Clinical Significance and Cost-Effectiveness of 24-hour Ambulatory Blood Pressure Monitoring.

Imai, Yutaka

doi:10.1620/tjem.176.1

Cited by 14 publications

(9 citation statements)

References 38 publications

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“…However, there is no consensus on the use of ABP to diagnose and manage hypertension, 3,4,[13][14][15][16][17] in part because reference values have not been established. Proposed reference values for ABPM are based on cross-sectional observations.…”

Section: -12mentioning

confidence: 99%

“…[1][2][3][4] Target-organ damage and cardiovascular morbidity are more strongly correlated with ABP than with casual blood pressure. [3][4][5][6][7][8][9][10][11][12] However, there is no consensus on the use of ABP to diagnose and manage hypertension, 3,4,[13][14][15][16][17] in part because reference values have not been established. Proposed reference values for ABPM are based on cross-sectional observations.…”

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confidence: 99%

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Reference Values for 24-Hour Ambulatory Blood Pressure Monitoring Based on a Prognostic Criterion

et al. 1998

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Abstract-Although reference values for ambulatory blood pressure (ABP) monitoring have been investigated in several population studies, these values were derived from cross-sectional observations and were based merely on the statistical distribution of blood pressure values. Therefore, we conducted a prospective cohort study to identify reference values for 24-hour ABP in relation to prognosis. We obtained measurements of 24-hour ABP for 1542 subjects (565 men) aged 40 years and over in a general population of a rural Japanese community and then followed-up their survival status. There were 117 deaths during the follow-up period (mean, 6.2 years). The association between baseline 24-hour ABP values and mortality, examined by the Cox proportional hazards regression model adjusted for possible confounding factors, showed a better fit with a second-degree equation than with a first-degree equation. On the basis of the results of this analysis, we identified the following reference values as the optimal blood pressure ranges that predict the best prognosis: 120 to 133 mm Hg for systolic blood pressure and 65 to 78 mm Hg for diastolic blood pressure. 24-Hour ABP values Ͼ134/79 mm Hg and Ͻ119/64 mm Hg were related to increased risks for cardiovascular and noncardiovascular mortality, respectively. This is the first report to propose reference values for 24-hour ABP based on a prognostic criterion. (Hypertension. 1998;32:255-259.)Key Words: blood pressure, ambulatory Ⅲ reference values Ⅲ mortality Ⅲ prospective studies Ⅲ Japanese population N oninvasive techniques for measuring ABP now make it possible to monitor blood pressure during activity and sleep and provide more reproducible information than casual (screening) blood pressure measurements.1-4 Target-organ damage and cardiovascular morbidity are more strongly correlated with ABP than with casual blood pressure. 3-12However, there is no consensus on the use of ABP to diagnose and manage hypertension, 3,4,[13][14][15][16][17] in part because reference values have not been established. Proposed reference values for ABPM are based on cross-sectional observations.18 -22 However, because the reference value must be the value that best predicts the risk of morbidity and mortality, a longitudinal study in a general population is needed to investigate the prognostic significance of the value.We initiated ABPM in the general population of a rural Japanese community 18 and have been monitoring the survival of these individuals since 1987. 23,24 The objective of the present study is to propose the reference values for 24-hour ABPM in relation to prognosis and to investigate the prognostic significance of the value. Methods DesignThe present report is based on a longitudinal observation of subjects who have been participating in an ABP measurement project in Ohasama, Iwate Prefecture, Japan, since 1987. The socioeconomic and demographic characteristics of this region and the details of the study project have been previously described. 18,23,24 The study protocol was approved ...

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Reference Values for 24-Hour Ambulatory Blood Pressure Monitoring Based on a Prognostic Criterion

et al. 1998

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“…3,4 Thus, the difference in the type of device may not have such an influence on the results. Although the reproducibility of ambulatory BP measurements are highly evaluated in several previous reports, [34][35][36] regression to the mean has still been observed in this method; 34,37 ie, repeated ambulatory BP monitoring gave lower results on a second reading, if higher results were observed during the first reading. However, this statistical phenomenon would be observed in all groups of treatment.…”

Section: Discussionmentioning

confidence: 94%

Differential effects of antihypertensive drugs with differing pharmacological properties on the basal ambulatory blood pressure

1998

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“…Many authors have studied "white coat" hypertension in Japan and elsewhere. [13][14][15][16][17][18] It hasn't been studied in the ED, but in my opinion, even if we accept that there is white coat hypertension in the ED…its presence would most likely increase the sensitivity of the test for asymptomatic hypertension at some expense to specificity. Are ED blood pressure readings adequate for screening asymptomatic patients for hypertension?…”

Section: Relevance To Emergency Medicine Other Specialty Practicesmentioning

confidence: 99%

“…Some possibilities would be the use of nurses, 26 electronic flagging, direct referral, discharge from the ED with ambulatory blood pressure monitors--all of these interventions have been widely studied in other settings, but not in the ED. 15,18,[27][28][29][30] 4. What are the parameters for identifying incipient or actual hypertension in the pediatric ED population?…”

Section: Approach To Asymptomatic Elevated Blood Pressure In the Ed Amentioning

confidence: 99%

Asymptomatically Elevated Blood Pressure in the Emergency Department: A Finding Deserving of Attention by Emergency Physicians?

Lewin

2009

Keio J. Med.

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The Emergency Department (ED) may be an ideal place to screen and refer patients for blood pressure monitoring in the outpatient setting. Yet, little is known about the public health significance of asymptomatically elevated blood pressure measurements in the ED and what to tell patients when these abnormal vital signs are recorded. Since the prevalence of hypertension and inadequately treated hypertension is so high, the incidental finding of elevated blood pressure in a previously undiagnosed patient may be a pivotal moment in that patient's life. For those patients carrying the diagnosis of hypertension, it is the author's opinion that the observation of elevated blood pressures should trigger advice to see their physicians to consider medication adjustments or changes. Emergency Physicians and their staff are in a unique position to screen and refer large populations of patients to their community physicians and help abort the long-term sequelae of unidentified or inadequately managed hypertension. How best to advise physicians and their patients requires research and innovative methods for transmitting important information to patients that may be unrelated to their primary complaint in the ED. (Keio J Med 58 (1) :

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Clinical Significance and Cost-Effectiveness of 24-hour Ambulatory Blood Pressure Monitoring.

Cited by 14 publications

References 38 publications

Reference Values for 24-Hour Ambulatory Blood Pressure Monitoring Based on a Prognostic Criterion

Reference Values for 24-Hour Ambulatory Blood Pressure Monitoring Based on a Prognostic Criterion

Differential effects of antihypertensive drugs with differing pharmacological properties on the basal ambulatory blood pressure

Asymptomatically Elevated Blood Pressure in the Emergency Department: A Finding Deserving of Attention by Emergency Physicians?

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