Impact on hypertension reclassification by Ambulatory Blood Pressure Monitoring (ABPM) according to the V Brazilian Guidelines on ABPM

Forestiero, Daniel; Mauad, Juliana Lustoza; Forestiero, Camila; Peixoto, Mario Lins; Ganassin, Fabio Peixoto; Gonzaga, Carolina de Campos; Cordeiro, A. C. C.; Rodrigues, Gabriel Doreto; Silveira, Tiago Bueno da; Amodeo, Celso

doi:10.5935/abc.20130031

Cited by 3 publications

(6 citation statements)

References 11 publications

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“…We support that it is necessary to move from thresholds based on statistical evidence to outcome‐driven thresholds. Based on a 10‐year cardiovascular risk equivalent to the risk obtained with office blood pressure measurement, suggested thresholds for ABPM were 131/79 mmHg for 24‐hour, 138/86 mmHg for daytime, and 120/71 mmHg for nighttime blood pressure substantially supporting the current indications provided by ESH guidelines, that is, 130/80 mmHg for 24 hours, 135/85 mmHg for daytime, and 120/70 mmHg for nighttime (Table ).…”

Section: General Considerationsmentioning

confidence: 60%

“…The cost‐effectiveness of identifying white coat hypertension through ABPM is related to the fact that the cost of care for hypertension is largely dominated by the cost of cardiovascular complications occurring in the long term, and by the cost for drug treatment, rather than by the cost of doctors' visits and of diagnostic investigations. This is of importance in LA for the limited resources available for health care, which require a long‐term acceptable cost‐effectiveness ratio for any approach proposed for hypertension management . When assessing the cost‐effectiveness of ABPM, in particular in LA where its use is only allowed in large cities and in some countries, the potential of this technique not only to improve the diagnosis and management of hypertension, but also as a means of ensuring implementation of a more effective control of hypertension at community level should be taken into consideration (Box 2).…”

Section: General Considerationsmentioning

confidence: 99%

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Ambulatory blood pressure monitoring over 24 h: A Latin American Society of Hypertension position paper—accessibility, clinical use and cost effectiveness of ABPM in Latin America in year 2020

Sánchez

Boggia

Barroso

et al. 2020

J of Clinical Hypertension

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Accurate office blood pressure measurement remains crucial in the diagnosis and management of hypertension worldwide, including Latin America (LA). Office blood pressure (OBP) measurement is still the leading technique in LA for screening and diagnosis of hypertension, monitoring of treatment, and long-term follow-up. Despite this, due to the increasing awareness of the limitations affecting OBP and to the accumulating evidence on the importance of ambulatory BP monitoring (ABPM), as a complement of OBP in the clinical approach to the hypertensive patient, a progressively greater attention has been paid worldwide to the information on daytime and nighttime BP patterns offered by 24-h ABPM in the diagnostic, prognostic, and therapeutic management of hypertension. In LA countries, most of the Scientific Societies of Hypertension and/or Cardiology have issued guidelines for hypertension care, and most of them include a special section on ABPM. Also, full guidelines on

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Section: General Considerationsmentioning

confidence: 60%

Section: General Considerationsmentioning

confidence: 99%

Ambulatory blood pressure monitoring over 24 h: A Latin American Society of Hypertension position paper—accessibility, clinical use and cost effectiveness of ABPM in Latin America in year 2020

Sánchez

Boggia

Barroso

et al. 2020

J of Clinical Hypertension

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“…In another national study with a retrospective analysis of ABPM examinations, 5 the impact of the reclassification of BP control thresholds was evaluated according to the application of the last two Brazilian ABPM Guidelines. With the adoption of the current guidelines, all modified thresholds reclassified the exams significantly.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…5 The authors observed that the new thresholds substantially reclassified hypertension, increasing the percentage of hypertensive patients, especially for the variable systolic BP during sleep. 5 When considering different thresholds for 24-hour borderline BP / hypertension and normal BP / borderline BP, and the reclassification of hypertensive patients in regard to their control, it was observed that the samples of patients in the studies were similar in regard to antihypertensive treatment. Regarding the IDACO study, 6 the guidelines from the European Society of Cardiology (ESC) have maintained BP thresholds for the definition of hypertension by 24-hour ABPM as values greater than or equal to 130 mmHg for systolic BP and 80 mmHg for diastolic BP.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Different Normality Thresholds for 24-hour ABPM at the Primary Health Care Level

Grezzana

Moraes

Stein

et al. 2016

Arquivos Brasileiros De Cardiologia

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BackgroundHypertension is an important risk factor for cardiovascular outcomes. Primary health care (PHC) physicians should be prepared to act appropriately in the prevention of cardiovascular risk factors. However, the rates of patients with control of blood pressure (BP) remain low. The impact of the reclassification of high BP by 24-hour ambulatory BP monitoring (ABPM) can lead to different medical decisions in PHC.ObjectiveTo evaluate the agreement between the BP measured by a conventional method by PHC physicians and by 24-hour ABPM, considering different BP normal thresholds for the 24-hour ABPM according to the V Brazilian ABPM Guidelines and the European Society of Hypertension Guidelines.MethodsA cross-sectional study including 569 hypertensive patients. The BP was initially measured by the PHC physicians and, later, by 24-hour ABPM. The BP measurements were obtained independently between the two methods. The therapeutic targets for the conventional BP followed the guidelines by the Eighth Joint National Committee (JNC 8), the V ABPM Brazilian Guidelines, and the 2013 European Hypertension Guidelines.ResultsThere was an accuracy of 54.8% (95% confidence interval [95%CI] 0.51 - 0.58%) for the BP measured with the conventional method when compared with the 24-hour ABPM, with a sensitivity of 85% (95%CI 80.8 - 88.6%), specificity of 31.9% (95%CI 28.7 - 34.7%), and kappa value of 0.155, when considering the European Hypertension Guidelines. When using more stringent thresholds to characterize the BP as "normal" by ABPM, the accuracy was 45% (95%CI 0.41 - 0.47%) for conventional measurement when compared with 24-hour ABPM, with a sensitivity of 86.7% (95%CI 0.81 - 0.91%), specificity of 29% (95%CI 0.26 - 0.30%), and kappa value of 0.103.ConclusionThe BP measurements obtained by PHC physicians showed low accuracy when compared with those obtained by 24-hour ABPM, regardless of the threshold set by the different guidelines.

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Is Non Dipping Hypertension Associated with Dyslipidemia, Type 2 Diabetes or Chronic Kidney Disease?

Tudor

Martinez

Mitrea

et al. 2013

Romanian Journal of Diabetes Nutrition and Metabolic Diseases

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Background and aims. Hypertension and dyslipidemia (DLP) increase the risk of cardiovascular diseases (CVD), especially in patients with chronic kidney disease (CKD). A non dipping pattern is very common in CKD. The aim of the study was to determine whether there is a difference between dipping/non dipping hypertension in subjects with CKD and DLP with or without lipid-lowering therapy (LLT). Material and methods. We performed a retrospective study that included 129 subjects from the Nephrology- Hypertension Out-patient Department of the University Campus Bio-Medico, Rome from January 2011 to April 2013. Results. From a total of 129 CKD subjects, 73 (56.59%) subjects had a non dipping pattern and 56 (43.41%) had a dipper pattern. We found statistically significant differences between the dipping and non-dipping pattern in subjects with CKD stages 1-2 versus stages 3-4 (p=0.018). When we analyzed the association between non-dipping status with DLP and type 2 diabetes (T2D), we did not find a statistically significant result. Conclusions. Only CKD significantly influenced the dipping/non dipping pattern in the study group

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Impact on hypertension reclassification by Ambulatory Blood Pressure Monitoring (ABPM) according to the V Brazilian Guidelines on ABPM

Cited by 3 publications

References 11 publications

Ambulatory blood pressure monitoring over 24 h: A Latin American Society of Hypertension position paper—accessibility, clinical use and cost effectiveness of ABPM in Latin America in year 2020

Ambulatory blood pressure monitoring over 24 h: A Latin American Society of Hypertension position paper—accessibility, clinical use and cost effectiveness of ABPM in Latin America in year 2020

Impact of Different Normality Thresholds for 24-hour ABPM at the Primary Health Care Level

Is Non Dipping Hypertension Associated with Dyslipidemia, Type 2 Diabetes or Chronic Kidney Disease?

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