et al 12 and Fagard et al,13 sample sizes for the twin analyses have been rather small, ie, at most, 66 pairs in total. Thus, there is a relative paucity of adequately powered twin studies on ambulatory measures. One way of increasing statistical power is to include singleton siblings. Such an extended twin design 15 further provides an optimal design to address the question whether results from twin studies on the genetics of ABP may be generalized to the singleton population, because it matches twins and singletons for familial factors like socioeconomic status (SES), diet habits, and maternal behaviors during pregnancy.Existing twin and family studies of ABP have excluded subjects using antihypertensive medication, 12,13 or have been performed with analyses of normotensive subjects only, 10,11 ther...

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Office compared with ambulatory blood pressure in assessing response to antihypertensive treatment

Cited by 193 publications

References 66 publications

Disparate Estimates of Hypertension Control From Ambulatory and Clinic Blood Pressure Measurements in Hypertensive Kidney Disease

Disparate Estimates of Hypertension Control From Ambulatory and Clinic Blood Pressure Measurements in Hypertensive Kidney Disease

Effect of Catheter-Based Renal Denervation on Morning and Nocturnal Blood Pressure

Heritability of Daytime Ambulatory Blood Pressure in an Extended Twin Design

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