Clinical Implications of Ambulatory and Home Blood Pressure Monitoring

Kim, Soon-Gil

doi:10.4070/kcj.2010.40.9.423

Cited by 15 publications

(26 citation statements)

References 70 publications

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“…Various features of the 24-hr pattern detected by ABPM have been assessed as potential triggers of target organ damage and cardiovascular (CV) events (3, 4). Particular attention has been paid to nocturnal BP variation, due to its association with poor CV prognosis (5).…”

Section: Introductionmentioning

confidence: 99%

A Reverse Dipping Pattern Predicts Cardiovascular Mortality In a Clinical Cohort

Kim

Lee

et al. 2013

J Korean Med Sci

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An abnormal dipping pattern in ambulatory blood pressure monitoring (ABPM) is a cardiovascular (CV) risk factor. However, its impact on CV mortality has not been investigated sufficiently in clinical practice to be considered a standard parameter. We assessed the association between abnormal dipping patterns and increased CV mortality in a tertiary hospital in Korea. Our retrospective cohort study included 401 patients who underwent ABPM between 1994 and 1996 in Hanyang University Hospital, Seoul, Korea. The patients were classified as risers (<0% drop in systolic BP; n=107), and others included dippers and non-dippers (≥0% drop, n=294). The follow-up period was 120 months. The frequency of CV mortality was 14.0% in risers and 5.8% in others. A Cox regression analysis found a significant association between dipping pattern and CV mortality, after adjusting for age, gender, body mass index, hypertension, diabetes mellitus, smoking and hypercholesterolemia. Risers were at greater risk of CV death than others (RR, 3.02, P=0.022), but there was no difference in event rates between dippers and non-dippers. The reverse dipping pattern may be more frequent in clinical settings than in the population at large, and it is strongly associated with increased risk of CV mortality in Korea.

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Section: Introductionmentioning

confidence: 99%

A Reverse Dipping Pattern Predicts Cardiovascular Mortality In a Clinical Cohort

Kim

Lee

et al. 2013

J Korean Med Sci

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“…A wide variety of studies have demonstrated that ABPM is more reproducible and a better predictor of organ damage and incidence of cardiovascular events compared with OBPM [3, 6]. In addition, ABPM identifies the white coat phenomenon (increased BP in a doctor’s office in patients with normal ambulatory BP) and discovers masked hypertension (normal doctor’s office BP in patients with high ambulatory BP [5-7].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, ABPM identifies the white coat phenomenon (increased BP in a doctor’s office in patients with normal ambulatory BP) and discovers masked hypertension (normal doctor’s office BP in patients with high ambulatory BP [5-7]. ABPM also allows better control of BP in pregnant women with preeclampsia or eclampsia risk, subjects with diabetes and metabolic syndrome [3, 8-10]. ABPM is indicated in the clinical management of hypertensive patients with resistance to treatment (defined as BP above goal despite the use of three agents of different classes in optimal doses, including a diuretic) [2, 3].…”

Section: Introductionmentioning

confidence: 99%

“…ABPM also allows better control of BP in pregnant women with preeclampsia or eclampsia risk, subjects with diabetes and metabolic syndrome [3, 8-10]. ABPM is indicated in the clinical management of hypertensive patients with resistance to treatment (defined as BP above goal despite the use of three agents of different classes in optimal doses, including a diuretic) [2, 3]. …”

Section: Introductionmentioning

confidence: 99%

“…Loss of the nocturnal dip has been associated with increased sympathetic tone and renal sodium reabsorption [3, 9, 11, 12]. Non-dippers are defined as patients who show a reduction in BP of less than 10% between average day and night BP determinations [3].…”

Section: Introductionmentioning

confidence: 99%

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Nurse-Driven Training Courses: Impact on Implementation of Ambulatory Blood Pressure Monitoring

Félez-Carrobé

Sagarra-Tió

Romero³

et al. 2013

Open Nurs J

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Background:Ambulatory blood pressure monitoring (ABPM) predicts cardiovascular risk and identifies white-coat and masked hypertension, efficacy of treatment and the circadian cycle of hypertensive patients.Objective:To analyze the effectiveness of ABPM implementation thoughtout a nurse-driven training program.Materials and Methodology:Twenty eight professionals were involved in the study carried out in the primary care center of the metropolitan area of Barcelona that serves 34,289 inhabitants. The ABPM implementation program was driven by two nurses that held four education sessions. After a 2-year follow-up period, we assessed the outcome of attendance at the educational sessions. First, we evaluated whether the program increased the number of orders of ABPM. Second, we used a survey to evaluate to what extent the input of our educational sessions was understood by attendants. Third, we analyzed the effect ABPM results had on the treatment of patients with a bad control of their hypertension.Results:After the training sessions we found a 6-fold increase in the number of patients undergoing ABPM. We analyzed 204 hypertensive individuals: 41% dippers, 34% were non-dippers, 20% were risers and 5% were extremely dippers. According to our survey, 100% of attendants had a good practice regarding ABPM management. However only 27% of riser patients were studied with a second ABPM.Conclusions:Specific training processes are needed for implementation of ABPM and an even more concentrated effort should be focused on training in the correct interpretation of ABPM results.

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Remote blood pressure monitoring in women at risk of or with hypertensive disorders of pregnancy: A systematic review and meta‐analysis

Rajkumar,

Hennessy,

Makris

2024

Intl J Gynecology & Obste

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BackgroundRemote blood pressure monitoring refers to an organized framework that either allows clinicians to review home‐based blood pressure readings and institute management, or provide participants with clear instructions for contacting care teams when blood pressure readings are out of prespecified targets. With widespread uptake of telemonitoring and mobile health in recent years, such models of care have been increasingly described in the literature.ObjectivesThis study aimed to review remote blood pressure monitoring in pregnant and postpartum women who are at high‐risk for or have an established diagnosis of hypertensive disorders of pregnancy, and its effect on maternal and fetal outcomes, healthcare utilization and psychosocial outcomes.Search strategyPubMed, Medline, Embase, Cochrane Library, Web of Science and CINAHL databases were searched electronically in June 2024 to their inception.Study selection criteriaIncluded studies compared remote blood pressure monitoring with standard care. Remote blood pressure monitoring was pre‐defined as any framework for measuring blood pressure remotely in pregnancy, with organized review by clinicians. Published full‐text and study abstracts describing randomized controlled trials and observational studies were included.The study population was pregnant women at high‐risk for developing pre‐eclampsia or postpartum (<6 weeks) women with an established diagnosis of a hypertensive disorder of pregnancy. Remote blood pressure monitoring undertaken in the antenatal and postnatal periods were analyzed separately.Data collection and analysisThis systematic review was conducted according to the Preferred Reporting Item for Systematic Reviews and Meta‐Analyses statement. Screening of records and data extraction were independently performed. Data were extracted and analyzed using Review Manager software (version 5.4; Cochrane Collaboration, Copenhagen, Denmark). Risk of bias and quality assessment was performed independently using the Risk Of Bias In Non‐randomized Studies‐of Interventions (ROBINS‐I) assessment tool and the Cochrane Risk of Bias 2 (RoB2) tool.Main resultsA total of 18 studies with 28 094 patients were included. Antenatal remote blood pressure monitoring reduces antenatal outpatient visits, antenatal hospital admissions for any cause, and antenatal hospital admissions specifically for hypertension. Importantly, there was no increase in adverse maternal and fetal outcomes, including the likelihood of cesarean section deliveries or induction of labor due to hypertension, composite maternal outcome, growth restriction, neonatal intensive care unit admissions, gestational age at delivery and the composite fetal outcome. Psychosocial outcomes were also not significantly different between the remote blood pressure monitoring and usual care groups. Postpartum remote blood pressure monitoring in women with an established hypertensive disorder of pregnancy led to greater compliance with blood pressure follow‐up within 10 days, with no increase in unscheduled hypertension‐related presentations, postpartum readmissions or outpatient antihypertensive prescription.ConclusionsUtilizing a model of remote blood pressure monitoring which incorporates organized review and management by clinicians, may reduce antenatal outpatient visits and admissions, without increasing adverse fetal and maternal outcomes, in pregnant women who require frequent monitoring of their blood pressure. In postpartum women with a hypertensive disorder of pregnancy, remote blood pressure monitoring can improve guideline recommended follow‐up within 10 days. However, the meta‐analysis was hampered by study heterogeneity and a paucity of high‐quality evidence. Further randomized controlled trials are needed to confirm the findings of this review and provide recommendations.

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Clinical Implications of Ambulatory and Home Blood Pressure Monitoring

Cited by 15 publications

References 70 publications

A Reverse Dipping Pattern Predicts Cardiovascular Mortality In a Clinical Cohort

A Reverse Dipping Pattern Predicts Cardiovascular Mortality In a Clinical Cohort

Nurse-Driven Training Courses: Impact on Implementation of Ambulatory Blood Pressure Monitoring

Remote blood pressure monitoring in women at risk of or with hypertensive disorders of pregnancy: A systematic review and meta‐analysis

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