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Ambulatory Blood Pressure Monitoring: Five Decades of More Light andLess Shadows

View Article: PubMed Central - PubMed

ABSTRACT

Casual blood pressure measurements have been extensively questioned over the lastfive decades. A significant percentage of patients have different blood pressurereadings when examined in the office or outside it. For this reason, a change inthe paradigm of the best manner to assess blood pressure has been observed. Themethod that has been most widely used is the Ambulatory Blood PressureMonitoring - ABPM. The method allows recording blood pressure measures in 24hours and evaluating various parameters such as mean BP, pressure loads, areasunder the curve, variations between daytime and nighttime, pulse pressurevariability etc. Blood pressure measurements obtained by ABPM are bettercorrelated, for example, with the risks of hypertension. The main indicationsfor ABPM are: suspected white coat hypertension and masked hypertension,evaluation of the efficacy of the antihypertensive therapy in 24 hours, andevaluation of symptoms. There is increasing evidence that the use of ABPM hascontributed to the assessment of blood pressure behaviors, establishment ofdiagnoses, prognosis and the efficacy of antihypertensive therapy. There is nodoubt that the study of 24-hour blood pressure behavior and its variations byABPM has brought more light and less darkness to the field, which justifies thetitle of this review.

No MeSH data available.


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Odds ratio of patients with white coat hypertension compared withnormotensive patients.34
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f3: Odds ratio of patients with white coat hypertension compared withnormotensive patients.34

Mentions: White coat hypertension occurs in 15-30% of individuals with elevated bloodpressure in the office setting.8 It occurs when abnormal blood pressure values are obtainedin the office (≥ 140/90 mm Hg) and normal values are obtained during theABPM (≤ 135/85 mm Hg).22,32Interestingly, in this case, there is a change from the diagnosis ofnormotension detected out of the office setting to the diagnosis of hypertensiondetected in the office. Since there are no pathognomonic signs of white coathypertension, the most common characteristics that help in the diagnosis are:elderly patients, women, pregnant women, non-smokers, patients with diagnosis ofstage 1 hypertension after blood pressure readings in the office, andindividuals without target-organ lesions.33 The attributable risk of white coat hypertension hasbeen extensively discussed.32Some studies have indicated that white coat hypertension has an intermediatecardiovascular risk, between normotension and hypertension, closer tonormotension though (Figure 3).34 The IDACO study, a cohortstudy involving 7,295 persons followed for 10.6 years, showed that the incidenceof cardiovascular events in untreated subjects with white coat hypertension wasnot different from that observed in normotensive, untreated subjects.35 There is no evidence ofbenefit from interventions in this group of patients.32 These patients need to be followed, and thechange of life habits is imperative.8,32 It isrecommended that the diagnosis of white coat hypertension be confirmed within3-6 months, and the patient should be followed every year by ABPM to detectprogression of hypertension, since these patients have a higher probability todevelop established hypertension.8


Ambulatory Blood Pressure Monitoring: Five Decades of More Light andLess Shadows
Odds ratio of patients with white coat hypertension compared withnormotensive patients.34
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940152&req=5

f3: Odds ratio of patients with white coat hypertension compared withnormotensive patients.34
Mentions: White coat hypertension occurs in 15-30% of individuals with elevated bloodpressure in the office setting.8 It occurs when abnormal blood pressure values are obtainedin the office (≥ 140/90 mm Hg) and normal values are obtained during theABPM (≤ 135/85 mm Hg).22,32Interestingly, in this case, there is a change from the diagnosis ofnormotension detected out of the office setting to the diagnosis of hypertensiondetected in the office. Since there are no pathognomonic signs of white coathypertension, the most common characteristics that help in the diagnosis are:elderly patients, women, pregnant women, non-smokers, patients with diagnosis ofstage 1 hypertension after blood pressure readings in the office, andindividuals without target-organ lesions.33 The attributable risk of white coat hypertension hasbeen extensively discussed.32Some studies have indicated that white coat hypertension has an intermediatecardiovascular risk, between normotension and hypertension, closer tonormotension though (Figure 3).34 The IDACO study, a cohortstudy involving 7,295 persons followed for 10.6 years, showed that the incidenceof cardiovascular events in untreated subjects with white coat hypertension wasnot different from that observed in normotensive, untreated subjects.35 There is no evidence ofbenefit from interventions in this group of patients.32 These patients need to be followed, and thechange of life habits is imperative.8,32 It isrecommended that the diagnosis of white coat hypertension be confirmed within3-6 months, and the patient should be followed every year by ABPM to detectprogression of hypertension, since these patients have a higher probability todevelop established hypertension.8

View Article: PubMed Central - PubMed

ABSTRACT

Casual blood pressure measurements have been extensively questioned over the lastfive decades. A significant percentage of patients have different blood pressurereadings when examined in the office or outside it. For this reason, a change inthe paradigm of the best manner to assess blood pressure has been observed. Themethod that has been most widely used is the Ambulatory Blood PressureMonitoring - ABPM. The method allows recording blood pressure measures in 24hours and evaluating various parameters such as mean BP, pressure loads, areasunder the curve, variations between daytime and nighttime, pulse pressurevariability etc. Blood pressure measurements obtained by ABPM are bettercorrelated, for example, with the risks of hypertension. The main indicationsfor ABPM are: suspected white coat hypertension and masked hypertension,evaluation of the efficacy of the antihypertensive therapy in 24 hours, andevaluation of symptoms. There is increasing evidence that the use of ABPM hascontributed to the assessment of blood pressure behaviors, establishment ofdiagnoses, prognosis and the efficacy of antihypertensive therapy. There is nodoubt that the study of 24-hour blood pressure behavior and its variations byABPM has brought more light and less darkness to the field, which justifies thetitle of this review.

No MeSH data available.


Related in: MedlinePlus