Ambulatory blood pressure monitoring and its utility in management of hypertension in a clinic setting in South India

Abstract

Introduction: High blood pressure (BP) is an important risk factor for cardiovascular diseases. The association of short-term BP variability (BPV) with target organ damage (TOD) is not clearly established. We conducted this observational study to evaluate the degree of concordance between Office BP measurements (OBPM) and ambulatory BP monitoring (ABPM) and to study the association of ABPM parameters on TOD. Materials and Methods: Patients attending clinics of the authors between January 2018 and August 2019 were enrolled. Their BP status was determined by OBPM and ABPM and the degree of concordance analyzed. ABPM parameters between those with TOD and without TOD were compared using appropriate statistical measures. Results: Data from 968 subjects (males 61.5%, mean age 59.39 ± 14.86 years) were analyzed. Masked hypertension (HTN) and white coat HTN were seen in 138 (14.3%) and 50 (5.2%) participants, respectively. There was moderate concordance between ABPM and OBPM readings (Cohen's κ =0.571, 95% confidence interval [CI]: 0.445, 0.595, P < 0.001). There were 530 (54.8%) nondippers and 189 (19.5%) reverse dippers. High morning surge (MS) was seen in 193 patients (19.9%) and TOD was seen in 378 patients (39%). Among all the ABPM parameters which were significantly associated with TOD on univariate analysis, only BPV (P = 0.04, odds ratio [OR]: 1.04, 95% CI: 1.00, 1.08) and systolic BP in active phase (P = 0.01, OR: 1.02, 95% CI: 1.00, 1.04) were found to be predictors of TOD after multiple logistic regression analysis. Dipping status and MS were not associated with TOD. Conclusions: ABPM is a useful tool for diagnosis and accurate categorization of HTN. The analysis of ABPM parameters helps to identify the patients with BPV which has important implications for the prevention of TOD. ABPM is recommended in all individuals with cardiometabolic risk profile or with established TOD even with normal office BP readings.