Current Hypertension Reports

, Volume 14, Issue 4, pp 366–373 | Cite as

Is It Possible to Manage Hypertension and Evaluate Therapy Without Ambulatory Blood Pressure Monitoring?

The Therapeutic Trials (G Mancia And Td Giles, Section Editors)

Abstract

In the management of patients with hypertension, blood pressure (BP) has been traditionally measured in the physician’s office. The contribution of ambulatory BP monitoring (ABPM) to the management of hypertensive patients has been increasingly recognized through clinical and epidemiological research. Ambulatory BP monitoring can enhance the ability to detect white-coat or masked hypertension, determine the absence of nocturnal dipping status, and evaluate BP control in patients on antihypertensive therapy. Recently, the United Kingdom National Clinical Guideline Centre published guidelines for the clinical management of primary hypertension in adults, recommending the routine use of ABPM to make the initial diagnosis of hypertension. While the advantages of ABPM are apparent from a clinical perspective, its use should be considered in relation to the cost of the equipment, data evaluation, and staff training as well as the possible inconvenience to the patient. In this review, we summarize the clinical importance of ABPM and discuss the current guidelines for establishing the diagnosis of hypertension.

Keywords

Ambulatory blood pressure Home blood pressure Office blood pressure Masked hypertension White-coat hypertension Cardiovascular risk Morning surge Nocturnal dipping Target organ damage 

Notes

Disclosure

Dr. White has served as a consultant on endpoint committees for Astra-Zeneca, Roche, and Takeda.

Dr. Maraka reported no potential conflicts of interest relevant to this article.

References

Recently published papers of particular interest have been highlighted as: • Of importance •• Of major importance

  1. 1.
    • Pickering TG, White WB, Giles TD, et al.: When and how to use self (home) and ambulatory blood pressure monitoring. J Am Soc Hypertens 2010, 4:56–61. Consensus document on clinical and practical recommendations for using home and ambulatory blood pressure monitoring. PubMedCrossRefGoogle Scholar
  2. 2.
    O'Brien E, Waeber B, Parati G, et al. Blood pressure measuring devices: Recommendations of the European Society of Hypertension. BMJ. 2001;322:531–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Pickering T. Recommendations for the use of home (self) and ambulatory blood pressure monitoring. American Society of Hypertension Ad Hoc Panel. Am J Hypertens. 1996;9:1–11.PubMedCrossRefGoogle Scholar
  4. 4.
    Pickering TG, Hall JE, Appel LJ, et al. Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Circulation. 2005;111:697–716.PubMedCrossRefGoogle Scholar
  5. 5.
    Williams B, Poulter NR, Brown MJ, et al. Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004-BHS IV. J Hum Hypertens. 2004;18:139–85.PubMedCrossRefGoogle Scholar
  6. 6.
    Mancia G, De Backer G, Dominiczak A, et al. Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2007;28:1462–536.PubMedGoogle Scholar
  7. 7.
    Imai Y, Otsuka K, Kawano Y, Shimada K, Hayashi H, Tochikubo O, et al. Japanese society of hypertension (JSH) guidelines for self-monitoring of blood pressure at home. Hypertens Res. 2003;26:771–82.PubMedCrossRefGoogle Scholar
  8. 8.
    World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension. Guidelines Subcommittee. J Hypertens. 1999;17:151–83.Google Scholar
  9. 9.
    Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289:2560–72.PubMedCrossRefGoogle Scholar
  10. 10.
    Clement DL, De Buyzere ML, De Bacquer DA, et al. Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension. N Engl J Med. 2003;348:2407–15.PubMedCrossRefGoogle Scholar
  11. 11.
    Dolan E, Stanton A, Thijs L, et al. Superiority of ambulatory over clinic blood pressure measurement in predicting mortality: the Dublin outcome study. Hypertension. 2005;46:156–61.PubMedCrossRefGoogle Scholar
  12. 12.
    •• Krause T, Lovibond K, Caulfield M, et al.: Management of hypertension: summary of NICE guidance. BMJ 2011, 343:d4891. An important summary of the updated NICE guidelines on the management of hypertension and one of the first using evidence to support using ambulatory blood pressure monitoring in clinical practice. PubMedCrossRefGoogle Scholar
  13. 13.
    Bloch MJ, Basile JN. New British guidelines mandate ambulatory blood pressure monitoring to diagnose hypertension in all patients: not ready for prime time in the United States. J Clin Hypertens (Greenwich). 2011;13:785–6.CrossRefGoogle Scholar
  14. 14.
    White WB. Ambulatory blood-pressure monitoring in clinical practice. N Engl J Med. 2003;348:2377–8.PubMedCrossRefGoogle Scholar
  15. 15.
    White WB. Circadian variation of blood pressure: clinical relevance and implications for cardiovascular chronotherapeutics. Blood Press Monit. 1997;2:47–51.PubMedGoogle Scholar
  16. 16.
    Sundberg S, Kohvakka A, Gordin A. Rapid reversal of circadian blood pressure rhythm in shift workers. J Hypertens. 1988;6:393–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Sternberg H, Rosenthal T, Shamiss A, Green M. Altered circadian rhythm of blood pressure in shift workers. J Hum Hypertens. 1995;9:349–53.PubMedGoogle Scholar
  18. 18.
    White WB, Mansoor GA, Tendler BE, Anwar YA. Nocturnal blood pressure epidemiology, determinants, and effects of antihypertensive therapy. Blood Press Monit. 1998;3:43–51.PubMedGoogle Scholar
  19. 19.
    Di Iorio A, Marini E, Lupinetti M, Zito M, Abate G. Blood pressure rhythm and prevalence of vascular events in hypertensive subjects. Age Ageing. 1999;28:23–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Harshfield GA, Hwang C, Grim CE. Circadian variation of blood pressure in blacks: influence of age, gender and activity. J Hum Hypertens. 1990;4:43–7.PubMedGoogle Scholar
  21. 21.
    Sherwood A, Thurston R, Steffen P, et al. Blunted nighttime blood pressure dipping in postmenopausal women. Am J Hypertens. 2001;14:749–54.PubMedCrossRefGoogle Scholar
  22. 22.
    Cuspidi C, Giudici V, Negri F, Sala C. Nocturnal nondipping and left ventricular hypertrophy in hypertension: an updated review. Expert Rev Cardiovasc Ther. 2010;8:781–92.PubMedCrossRefGoogle Scholar
  23. 23.
    Pickering TG, Shimbo D, Haas D. Ambulatory blood-pressure monitoring. N Engl J Med. 2006;354:2368–74.PubMedCrossRefGoogle Scholar
  24. 24.
    Fan HQ, Li Y, Thijs L, et al. Prognostic value of isolated nocturnal hypertension on ambulatory measurement in 8711 individuals from 10 populations. J Hypertens. 2010;28:2036–45.PubMedGoogle Scholar
  25. 25.
    Gorostidi M, Sobrino J, Segura J, et al. Ambulatory blood pressure monitoring in hypertensive patients with high cardiovascular risk: a cross-sectional analysis of a 20,000-patient database in Spain. J Hypertens. 2007;25:977–84.PubMedCrossRefGoogle Scholar
  26. 26.
    de la Sierra A, Segura J, Gorostidi M, et al. Diurnal blood pressure variation, risk categories and antihypertensive treatment. Hypertens Res. 2010;33:767–71.PubMedCrossRefGoogle Scholar
  27. 27.
    de la Sierra A, Redon J, Banegas JR, et al. Prevalence and factors associated with circadian blood pressure patterns in hypertensive patients. Hypertension. 2009;53:466–72.PubMedCrossRefGoogle Scholar
  28. 28.
    Cuspidi C, Macca G, Sampieri L, et al. Target organ damage and non-dipping pattern defined by two sessions of ambulatory blood pressure monitoring in recently diagnosed essential hypertensive patients. J Hypertens. 2001;19:1539–45.PubMedCrossRefGoogle Scholar
  29. 29.
    Verdecchia P. Prognostic value of ambulatory blood pressure: current evidence and clinical implications. Hypertension. 2000;35:844–51.PubMedCrossRefGoogle Scholar
  30. 30.
    White WB, Larocca GM. Improving the utility of the nocturnal hypertension definition by using absolute sleep blood pressure rather than the "dipping" proportion. Am J Cardiol. 2003;92:1439–41.PubMedCrossRefGoogle Scholar
  31. 31.
    Mochizuki Y, Okutani M, Donfeng Y, et al. Limited reproducibility of circadian variation in blood pressure dippers and nondippers. Am J Hypertens. 1998;11:403–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Omboni S, Parati G, Palatini P, et al. Reproducibility and clinical value of nocturnal hypotension: prospective evidence from the SAMPLE study. Study on Ambulatory Monitoring of Pressure and Lisinopril Evaluation. J Hypertens. 1998;16:733–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Kario K, White WB. Early morning hypertension: what does it contribute to overall cardiovascular risk assessment? J Am Soc Hypertens. 2008;2:397–402.PubMedCrossRefGoogle Scholar
  34. 34.
    White WB. Cardiovascular risk and therapeutic intervention for the early morning surge in blood pressure and heart rate. Blood Press Monit. 2001;6:63–72.PubMedCrossRefGoogle Scholar
  35. 35.
    Wroe SJ, Sandercock P, Bamford J, et al. Diurnal variation in incidence of stroke: Oxfordshire community stroke project. BMJ. 1992;304:155–7.PubMedCrossRefGoogle Scholar
  36. 36.
    Elliott WJ. Circadian variation in the timing of stroke onset: a meta-analysis. Stroke. 1998;29:992–6.PubMedCrossRefGoogle Scholar
  37. 37.
    Casetta I, Granieri E, Portaluppi F, Manfredini R. Circadian variability in hemorrhagic stroke. JAMA. 2002;287:1266–7.PubMedCrossRefGoogle Scholar
  38. 38.
    Gallerani M, Manfredini R, Ricci L, et al. Chronobiological aspects of acute cerebrovascular diseases. Acta Neurol Scand. 1993;87:482–7.PubMedCrossRefGoogle Scholar
  39. 39.
    Kario K, Pickering TG, Umeda Y, et al. Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives: a prospective study. Circulation. 2003;107:1401–6.PubMedCrossRefGoogle Scholar
  40. 40.
    Li Y, Thijs L, Hansen TW, et al. Prognostic value of the morning blood pressure surge in 5645 subjects from 8 populations. Hypertension. 2010;55:1040–8.PubMedCrossRefGoogle Scholar
  41. 41.
    Sander GE, Giles TD. Resistant hypertension: concepts and approach to management. Curr Hypertens Rep. 2011;13:347–55.PubMedCrossRefGoogle Scholar
  42. 42.
    Den Hond E, Staessen JA, Celis H, et al. Antihypertensive treatment based on home or office blood pressure–the THOP trial. Blood Press Monit. 2004;9:311–4.CrossRefGoogle Scholar
  43. 43.
    Stergiou GS, Salgami EV, Tzamouranis DG, Roussias LG. Masked hypertension assessed by ambulatory blood pressure versus home blood pressure monitoring: is it the same phenomenon? Am J Hypertens. 2005;18:772–8.PubMedCrossRefGoogle Scholar
  44. 44.
    Liu JE, Roman MJ, Pini R, et al. Cardiac and arterial target organ damage in adults with elevated ambulatory and normal office blood pressure. Ann Intern Med. 1999;131:564–72.PubMedGoogle Scholar
  45. 45.
    • Viera AJ, Hinderliter AL, Kshirsagar AV, Fine J, Dominik R: Reproducibility of masked hypertension in adults with untreated borderline office blood pressure: comparison of ambulatory and home monitoring. Am J Hypertens 2010, 23:1190–1197. Illustrates that home blood pressure monitoring may not be adequate to detect masked hypertension. PubMedCrossRefGoogle Scholar
  46. 46.
    Perloff D, Sokolow M, Cowan R. The prognostic value of ambulatory blood pressures. JAMA. 1983;249:2792–8.PubMedCrossRefGoogle Scholar
  47. 47.
    Fagard RH, Staessen JA, Thijs L, et al. Response to antihypertensive therapy in older patients with sustained and nonsustained systolic hypertension. Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Circulation. 2000;102:1139–44.PubMedCrossRefGoogle Scholar
  48. 48.
    Staessen JA, Thijs L, Fagard R, et al. Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension. Systolic Hypertension in Europe Trial Investigators. JAMA. 1999;282:539–46.PubMedCrossRefGoogle Scholar
  49. 49.
    • Minutolo R, Agarwal R, Borrelli S, et al.: Prognostic role of ambulatory blood pressure measurement in patients with nondialysis chronic kidney disease. Arch Intern Med 2011, 171:1090–1098. Demonstrates the importance and utility of using ambulatory blood pressure monitoring in patients with chronic kidney disease as it relates to cardiovascular and renal outcomes. PubMedCrossRefGoogle Scholar
  50. 50.
    Neutel JM. The importance of 24-h blood pressure control. Blood Press Monit. 2001;6:9–16.PubMedCrossRefGoogle Scholar
  51. 51.
    White WB, Lacourciere Y, Davidai G. Effects of the angiotensin II receptor blockers telmisartan versus valsartan on the circadian variation of blood pressure: impact on the early morning period. Am J Hypertens. 2004;17:347–53.PubMedCrossRefGoogle Scholar
  52. 52.
    • Hermida RC, Ayala DE, Mojon A, Fernandez JR: Influence of circadian time of hypertension treatment on cardiovascular risk: results of the MAPEC study. Chronobiol Int 2010, 27:1629–1651. This article provides information on the effect of timing of hypertension treatment using ambulatory blood pressure monitoring and actigraphy. PubMedCrossRefGoogle Scholar
  53. 53.
    Graves JW, Nash C, Burger K, Bailey K, Sheps SG. Clinical decision-making in hypertension using an automated (BpTRU) measurement device. J Hum Hypertens. 2003;17:823–7.PubMedCrossRefGoogle Scholar
  54. 54.
    Pickering TG, Miller NH, Ogedegbe G, et al. Call to action on use and reimbursement for home blood pressure monitoring: executive summary a joint scientific statement from the american heart association, american society of hypertension, and preventive cardiovascular nurses association. J Am Soc Hypertens. 2008;2:192–202.PubMedCrossRefGoogle Scholar
  55. 55.
    Mule G, Caimi G, Cottone S, et al. Value of home blood pressures as predictor of target organ damage in mild arterial hypertension. J Cardiovasc Risk. 2002;9:123–9.PubMedCrossRefGoogle Scholar
  56. 56.
    Tachibana R, Tabara Y, Kondo I, Miki T, Kohara K. Home blood pressure is a better predictor of carotid atherosclerosis than office blood pressure in community-dwelling subjects. Hypertens Res. 2004;27:633–9.PubMedCrossRefGoogle Scholar
  57. 57.
    Ohkubo T, Imai Y, Tsuji I, et al. Home blood pressure measurement has a stronger predictive power for mortality than does screening blood pressure measurement: a population-based observation in Ohasama, Japan. J Hypertens. 1998;16:971–5.PubMedCrossRefGoogle Scholar
  58. 58.
    Sega R, Facchetti R, Bombelli M, et al. Prognostic value of ambulatory and home blood pressures compared with office blood pressure in the general population: follow-up results from the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study. Circulation. 2005;111:1777–83.PubMedCrossRefGoogle Scholar
  59. 59.
    Agarwal R, Andersen MJ. Prognostic importance of clinic and home blood pressure recordings in patients with chronic kidney disease. Kidney Int. 2006;69:406–11.PubMedCrossRefGoogle Scholar
  60. 60.
    •• Hodgkinson J, Mant J, Martin U, et al.: Relative effectiveness of clinic and home blood pressure monitoring compared with ambulatory blood pressure monitoring in diagnosis of hypertension: systematic review. BMJ 2011, 342:d3621. Recent review that provides a systematic evidence-based review on the diagnosis of hypertension with different methods of blood pressure measurement. PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Division of Hypertension and Clinical Pharmacology, Pat and Jim Calhoun Cardiology CenterUniversity of Connecticut School of MedicineFarmingtonUSA
  2. 2.Department of MedicineUniversity of Connecticut School of MedicineFarmingtonUSA

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