Prognostic Value of Ambulatory Blood Pressure in the Obese: The Ambulatory Blood Pressure‐International Study

Palatini, Paolo; Reboldi, Gianpaolo; Beilin, Lawrence J.; Casíglia, Edoardo; Eguchi, Kazuo; Imai, Yutaka; Kario, Kazuomi; Pierdomenico, Sante D.; Schwartz, Joseph E.; Wing, L. M. H.; Verdecchia, Paolo

doi:10.1111/jch.12700

Cited by 6 publications

(6 citation statements)

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“…Ambulatory 24-hour BP measurement is more reliable than single or multiple office measurements to identify hypertension and as a predictor of cardiovascular outcomes. 52,53 It is currently the diagnostic tool recommended to confirm a diagnosis of hypertension. The Longitudinal Victorian Infant Collaborative Study of EPT and/or extremely low birth weight (ELBW) survivors performed a single reading of office BP at 8 years and revealed no differences compared with term control group members.…”

Section: Discussionmentioning

confidence: 99%

High Blood Pressure at Early School Age Among Extreme Preterms

et al. 2018

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Section: Discussionmentioning

confidence: 99%

High Blood Pressure at Early School Age Among Extreme Preterms

et al. 2018

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“…At present, no antihypertensive intervention would be approved without having been assessed by out‐of‐office BP measurements (Mancia et al., ), mostly due to the greater prognostic value of ambulatory BP measurements in comparison with office BP (Palatini et al., ). That should be the same for non‐pharmacological measures such as physical activity.…”

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confidence: 99%

The ambulatory hypotensive effect of aerobic training: a reappraisal through a meta‐analysis of selected moderators

Sosner

Guiraud

Grémeaux

et al. 2016

Scandinavian Med Sci Sports

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The effectiveness of regular exercise in decreasing both systolic and diastolic blood pressure (BP) is well-established. Our purpose was to assess the impact of both subject and physical activity program characteristics on ambulatory BP through a meta-analysis of the existing literature. Three databases (PubMed, Embase, Web of Science) were searched using relevant terms and strategies. From 637 identified records, 37 studies met inclusion criteria: details about training intervention and participant characteristics, pre- and post-training ambulatory BP measurements, at home (HBPM) or during 24-h (ABPM). The weighted mean difference was for 24-h systolic/diastolic ABPM (n = 847 participants): -4.06/-2.77 mmHg (95%CI: -5.19 to -2.93/-3.58 to -1.97; P < 0.001), for daytime (ABPM or HBPM, n = 983): -3.78/-2.73 mmHg (95%CI: -5.09 to -2.47/-3.57 to -1.89; P < 0.001) and nighttime ABPM periods (n = 796): -2.35/-1.70 mmHg (95%CI: -3.26 to -1.44/-2.45 to -0.95; P < 0.001). Characteristics significantly influencing BP improvement were: an initial office BP ≥130/85 mmHg and diet-induced weight-loss. We found no differences according to sex, age, or training characteristics (intensity, number of sessions, training duration). Antihypertensive effects of aerobic training assessed by ambulatory BP measurements appear significant and clinically relevant for both daytime and nighttime periods, in particular for participants with an office BP ≥130/85 mmHg.

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“…The authors conclude that their results indicate that ABPM is as accurate in obese patients as in nonobese patients, at least insofar as the prediction of CVEs is concerned, and that ABPM may be offered as readily to obese patients as to those who are not obese. 1 This finding has important implications for practice. Firstly, the study does not show that ABPM is as accurate in obese as in nonobese patients.…”

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confidence: 94%

“…Moreover, the study showed that the good prognostic performance of ABPM was also maintained in the group of patients with more severe obesity. The authors conclude that their results indicate that ABPM is as accurate in obese patients as in nonobese patients, at least insofar as the prediction of CVEs is concerned, and that ABPM may be offered as readily to obese patients as to those who are not obese …”

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Prognostic Value of Ambulatory Blood Pressure Monitoring in Obese Patients

O’Brien

2015

J of Clinical Hypertension

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In this issue of the Journal, Palatini and his colleagues 1 ask and answer an important question. The question is simply this: because blood pressure (BP) measurement is prone to error in patients with obese arms, is ambulatory BP monitoring (ABPM) as accurate in obese patients as in the nonobese? Or, put another way, if ABPM is shown to be inaccurate in obese patients, other methods of measurement will have to be devised for this population of patients who constitute as many as 30% of individuals with hypertension. Palatini's group approaches the problem in a unique manner. Rather than simply comparing ABPM measurements in obese patients (with a large arm circumference) with nonobese patients (with normal arm circumference), they chose to examine cardiovascular outcome in obese and nonobese patients who had both office BP and ABPM performed, the premise being that if predictive values for cardiovascular events (CVEs) with ABPM are similar in both groups, the technique can be recommended for obese as well as nonobese patients. There are many reasons as to why ABPM might be inaccurate in obese individuals. These include technical problems related to arm size and adiposity that might lead to failed readings, negating the benefit of recording BP in ambulatory conditions; the use of monitors provided with undersized cuffs leading to overestimation of ABPM in obese arms; the discomfort caused by repeated long inflations of a large cuff causing disruption of nighttime sleep with falsely elevated BP readings; inappropriateness of cuff shape as cylindrical cuffs do not always wrap snugly around conically shaped upper arms in obese patients; and oscillometric measurements can be influenced by the stiffer arteries often present in obese patients. Furthermore, it is possible that current measurement ABPM algorithms are not adjusted for obese arms because validation protocols do not consider arm circumference as a selection criterion for testing monitor performance and usually only a few obese patients are recruited in validation studies. For these reasons, the reliability of ABPM in obese patients is often questioned. The recent European Society of Hypertension guidelines recommend, therefore, separate validation of ABPM devices in obese people.3 However, the practical difficulty (and cost) of such studies means that, in effect, specific validation studies have not been performed in the obese population.The Ambulatory Blood Pressure-International Study is an international registry established to promote the investigation of the relationship of noninvasive 24-hour ABPM with morbidity and mortality in a large patient population recruited in different countries. 4 The database was constructed by data from three European, three Japanese, one North American, and one Australian center, in which there were 10,817 individuals (5136 women and 5681 men, 9408 nonobese and 1409 obese) aged older than 60 years who had casual BP measurements and 24-hour ABPM performed under standardized conditions. Average 24-hour BP was superior to off...

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Prognostic Value of Ambulatory Blood Pressure in the Obese: The Ambulatory Blood Pressure‐International Study

Cited by 6 publications

References 35 publications

High Blood Pressure at Early School Age Among Extreme Preterms

High Blood Pressure at Early School Age Among Extreme Preterms

The ambulatory hypotensive effect of aerobic training: a reappraisal through a meta‐analysis of selected moderators

Prognostic Value of Ambulatory Blood Pressure Monitoring in Obese Patients

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