Ambulatory Blood Pressure Monitoring and Risk of Cardiovascular Disease: A Population Based Study

Hansen, Tine W.; Jeppesen, Jørgen; Rasmussen, Susanne; Ibsen, Hans; Torp‐Pedersen, Christian

doi:10.1016/j.amjhyper.2005.09.018

Cited by 226 publications

(277 citation statements)

References 29 publications

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“…[13][14] Extensive studies have clearly demonstrated predictive information of cardiovascular outcomes in population-based surveys. [15][16][17][18][19] In addition to the mean 24-h BP, nocturnal BP has frequently been considered an important predictor of both target-organ damage and cardiovascular events. [18][19][20] A normal dipping pattern (dipper) is seen when the drop in the average SBP during the night is 410% of the mean daytime SBP.…”

Section: Discussionmentioning

confidence: 99%

“…[15][16][17][18][19] In addition to the mean 24-h BP, nocturnal BP has frequently been considered an important predictor of both target-organ damage and cardiovascular events. [18][19][20] A normal dipping pattern (dipper) is seen when the drop in the average SBP during the night is 410% of the mean daytime SBP. Individuals with a non-dipper pattern (reduction in nighttime SBP o10%) are at increased risk for cerebrovascular and cardiovascular complications Nocturnal dipping and endothelial function in resistant hypertension T Quinaglia et al when compared with individuals with a normal dipper profile.…”

Section: Discussionmentioning

confidence: 99%

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Non-dipping pattern relates to endothelial dysfunction in patients with uncontrolled resistant hypertension

et al. 2011

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Resistant hypertension (RHTN) includes both patients whose blood pressure (BP) is uncontrolled on three or more medications (uncontrolled RHTN (UCRH)) and patients whose BP is controlled with use of four or more drugs (controlled RHTN (CRH)). It is unknown whether endothelial function and nocturnal drop demonstrate a similar pattern in patients with CRH and UCRH. We examined circadian BP patterns and vascular function in these patients. In all, 40 CRH and 26 UCRH patients, and 25 normotensives underwent biochemical testing, ambulatory BP monitoring, determination of brachial artery responses to endothelial-dependent (flow-mediated; dilation (FMD)) and independent (nitroglycerin mediated) stimuli. The nighttime drop in systolic BP (SBP) and diastolic BP (DBP) was less pronounced in UCRH than in CRH (SBP, 1.9±1.6 versus 4.9 ± 1.7%; DBP, 7.5 ± 1.8 versus 10.9 ± 1.8%, UCRH and CRH, respectively; Po0.05). FMD was greater in control group compared with RHTN patients. Patients with UCRH had significantly impaired FMD compared with CRH (5.9 ± 2.3% versus 7.1 ± 5.1%; Po0.0001). Therefore, UCRH patients have less nocturnal dipping and a more impaired endothelial response compared with CRH patients. These findings suggest that important differences among patients with RHTN may allow identify subgroups with increased cardiovascular risk.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Non-dipping pattern relates to endothelial dysfunction in patients with uncontrolled resistant hypertension

et al. 2011

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“…However, overall, the prognostic values of nondipping were inconsistent; the reasons may in part be explained by the arbitrary and varying definition of nondipping, poor reproducibility, differences in the study population or differences in the adjusted factors used in each study. 8,20,30 A systematic review by Hansen et al 20 revealed that nondipping was associated with higher total mortality and cardiovascular events in the general population, although it added only 0.1% prognostic value beyond that of the 24-hour BP levels.…”

Section: Nocturnal Bp Dipping and Cardiovascular Riskmentioning

confidence: 99%

Nocturnal blood pressure and cardiovascular disease: a review of recent advances

2012

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The accurate measurement, prediction and treatment of high blood pressure (BP) are essential issues in the management of hypertension. Ambulatory blood pressure monitoring (ABPM) has been shown to be superior to clinic BP measurements as ABPM can provide the following important information: (i) the mean BP levels, (ii) the diurnal variation in BP and (iii) the short-term BP variability. Among these parameters, there is increasing evidence that the mean nocturnal BP level is the most sensitive predictor of cardiovascular morbidity and mortality. Furthermore, several studies have shown that less nocturnal BP dipping, defined as less nocturnal BP decline relative to daytime BP, or a high night-day BP ratio was associated with poor prognosis irrespective of the 24-hour BP levels. These findings can be interpreted in at least two ways: namely, high nocturnal BP or less nocturnal BP dipping might be not only a potent risk factor for cardiovascular disease (CVD), but also a marker of pre-existing or concurrent diseases that can lead to nocturnal BP elevation. In this review, we consider the clinical utility of ABPM and in particular focus on the nocturnal BP levels or nocturnal BP dipping as a potent risk factor for CVD. In addition, the clinical management of high nocturnal BP and blunted nocturnal BP dipping with antihypertensive medications is discussed.

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“…3 Accordingly, ambulatory blood pressure measurement is a better predictor of cardiovascular morbidity and mortality than office blood pressure. [8][9][10][11][12][13][14][15] Randomized studies using ambulatory blood pressure measurement for the management of antihypertensive treatment are scarce. 16 In one study, less intensive antihypertensive drug treatment was observed with the use of 24-h blood pressure measurement, whereas overall blood pressure con-trol was maintained in both treatment groups.…”

Section: Introductionmentioning

confidence: 99%

“…This would be highly desirable because of the high cardiovascular risk in these individuals. 12,17,18 We therefore designed the present study to compare 24-h ambulatory blood pressure to standard office blood pressure in the management of antihypertensive therapy in individuals with sustained hypertension.…”

Section: Introductionmentioning

confidence: 99%

Twenty-four hour ambulatory blood pressure for the management of antihypertensive treatment: a randomized controlled trial

2008

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The aim of this study was to assess whether the use of 24-h blood pressure (BP) measurement in the management of antihypertensive therapy improves BP in patients with sustained hypertension. Patients with sustained hypertension (office BP X140/90 mm Hg, and 24-h systolic BP X130/80 mm Hg) were randomly assigned to a strategy using 24-h BP to manage antihypertensive treatment (target o130/80 mm Hg) or to a standard strategy using office BP (target o140/90 mm Hg). The primary end point was change in 24-h systolic BP at 1 year of follow-up. We included 136 patients in the primary analysis. After 1 year of follow-up, the change in 24-h systolic BP was significantly greater in the ambulatory BP group compared with the office BP group (mean difference (95% confidence interval) À3.6 (À7.0, À0.3), P ¼ 0.03). Intentionto-treat analysis revealed essentially unchanged results.The mean number of antihypertensive drugs per participant at 1 year of follow-up was 1.76 ± 1.1 and 1.95 ± 0.9 in the ambulatory and office BP group, respectively (P ¼ 0.049). The benefit of ambulatory BP monitoring was mainly seen in patients with previously known hypertension (mean difference À7.2 (À11.6, À2.8), P ¼ 0.002), but not in those with newly detected hypertension (mean difference 0.2 (À4.9, 5.4), P ¼ 0.93). In conclusion, using 24-h BP for the management of antihypertensive therapy in patients with sustained hypertension leads to a greater BP reduction compared with a standard treatment strategy using office BP, although fewer antihypertensive drugs were used in the ambulatory BP group.

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Ambulatory Blood Pressure Monitoring and Risk of Cardiovascular Disease: A Population Based Study

Cited by 226 publications

References 29 publications

Non-dipping pattern relates to endothelial dysfunction in patients with uncontrolled resistant hypertension

Non-dipping pattern relates to endothelial dysfunction in patients with uncontrolled resistant hypertension

Nocturnal blood pressure and cardiovascular disease: a review of recent advances

Twenty-four hour ambulatory blood pressure for the management of antihypertensive treatment: a randomized controlled trial

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