Ambulatory blood pressure monitoring: Is it mandatory for blood pressure control in treated hypertensive patients?

Lehmann, M; Zeymer, Uwe; Dechend, Ralf; Kaiser, E.; Hagedorn, Ina; Deeg, Evelin; Senges, Jochen; Schmieder, Roland E.

doi:10.1016/j.ijcard.2013.01.209

Cited by 20 publications

(16 citation statements)

References 40 publications

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“…Compared with office BP measurements, ABPM is superior in predicting cardiovascular events . Therefore, the use of ABPM is considered to be crucial for BP control in hypertensive patients . Moreover, APBM provides a full BP profile and a high number of readings, resulting in a high reproducibility of BP levels .…”

Section: Discussionmentioning

confidence: 99%

Effects of Renal Denervation on Ambulatory Blood Pressure Measurements in Patients With Resistant Arterial Hypertension

Lambert

Blessberger

Gammer

et al. 2014

Clinical Cardiology

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Background: The sympathetic nervous system is an important factor in hypertension. In patients suffering from resistant hypertension, transfemoral renal sympathetic denervation (RDN) reduces office blood pressure (BP) values. Hypothesis: Ambulatory BP measurement (ABPM) is a better predictor than office BP of cardiovascular morbidity and mortality. We thus believe that ABPM should be added to the systematic evaluation and follow-up protocol when treating patients with resistant hypertension with RDN. Therefore, we evaluated the effect of RDN on mean 24-hour BP by the use of ABPM. Methods: Patients with resistant hypertension (office systolic BP >160 mm Hg, or >150 mm Hg in patients with diabetes) have been treated with RDN. Ambulatory BP measurement was performed at baseline and at 3 and 6 months after RDN. Patients with a 24-hour systolic BP reduction of ≥5 mm Hg were classified as responders.Results: Of 86 patients initially enrolled in the study, 5 had to be excluded from the analysis because of <70% valid ABPM recordings. Out of the 81 studied patients, we found 49 responders (60.5%). In all patients, office BP decreased from 169.9/87.8 mm Hg to 153.5/86.3 mm Hg (P < 0.001/P = not significant [NS]) and 24-hour BP decreased from 144.3/86.0 mm Hg to 139.9/84.0 mm Hg (P = 0.025/P = NS) 6 months after RDN. In responders, office BP decreased from 169.6/90.3 mm Hg to 143.7/79.7 mm Hg (P < 0.001/P < 0.001). The ABPM levels started at 144.3/84.7 mm Hg and decreased to 138.3/81.5 mm Hg (P = 0.025/P = 0.045). In nonresponders, office BP was 150.2/84.0 mm Hg and 24-hour BP was 144.5/84.7 mm Hg at baseline; at 6 months, office BP was 168.7/96.4 mm Hg (P < 0.001/P = NS) and 24-hour BP was 142.2/81.5 mm Hg (P = NS/P = NS). Conclusions: Office BP and AMBP levels can be significantly lowered by RDN in patients with resistant hypertension.

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Section: Discussionmentioning

confidence: 99%

Effects of Renal Denervation on Ambulatory Blood Pressure Measurements in Patients With Resistant Arterial Hypertension

Lambert

Blessberger

Gammer

et al. 2014

Clinical Cardiology

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“…6 The 3A Registry is a prospective, observational, noninterventional, multicenter registry listed under clinicaltrials.gov (NCT01454583) and the Abstract-The long-term relationship between 24-hour ambulatory blood pressure (ABP) and office BP in patients on therapy is not well documented. From a registry we included all patients in whom antihypertensive therapy needed to be uptitrated.…”

mentioning

confidence: 99%

“…5,6 This database represents, therefore, a tool allowing us to compare the changes of office BP measurements to the changes of ABP obtained under real-life conditions.…”

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confidence: 99%

Disproportional Decrease in Office Blood Pressure Compared With 24-Hour Ambulatory Blood Pressure With Antihypertensive Treatment

et al. 2014

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The present analysis is based on the data of 3A Registry. 6 The 3A Registry is a prospective, observational, noninterventional, multicenter registry listed under clinicaltrials.gov (NCT01454583) and the Abstract-The long-term relationship between 24-hour ambulatory blood pressure (ABP) and office BP in patients on therapy is not well documented. From a registry we included all patients in whom antihypertensive therapy needed to be uptitrated. Drug treatment included the direct renin inhibitor aliskiren or an angiotensin-converting enzyme inhibitor/ angiotensin receptor blocker or drugs not blocking the renin-angiotensin system, alone or on top of an existing drug regimen. In all patients, office BP and 24-hour ABP were obtained at baseline and after 1 year with validated devices. In the study population of 2722 patients, there was a good correlation between the change in office BP and 24-hour ABP (systolic: r=0.39; P<0.001; diastolic: r=0.34; P<0.001). However, the numeric decrease in office BP did not correspond to the decrease in ABP in a 1:1 fashion, for example, a decrease of 10, 20, and 30 mm Hg corresponded to a decrease of ≈7.2, 10.5, and 13.9 mm Hg in systolic ABP, respectively. The disproportionally greater decrease in systolic office BP compared with ABP was dependent on the level of the pretreatment BP, which was consistently higher for office BP than ABP. The white coat effect (difference between office BP and ABP) was on average 10/5 mm Hg lower 1 year after intensifying treatment and the magnitude of that was also dependent on pretreatment BP. There was a disproportionally greater decrease in systolic office BP than in ABP, which for both office BP and ABP seemed to depend on the pretreatment

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“…The relevance of this finding consists principally on the fact that patients with normal BP levels in ABPM or HBPM do not require further antihypertensive pharmacological therapy because goal BP is already attained. It has been considered that either ABPM or HBPM are required in treated hypertensives in order to have a better idea of the real BP of the patients so as to avoid an inadequate further drop in BP that could provoke unwanted CV and/or renal damage [28,29]. Nevertheless, data from theHypertension in the Very Elderly Trial (HYVET) have shown positive data for the outcome of elderly hypertensive patients, albeit an estimate of 50 % of them presented WCH in the study [30].…”

Section: Importance Of White-coat Hypertension In Treated Hypertensivesmentioning

confidence: 99%

White-Coat Hypertension: Do We Really Understand It Now?

Ruilope

2014

Chronic Kidney Disease and Hypertension

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Ambulatory blood pressure monitoring: Is it mandatory for blood pressure control in treated hypertensive patients?

Cited by 20 publications

References 40 publications

Effects of Renal Denervation on Ambulatory Blood Pressure Measurements in Patients With Resistant Arterial Hypertension

Effects of Renal Denervation on Ambulatory Blood Pressure Measurements in Patients With Resistant Arterial Hypertension

Disproportional Decrease in Office Blood Pressure Compared With 24-Hour Ambulatory Blood Pressure With Antihypertensive Treatment

White-Coat Hypertension: Do We Really Understand It Now?

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