Use and interpretation of ambulatory blood pressure monitoring: recommendations of the British hypertension society.
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ABSTRACT:
SUBMITTER: O'Brien E
PROVIDER: S-EPMC1127256 | biostudies-literature | 2000 Apr
REPOSITORIES: biostudies-literature
Publications
Use and interpretation of ambulatory blood pressure monitoring: recommendations of the British hypertension society.
O'Brien E E Coats A A Owens P P Petrie J J Padfield P L PL Littler W A WA de Swiet M M Mee F F
BMJ (Clinical research ed.) 20000401 7242
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Project description:Twenty-four-hour ambulatory blood pressure monitoring (ABPM) is recognized as a reference tool for accurately diagnosing hypertension. Until a few years ago, this technique was restricted to use by specialists. Recently, however, due to the need for wider availability and thanks to technological innovation, simplification of analysis processes, and increasing recognition of the importance of this tool for the diagnosis of hypertension, ABPM is now also being used in non-specialist settings. In such settings, ABPM is used with a two-pronged approach: (i) independently by a general practitioner with the possibility of specialist supervision for particular and complex cases; (ii) in the non-medical setting (community pharmacies, home care services, etc.) where the healthcare provider is trained in the proper use of the technique, with the understanding a physician must be responsible for the final clinical reporting. Unfortunately, due to the increasingly wide diffusion of ABPM, there has been considerable confusion about management roles and responsibilities in recent years. To clarify competencies and roles and standardize the processes related to the technique's implementation and proper management, experts of the Blood Pressure Monitoring Working Group of the Italian Society of Hypertension have drafted this document with the aim of providing a quick and easy reference guide for training healthcare professionals in the field.
| S-EPMC11485039 | biostudies-literature
Project description:Guidelines recommend measuring out-of-clinic blood pressure (BP) to identify masked hypertension (MHT) defined by out-of-clinic BP in the hypertensive range among individuals with clinic-measured BP not in the hypertensive range. The aim of this study was to determine the overlap between ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM) for the detection of MHT. We analyzed data from 333 community-dwelling adults not taking antihypertensive medication with clinic BP <140/90 mm Hg in the IDH study (Improving the Detection of Hypertension). Any MHT was defined by the presence of daytime MHT (mean daytime BP ≥135/85 mm Hg), 24-hour MHT (mean 24-hour BP ≥130/80 mm Hg), or nighttime MHT (mean nighttime BP ≥120/70 mm Hg). Home MHT was defined as mean BP ≥135/85 mm Hg on HBPM. The prevalence of MHT was 25.8% for any MHT and 11.1% for home MHT. Among participants with MHT on either ABPM or HBPM, 29.5% had MHT on both ABPM and HBPM; 61.1% had MHT only on ABPM; and 9.4% of participants had MHT only on HBPM. After multivariable adjustment and compared with participants without MHT on ABPM and HBPM, those with MHT on both ABPM and HBPM and only on ABPM had a higher left ventricular mass index (mean difference [SE], 12.7 [2.9] g/m2, P<0.001; and 4.9 [2.1] g/m2, P=0.022, respectively), whereas participants with MHT only on HBPM did not have an increased left ventricular mass index (mean difference [SE], -1.9 [4.8] g/m2, P=0.693). These data suggest that conducting ABPM will detect many individuals with MHT who have an increased cardiovascular disease risk.
| S-EPMC6207212 | biostudies-literature
Project description:This review portrays how ambulatory blood pressure (BP) monitoring was established and recommended as the method of choice for the assessment of BP and for the rational use of antihypertensive drugs. To establish much-needed diagnostic ambulatory BP thresholds, initial statistical approaches evolved into longitudinal studies of patients and populations, which demonstrated that cardiovascular complications are more closely associated with 24-hour and nighttime BP than with office BP. Studies cross-classifying individuals based on ambulatory and office BP thresholds identified white-coat hypertension, an elevated office BP in the presence of ambulatory normotension as a low-risk condition, whereas its counterpart, masked hypertension, carries a hazard almost as high as ambulatory combined with office hypertension. What clinically matters most is the level of the 24-hour and the nighttime BP, while other BP indexes derived from 24-hour ambulatory BP recordings, on top of the 24-hour and nighttime BP level, add little to risk stratification or hypertension management. Ambulatory BP monitoring is cost-effective. Ambulatory and home BP monitoring are complimentary approaches. Their interchangeability provides great versatility in the clinical implementation of out-of-office BP measurement. We are still waiting for evidence from randomized clinical trials to prove that out-of-office BP monitoring is superior to office BP in adjusting antihypertensive drug treatment and in the prevention of cardiovascular complications. A starting research line, the development of a standardized validation protocol for wearable BP monitoring devices, might facilitate the clinical applicability of ambulatory BP monitoring.
| S-EPMC7803442 | biostudies-literature
Project description: Not available
| S-EPMC1767663 | biostudies-literature
Project description:AbstractAmbulatory blood pressure monitoring (ABPM) has become indispensable in the current management of hypertension. ABPM is particularly useful in the accurate diagnosis of hypertension. Its diagnostic thresholds had been recently established based on hard clinical outcomes. Cross-classification of patients according to office and ambulatory blood pressure identifies white-coat, masked, and sustained hypertension. ABPM is also useful in cardiovascular (CV) risk assessment. It provides information on daytime and nighttime blood pressure and circadian rhythm, particularly nighttime blood pressure dipping. Nighttime blood pressure is predictive of CV risk independent of office and daytime blood pressure. Isolated nocturnal hypertension is a special form of masked hypertension, with normal daytime but elevated nocturnal blood pressure. It also helps in the evaluation of blood pressure fluctuation and variation, such as morning blood pressure surge and reading-to-reading blood pressure variability. ABPM may derive several other indexes, such as ambulatory blood pressure index and salt sensitivity index, which may be useful in CV evaluations.
| S-EPMC9276356 | biostudies-literature
Project description:Blood pressure (BP) measurements obtained during a twenty-four-hour ambulatory blood pressure monitoring (24 h ABPM) have not been reliably applied to extract arterial hemodynamics. We aimed to describe the hemodynamic profiles of different hypertension (HT) subtypes derived from a new method for total arterial compliance (Ct) estimation in a large group of individuals undergoing 24 h ABPM. A cross-sectional study was conducted, which included patients with suspected HT. Cardiac output, Ct, and total peripheral resistance (TPR) were derived through a two-element Windkessel model without having a pressure waveform. Arterial hemodynamics were analyzed according to HT subtypes in 7434 individuals (5523 untreated HT and 1950 normotensive controls [N]). The individuals mean age was 46.2 ± 13.0 years; 54.8% were male, and 22.1% were obese. In isolated diastolic hypertension (IDH), the cardiac index (CI) was greater than that in normotensive (N) controls (CI: IDH vs. N mean difference 0.10 L/m/m2; CI 95% 0.08 to 0.12; p value <0.001), with no significant clinical difference in Ct. Isolated systolic hypertension (ISH) and divergent systolic-diastolic hypertension (D-SDH) had lower Ct values than nondivergent HT subtype (Ct: divergent vs. nondivergent mean difference -0.20 mL/mmHg; CI 95% -0.21 to -0.19 mL/mmHg; p value <0.001). Additionally, D-SDH displayed the highest TPR (TPR: D-SDH vs. N mean difference 169.8 dyn*s/cm-5; CI 95% 149.3 to 190.3 dyn*s/cm-5; p value <0.001). A new method is provided for the simultaneous assessment of arterial hemodynamics with 24 h ABPM as a single diagnostic tool, which allows a comprehensive assessment of arterial function for hypertension subtypes. Main hemodynamic findings in arterial HT subtypes with regard to Ct and TPR. The 24 h ABPM profile reflects the state of Ct and TPR. Younger individuals with IDH present with a normal Ct and frequently increased CO. Patients with ND-SDH maintain an adequate Ct with a higher TPR, while subjects with D-SDH present with a reduced Ct, high PP and high TPR. Finally, the ISH subtype occurs in older individuals with significantly reduced Ct, high PP and a variable TPR proportional to the degree of arterial stiffness and MAP values. There was an observed increase in PP with age in relation to the changes in Ct (see also text). SBP: systolic blood pressure; DBP: diastolic blood pressure; MAP: mean arterial pressure; PP: pulse pressure; N: normotension; HT: hypertension; IDH: isolated diastolic hypertension; ND-SDH: nondivergent systole-diastolic hypertension; D-SDH: divergent systolic-diastolic hypertension; ISH: isolated systolic hypertension; Ct: total arterial compliance; TPR: total peripheral resistance; CO: cardiac output; 24 h ABPM: 24 h ambulatory blood pressure monitoring.
| S-EPMC10239728 | biostudies-literature
Project description: Not available
| S-EPMC1119736 | biostudies-literature
Project description:ObjectivesThe aim of this study was to evaluate the cost effectiveness of ambulatory blood pressure monitoring (ABPM) compared with home blood pressure monitoring (HBPM) and clinic blood pressure monitoring (CBPM) in diagnosing hypertension in Australia.MethodsA cohort-based Markov model was built from the Payer's perspective (Australian government) comparing lifetime costs and effectiveness of ABPM, HBPM and CBPM in people aged ≥ 35 years with suspected hypertension who have a CBPM between ≥ 140/90 mmHg and ≤ 180/110 mmHg using a sphygmomanometer and have not yet commenced antihypertensive treatment. The main outcome measures were incremental cost-effectiveness ratio (ICER) assessing cost per quality-adjusted life-year (QALY) and life-years (LYs) gained by ABPM versus HBPM and CBPM. Cost was measured in Australian dollars (A$).ResultsOver a lifetime model, ABPM had lower total costs (A$8,491) compared with HBPM (A$9,648) and CBPM (A$10,206) per person. ABPM was associated with a small but significant improvement in the quality and quantity of life for people with suspected hypertension with 12.872 QALYs and 17.449 LYs compared with 12.857 QALYs and 17.433 LYs with HBPM, and 12.850 QALYs and 17.425 LYs with CBPM. In the base-case analysis, ABPM dominated HBPM and CBPM. In scenario analyses, at 100% specificity of HBPM, ABPM no longer remained cost effective at a A$50,000/QALY threshold. However, in probabilistic sensitivity analysis, over 10,000 iterations, ABPM remained dominant.ConclusionABPM was the dominant strategy for confirming the diagnosis of hypertension among Australian adults aged ≥ 35 years old with suspected hypertension. The findings of this study are important for reimbursement decision makers to support policy change and for clinicians to make practice changes consistent with ABPM recommendations in primary care.
| S-EPMC9929017 | biostudies-literature
Project description:Introduction2018 ESC/ESH guidelines have recommended 24-h ambulatory blood pressure monitoring to assess hypotensive therapy in many circumstances. Recommended target blood pressure in office blood pressure measurements is between 120/70 and 130/80 mmHg. Such targets for 24-h ambulatory blood pressure monitoring lacks.AimWe aimed to define target values of blood pressure in 24-h ambulatory blood pressure monitoring in hypertensive patients.MethodsOffice blood pressure measurements and 24-h ambulatory blood pressure monitoring data were collected from 1313 hypertensive patients and sorted following increasing systolic (SBP)/diastolic (DBP) blood pressure in office blood pressure measurements. The corresponding 24-h ambulatory blood pressure monitoring to office blood pressure measurements values were calculated.ResultsValues 130/80 mmHg in office blood pressure measurements correspond in 24-h ambulatory blood pressure monitoring: night-time SBP/DBP mean: 113.74/66.95 mmHg; daytime SBP/DBP mean: 135.02/81.78 mmHg and 24-h SBP/DBP mean: 130.24/78.73 mmHg. Values 120/70 mmHg in office blood pressure measurements correspond in 24-h ambulatory blood pressure monitoring: night-time SBP/DBP mean: 109.50/63.43 mmHg; daytime SBP/DBP mean: 131.01/78.47 mmHg and 24-h SBP/DBP mean: 126.36/75.31 mmHg.ConclusionsThe proposed blood pressure target values in 24-h ambulatory blood pressure monitoring complement the therapeutic target indicated in the ESC/ESH recommendations and improves 24-h ambulatory blood pressure monitoring usefulness in clinical practice.
| S-EPMC9908722 | biostudies-literature
Project description:ObjectiveTo determine the relative accuracy of clinic measurements and home blood pressure monitoring compared with ambulatory blood pressure monitoring as a reference standard for the diagnosis of hypertension.DesignSystematic review with meta-analysis with hierarchical summary receiver operating characteristic models. Methodological quality was appraised, including evidence of validation of blood pressure measurement equipment.Data sourcesMedline (from 1966), Embase (from 1980), Cochrane Database of Systematic Reviews, DARE, Medion, ARIF, and TRIP up to May 2010. Eligibility criteria for selecting studies Eligible studies examined diagnosis of hypertension in adults of all ages using home and/or clinic blood pressure measurement compared with those made using ambulatory monitoring that clearly defined thresholds to diagnose hypertension.ResultsThe 20 eligible studies used various thresholds for the diagnosis of hypertension, and only seven studies (clinic) and three studies (home) could be directly compared with ambulatory monitoring. Compared with ambulatory monitoring thresholds of 135/85 mm Hg, clinic measurements over 140/90 mm Hg had mean sensitivity and specificity of 74.6% (95% confidence interval 60.7% to 84.8%) and 74.6% (47.9% to 90.4%), respectively, whereas home measurements over 135/85 mm Hg had mean sensitivity and specificity of 85.7% (78.0% to 91.0%) and 62.4% (48.0% to 75.0%).ConclusionsNeither clinic nor home measurement had sufficient sensitivity or specificity to be recommended as a single diagnostic test. If ambulatory monitoring is taken as the reference standard, then treatment decisions based on clinic or home blood pressure alone might result in substantial overdiagnosis. Ambulatory monitoring before the start of lifelong drug treatment might lead to more appropriate targeting of treatment, particularly around the diagnostic threshold.
| S-EPMC3122300 | biostudies-literature