Usefulness of ambulatory blood pressure measurement for hypertension management in India: the India ABPM study

Upendra Kaul,Eric Borges,C K Ponde,Willem J Verberk,Abraham Oomman,J P S Swahney,Tiny Nair,Manoj Chopda,Sunil Kapoor,Priyadarshini Arambam,Sanjiv Jasuja,Sanjiv Jasuja,Jagdish Hiremath,Srinivas Rao,Kamal Sharma,Kamal Sharma,Viraj Suvarna,B C Srinivas

doi:10.1038/s41371-019-0243-6

Abstract

The present paper reports differences between office blood pressure (BP) measurement (OBPM) and ambulatory blood pressure measurement (ABPM) in a large multi-centre Indian all comers’ population visiting primary care physicians. ABPM and OBPM data from 27,472 subjects (aged 51 ± 14 years, males 68.2%, treated 45.5%) were analysed and compared. Patients were classified based on the following hypertension thresholds: systolic BP (SBP) ≥ 140 and/or diastolic BP (DBP) ≥90 mmHg for OBPM, and SBP ≥ 130 and/or DBP ≥ 80 mmHg for 24-h ABPM, and SBP ≥ 120 and/or DBP ≥ 70 mmHg for night-time ABPM and SBP ≥ 135 and/or DBP ≥ 85 mmHg for daytime ABPM, all together. White coat hypertension (WCH) was seen in 12.0% (n = 3304), masked hypertension (MH) in 19.3% (n = 5293) and 55.5% (n = 15,246) had sustained hypertension. Isolated night-time hypertension (INH) was diagnosed in 11.9% (n = 3256). Untreated subjects had MH relatively more often than treated subjects (23.0% vs. 14.8%, p < 0.0001; respectively). Females had higher relative risk (RR) of having WCH than males (RR 1.16 [CI 95, 1.07–1.25], p < 0.0001). Whereas, males had higher RR of MH than females (RR 1.09 [CI 95, 1.02–1.17] p < 0.01). INH subjects had lower average systolic and diastolic dipping percentages (0.7 ± 6.6/ 2.2 ± 7.9 vs. 9.0 ± 7.3/11.9 ± 8.5, p < 0.001) than those without INH. In conclusion, for diagnosis of hypertension there was a contradiction between OBPM and ABPM in approximately one-third of all patients, and a substantial number of patients had INH. Using ABPM in routine hypertension management can lead to a reduction in burden and associated costs for Indian healthcare.

Highlights

Supplementary information The online version of this article contains supplementary material, which is available to authorised users.Research Centre, Civil Hospital, Ahmedabad, India 6 PRS Hospital, Department of Cardiology, Killipalam, Trivandrum, IndiaIn India, cardiovascular disease (CVD) is the number one cause of mortality, causing over 2 million deaths covering more than a quarter of all deaths in 2015 [1]
office BP measurement (OBPM) values were significantly higher than daytime Ambulatory BP measurement (ABPM), 24-h ABPM and nighttime ABPM, respectively, both for systolic BP (SBP) and diastolic BP (DBP) (Fig. 1)
Considering that 24-h ABPM is superior to OBPM for diagnosing hypertension, the present study showed that from the 27,472 patients, 8597 patients (31.3%) would have been wrongly diagnosed if only OBPM was considered as common in current Indian primary care practice

Summary

Introduction

Out-of-office BP monitoring offers specific advantages over OBPM, such as the possibility to obtain many measurements in a non-clinical setting This has proven to reduce the white coat effect that may lead to a reduction of unnecessary treatment and save costs for healthcare when ambulatory [8] or self BP measurement is performed [9]. For this reason, the National Institute for Health and Care Excellence (NICE) in the UK has recommended the use of ABPM for standard clinical practice and, recently, the JNC [10] and ESC [11] followed. The present study is aimed at investigating the prevalence of WCH, and MH and some other relevant parameters of ABPM for hypertension management in a large Indian all comers’ population visiting primary care physicians

Methods

Results

Discussion

Conclusion