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Ambulatory Blood Pressure Monitoring in the Diagnosis, Prognosis, and Management of Resistant Hypertension: Still a Matter of our Resistance?

  • Resistant Hypertension (E Pimenta, Section Editor)
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Abstract

Resistant hypertension, commonly described as the failure to achieve goal blood pressure (BP) despite an appropriate regimen of three antihypertensive drugs at the maximal tolerated doses, one of which is diuretic, is increasingly recognized as an important problem of public health. Large population studies with office measurements suggest that the prevalence of resistance hypertension is approximately at 6–12 % of the general hypertensive population and 8–28 % of treated hypertensives. However, these estimations do not take into account factors of pseudo-resistance, most importantly, the white-coat effect that can be effectively ruled out with ambulatory blood pressure monitoring (ABPM). Recent studies have clearly shown that when ABPM is used, at least 30–35 % of patients labeled as “resistant hypertensives” turn out to have well-controlled BP on ambulatory basis, a finding changing entirely the estimates of prevalence of resistance hypertension and actual patient handling. Furthermore, current evidence suggests that ABPM is a much more accurate predictor of cardiovascular events in resistant hypertension compared to office BP and thus can offer a better risk stratification for these high-risk individuals. Finally, ABPM offers the potential of a better evaluation of the effect of pharmacologic and non-pharmacologic therapeutic interventions. This review attempts to summarize recent evidence on the advantages of ABPM in the diagnosis, prognosis, and management of resistant hypertension.

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Conflict of Interest

Drs. Lazaridis, Sarafidis, and Ruilope declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Second Propedeutic Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Antonios A. Lazaridis

  2. Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Pantelis A. Sarafidis

  3. Hypertension Unit, Hospital 12 de Octubre, Madrid, Spain

    Luis M. Ruilope

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  1. Antonios A. Lazaridis
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  2. Pantelis A. Sarafidis
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  3. Luis M. Ruilope
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Correspondence to Pantelis A. Sarafidis.

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This article is part of the Topical Collection on Resistant Hypertension

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Lazaridis, A.A., Sarafidis, P.A. & Ruilope, L.M. Ambulatory Blood Pressure Monitoring in the Diagnosis, Prognosis, and Management of Resistant Hypertension: Still a Matter of our Resistance?. Curr Hypertens Rep 17, 78 (2015). https://doi.org/10.1007/s11906-015-0590-9

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