Ambulatory Blood-Pressure Monitoring

Pickering, Thomas G.; Shimbo, Daichi; Haas, Donald

doi:10.1056/nejmra060433

Cited by 798 publications

(622 citation statements)

References 108 publications

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“…2,[10][11][12][13] In our series the prevalence of 'white-coat' hypertension (isolated clinic hypertension in untreated patients or office resistant control when treated) was 33%. The prevalence of 'white-coat' hypertension in other studies dealing with diabetic patients ranged between 14 and 51%.…”

Section: Discussionmentioning

confidence: 99%

“…1 Ambulatory blood pressure monitoring (ABPM) provides a high-quality approach in estimating the true levels of blood pressure (BP). 2 Several population-and patient-based studies have showed the benefits of ABPM in exploring the relationship between BP and cardiovascular events. 2,3 A series of reports dealing with diabetic patients have also shown a close correlation between ambulatory BP and diabetic complications.…”

Section: Introductionmentioning

confidence: 99%

“…2 Several population-and patient-based studies have showed the benefits of ABPM in exploring the relationship between BP and cardiovascular events. 2,3 A series of reports dealing with diabetic patients have also shown a close correlation between ambulatory BP and diabetic complications. 4,5 Evidences are available for the entire cardiorenal continuum of diabetic damage from the prediction of microalbuminuria by early changes in nocturnal BP in type 1 patients 6 to the effect of a riser pattern on mortality in patients with type 2 diabetes.…”

Section: Introductionmentioning

confidence: 99%

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Abnormalities in ambulatory blood pressure monitoring in hypertensive patients with diabetes

et al. 2011

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on behalf of the Spanish Society of Hypertension ABPM Registry investigators 9Our aim was to assess the ambulatory blood pressure monitoring (ABPM) characteristics or patterns in hypertensive patients with diabetes compared with non-diabetic hypertensives. We performed a cross-sectional analysis of a 68 045 patient database from the Spanish Society of Hypertension ABPM Registry, a nation-wide network of 41200 primary-care physicians performing ABPM under standardized conditions in daily practice. We identified 12 600 (18.5%) hypertensive patients with diabetes. When compared with patients without diabetes, diabetic hypertensives exhibited higher systolic blood pressure (BP) levels in every ABPM period (daytime 135.4 vs. 131.8, and nighttime 126.0 vs. 121.0 mm Hg, Po0.001 for both) despite they were receiving more antihypertensive drugs (mean number 1.71 vs. 1.23, Po0.001). Consequently, diabetic patients suffered from lack of control of BP more frequently than non-diabetic subjects particularly during the night (65.5% vs. 57.4%, Po0.001).Prevalence of a non-dipping BP profile (64.2% vs. 51.6%, Po0.001) was higher in diabetic patients. In the other hand, prevalence of 'white-coat' hypertension in diabetic patients was 33.0%. We conclude that there was a remarkably high prevalence of alterations in ABPM in patients with diabetes. Abnormalities in systolic BP, particularly during the night, and in circadian BP pattern could be linked with the excess of BP-related cardiovascular risk of diabetes. A wider use of ABPM in diabetic patients should be considered. Hypertension Research (2011) 34, 1185-1189; doi:10.1038/hr.2011.100; published online 11 August 2011Keywords: ambulatory blood pressure monitoring; circadian profile; diabetes; hypertension control INTRODUCTION Hypertension affects the majority of patients with diabetes and constitutes a major risk factor for vascular complications. 1 Ambulatory blood pressure monitoring (ABPM) provides a high-quality approach in estimating the true levels of blood pressure (BP). 2 Several population-and patient-based studies have showed the benefits of ABPM in exploring the relationship between BP and cardiovascular events. 2,3 A series of reports dealing with diabetic patients have also shown a close correlation between ambulatory BP and diabetic complications. 4,5 Evidences are available for the entire cardiorenal continuum of diabetic damage from the prediction of microalbuminuria by early changes in nocturnal BP in type 1 patients 6 to the effect of a riser pattern on mortality in patients with type 2 diabetes. 7 Nevertheless, information about the ABPM characteristics of large cohorts of diabetic hypertensives attending primary care centers is scarce. We aimed to assess such characteristics in comparison with non-diabetic hypertensives by using the Spanish Society of Hypertension ABPM Registry.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Abnormalities in ambulatory blood pressure monitoring in hypertensive patients with diabetes

et al. 2011

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“…Although the evidence that 'out of office' blood pressure (BP) better predicts cardiovascular outcome than clinic readings is strong, [1][2][3][4][5][6] there remains a great deal of uncertainty as to how this technology should be used in clinical practise. Ambulatory BP monitoring (ABPM) has come to be regarded as the 'gold standard', probably because it has been studied more extensively than self-monitoring of BP (SBPM).…”

Section: Introductionmentioning

confidence: 99%

Self blood pressure monitoring: a worthy substitute for ambulatory blood pressure?

McGowan

Padfield

2010

J Hum Hypertens

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lines for self-monitoring of blood pressure (SBPM). We aimed to demonstrate the equivalence of SBPM with ambulatory blood pressure monitoring (ABPM) in the assessment of hypertension. A total of 87 consecutive subjects referred from primary care for standard ABPM underwent a 1-week period of SBPM, as defined by the ESH guidelines, either before or after ABPM. There was no difference in mean blood pressure (BP): SBPM 142/ 87 mm Hg, daytime average ABPM 141/86 mm Hg. The intra-class correlation coefficient was 0.72 and 0.89 for systolic and diastolic pressure, respectively. SBPM is concordant with ABPM in classifying subjects as hypertensive or normotensive in 87% of cases (j ¼ 0.56). The coefficient of variation of SBPM compared with ABPM was 5%. In answer to a direct question 81% of subjects preferred SBPM to ABPM. The current self-monitoring schedule recommended by the ESH, AHA and ASH is valid. The mean BP obtained from SBPM is equivalent to awake-time BP on ABPM, the accepted reference standard for 'out of office' BP measurement. SBPM is simpler to carry out, preferred by patients and should be considered on a par with ABPM.

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“…There is good evidence supporting the utility of ABPM findings in the prediction of cardiovascular outcomes, both in adults and children ( Belsha et al , 1998; Lurbe et al , 2004; Pickering et al , 2006; Singh et al , 2013; Sorof et al , 2002). ABPM can account for the white coat effect as well as measurement and observer errors.…”

Section: Introductionmentioning

confidence: 97%

Nocturnal Hypertension and Attenuated Nocturnal Blood Pressure Dipping is Common in Pediatric Lupus

2015

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Hypertension is an important manifestation of systemic lupus erythematosus (SLE) but reports of prevalence vary between 20-70% in published reports of adult and pediatric patients. For both children and adults with SLE, the clinical diagnosis and management of hypertension has traditionally been based on guidelines developed for the general population. In clinical trials, the criteria used for defining participants with hypertension are mostly undefined. As a first step towards formally assessing the blood pressure (BP) patterns of children diagnosed with SLE, 24-hr ambulatory BP monitoring data was analyzed on clinic patients who presented with prehypertension or stage I hypertension. In this pediatric SLE cohort, 20% met daytime criteria for a diagnosis of hypertension. Patterns of BP elevation varied widely with white coat, masked, isolated systolic, and diastolic nocturnal hypertension all identified. Nocturnal hypertension was detected in 60% and attenuated nocturnal BP dipping in 90% of both hypertensive and normotensive SLE patients. In SLE patients, the median nighttime systolic and diastolic loads were 25% and 15.5% compared with median daily loads of 12.5% and 11.5%. Daytime and nighttime systolic and diastolic BP load and nocturnal dipping was compared to a control population consisting of 85 non-SLE patients under 21 years old with prehypertension or stage 1 hypertension presenting to hypertension clinic. Median systolic BP dipped 5.3 mmHg in SLE patients compared to 11.9 mmHg in non-lupus ( p-value = 0.001). Median diastolic BP dipped 12.9 mmHg versus 18.5 mmHg in non-lupus ( p-value = 0.003). Patterns of BP dysregulation in pediatric SLE merit further exploration. Children with or without SLE displaying prehypertensive or stage 1 casual BP measurements had similar rates of hypertension by ambulatory BP monitoring. However, regardless of BP diagnosis, and independent of kidney involvement, there was an increased proportion with attenuated nocturnal dipping and nocturnal hypertension in SLE patients.

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Ambulatory Blood-Pressure Monitoring

Cited by 798 publications

References 108 publications

Abnormalities in ambulatory blood pressure monitoring in hypertensive patients with diabetes

Abnormalities in ambulatory blood pressure monitoring in hypertensive patients with diabetes

Self blood pressure monitoring: a worthy substitute for ambulatory blood pressure?

Nocturnal Hypertension and Attenuated Nocturnal Blood Pressure Dipping is Common in Pediatric Lupus

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