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

Abstract

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.

Shared decision-making in antihypertensive therapy: a cluster randomised controlled trial

“…Our finding that BP decreased between T0 and T1 is in line with other studies which showed that the implementation of ABPM contributed to a more effective antihypertensive treatment [52-54]. However, it is necessary to take into consideration that at T0 the mean 24h BP values of the whole sample only marginally exceeded the recommended ABPM thresholds.…”

Age-Specific Differences Between Conventional and Ambulatory Daytime Blood Pressure Values

“…Accordingly, ABPM has been shown to be a better predictor of cardiovascular complications and death than CBPM 3,4 and may help to implement a more efficient BP-lowering treatment regimen. 5,6 ABPM values are usually considered to be lower than conventional BP (CBP) values in the same individual. Accordingly, diagnostic thresholds for hypertension based on 24-hour ABPM are lower than those for CBPM.…”

Avaliação da pressão arterial no ambulatório - Revisão baseada na evidência

“…Tal como o observado para a AMPA, a generalidade dos estudos originais referentes à utilização da MAPA reportam taxas mais elevadas de controlo tensional, entre 24% a 57% (Quadro VIII). [42][43][44][45] Os estudos foram aplicados no contexto do seguimento de hipertensos tratados em cuidados de saúde primários, na Suiça, 42 Espanha (de larga escala), 43 Reino Unido 44 e Itália. 45 Nestes estudos, para cada hipertenso, a MAPA revelou, em média, valores mais baixos do que a PA medida pela técnica do consultório e, por inerência, maiores taxas de controlo.…”

“…No entanto, na maioria dos estudos realizados em contexto de cuidados de saúde primários, um dos quais realizado na população portuguesa, 39 a hipertensão da bata branca tem maior peso. Os estudos suiço 42 e britânico 44 foram considerados com nível de evidência 2 pelo inferior poder estatístico inerente a amostras mais reduzidas, e por falhas na caracterização inicial da população. Os dois restantes estudos foram considerados bons sob o ponto de vista metodológico (nível de evidência 1).…”