A11591 Ambulatory Blood Pressure Monitoring (ABPM) and Holter Monitoring Simultaneously as a Standard Care Approach to Evaluate the Risk Correlates in Hypertensives

Abstract

Objectives: We evaluated 3230 (Males = 2228, Females = 1002) hypertensives, hospitalised for 24 hours to analyse association of hypertension and arrhythmia simultaneously for three years Methods: We used holter recorder and ABPM. ST depression was defined as an ST segment depression (1 mm limb or chest recordings V1 to V6) Results: Mean age was 51.2 ± 7.9 years (range 41 - 82 yrs). The tertile in triad of age > 60 years, duration of diabetes > 20 years and HbA1c > 11% had highest incidence of arrhythmias, statistically significant as compared with the other tertiles (p < 0.0001). Socioeconomic status were high, middle income and low income in 43% (n = 1388), 36 % (n = 1163) and 21 % (n = 679), respectively. Awake and asleep BP mean were 147 ± 11 mmHg and 137 ± 13.7 mmHg for SBP, 89.5 ± 10.2 and 83.1 ± 8.9 mmHg for DBP, respectively. Arterial pressure variability and bradyarrhythmia were significantly associated with sleep apnea (p < 0.0001). Patients with ST-T wave depression > 1 mm (26%) and tachycardia (31%) were significantly associated with both the reverse dippers and non-dippers. (p < 0.0001) Conclusion: The combined-simultaneous approach of holter and ABPM is a suitable approach for optimising the standard care in hypertensives. Association of various arrhythmia and BP patterns are important to triage high-risk patients and customise therapeutic approach. We could not draw out association between white coat hypertension and BP variability as ABPM was done under controlled environment in hospital setting only. Chronotherapy in concurrence with circadian rhythm to reduce side effects, optimise the dosage, reduce pill burden would be a suitable option to achieve a better BP control. Nocturnal anti-hypertensive dosing to target nocturnal hypertension would be an appropriate management approach