Ambulatory Blood Pressure Monitoring Techniques Research Articles

Asian management of hypertension: Current status, home blood pressure, and specific concerns in Japan.

Hypertension is highly prevalent in Japan, affecting up to 60% of males and 45% of females. Stroke is the main adverse cardiovascular event, occurring at a higher rate than acute myocardial infarction. Reducing blood pressure (BP) therefore has an important role to play in decreasing morbidity and mortality. The high use of home BP monitoring (HBPM) in Japan is a positive, and home BP is a better predictor of cardiovascular event occurrence than office BP. New 2019 Japanese Society of Hypertension Guidelines strongly recommend the use of HBPM to facilitate control of hypertension to new lower target BP levels (office BP<130/80mmHg and home BP<125/75mmHg). Lifestyle modifications, especially reducing salt intake, are also an important part of hypertension management strategies in Japan. The most commonly used antihypertensive agents are calcium channel blockers followed by angiotensin receptor blockers, and the combination of agents from these two classes is the most popular combination therapy. These agents are appropriate choices in South East Asian countries given that they have been shown to reduce stroke more effectively than other antihypertensives. Morning hypertension, nocturnal hypertension, and BP variability are important targets for antihypertensive therapy based on their association with target organ damage and cardiovascular events. Use of home and ambulatory BP monitoring techniques is needed to monitor these important hypertension phenotypes. Information and communication technology-based monitoring platforms and wearable devices are expected to facilitate better management of hypertension in Japan in the future.

In Memoriam: Alberto Zanchetti (Parma July 27, 1926 - Milan March 24, 2018).

In Memoriam: Alberto Zanchetti (Parma July 27, 1926 - Milan March 24, 2018).

Out-of-office blood pressure measurement in children and adolescents

Out-of-office blood pressure measurement in children and adolescents

Blood pressure variability, cardiovascular risk and antihypertensive treatment.

TWENTY-FOUR HOUR BLOOD PRESSURE PARAMETERS: The use of ambulatory blood pressure monitoring techniques has shown clearly that 24-h average blood pressure is more closely related to the end-organ damage of hypertension than isolated office blood pressure readings. It has also provided evidence that the degree of blood pressure variability over a 24-h period may be independently related to the cardiovascular complications of hypertension. However, all the available data on this issue come from cross-sectional studies, and prospective evidence on the actual prognostic value of 24-h blood pressure parameters has only recently been provided for daytime blood pressure variability. There is still no prospective evidence concerning overall 24-h blood pressure variability. ANTIHYPERTENSIVE AGENTS AND BLOOD PRESSURE VARIABILITY: Available antihypertensive agents are unable to effectively buffer blood pressure variability. However, drugs with a long-lasting antihypertensive effect and an optimal trough: peak ratio may at least prevent further iatrogenic increases in the amplitude of blood pressure fluctuations. BEAT-TO-BEAT BLOOD PRESSURE MONITORING: The ability of antihypertensive agents to actually reduce 24-h blood pressure variability needs to be demonstrated in future studies, using beat-to-beat blood pressure monitoring which is now possible by means of non-invasive techniques.

Blood pressure reduction and end-organ damage in hypertension.

VALUE OF AMBULATORY BLOOD PRESSURE MONITORING: Studies that have used ambulatory blood pressure monitoring techniques have shown that the average 24-h or daytime blood pressure values are more closely related to the end-organ damage associated with hypertension than are isolated office readings. IMPORTANCE OF BLOOD PRESSURE VARIABILITY IN PROGNOSIS: More recently, blood pressure variability, measured as the overall 24-h blood pressure standard deviation, has been shown to have a significant relationship to end-organ damage in hypertensive patients. The potential clinical relevance of blood pressure variability has been strengthened in a recent prospective study. The possible prognostic value of blood pressure variability has practical implications for antihypertensive treatment; it may mean, for example, that the optimal antihypertensive drug should reduce not only the mean 24-h values but also the degree of fluctuation in blood pressure. This is more likely to occur with long-acting drugs, which induce a more balanced reduction in blood pressure throughout the 24 h. USE OF THE TROUGH:PEAK RATIO: A proposed measure of a balanced 24-h blood pressure effect is the trough:peak ratio of the blood pressure fall. This ratio can be obtained by clinic blood pressure measurements but ambulatory blood pressure monitoring offers some distinct advantages. One of these advantages is that by revealing the possibility of an excessive fall in blood pressure at the time of the peak effect or an uncontrolled rise at the trough, ambulatory monitoring can also reveal the possible impact of pharmacological treatment on 24-h blood pressure variability.

Calcium antagonists in the treatment of arterial hypertension

Calcium antagonists are widely used antihypertensive agents whose hemodynamic effects consist of a reduction in blood pressure and peripheral vascular resistance that is associated, in case of short-term administration, with a reflex increase in heart rate and cardiac output. These compounds exert several additional positive effects besides blood pressure reduction. Among them, calcium antagonists exert their antihypertensive effect without negatively interfering with both central and reflex neural control of circulation. The only change in baroreflex function observed during the administration of these compounds is a resetting of the baroreflex toward the lower blood pressure values achieved by treatment. New calcium antagonists of the dihydropyridine type are characterized by a greater vascular selectivity, and by the ability to exert a persistent blood pressure reduction throughout the 24 hours when administered in a single oral dose. The latter feature can be properly assessed by means of ambulatory blood pressure monitoring techniques.

Ambulatory blood pressure monitoring: Assessing the diurnal variation of blood pressure

The purposes of this paper are to examine the effects of activity, situation of measurement, mood, and occupation on the daily variation of blood pressure and to discuss the potential utility of ambulatory blood pressure monitoring in physical anthropological studies. The subjects of the blood pressure variability study are 125 men who were referred to the Hypertension Center at New York Hospital--Cornell Medical Center for evaluation of hypertension. There were 1,386 blood pressure measurements from these subjects available for study, which were taken using noninvasive ambulatory blood pressure monitoring techniques. Pressures were transformed to z scores using the subject's daily mean pressure and standard deviation to assess the relative elevation during the experience of the various factors. The results show that activity and mood are the most significant sources of blood pressure variation (P less than .005) and are additive. Occupation, which may be an indicator of social class in this population, also modified the mood effects. Because ambulatory blood pressure monitors obtain many readings over a day under a variety of circumstances, their use can improve epidemiological and human biological studies of the inheritance and variability of blood pressure. Ambulatory blood pressure monitoring is an important new tool in the study of human biological variation.

Sex differences in factors affecting the daily variation of blood pressure

The purpose of this study was to examine whether the life experiences described by postural, situational, and emotional changes during the day have similar effects on the blood pressure of men and women. The subjects of the study were 137 men and 67 women from the clinical population of the Hypertension Center at The New York Hospital-Cornell Medical Center. There were 3023 individual pressure measurements available for study, 2072 from the men, and 951 from the women, which were taken using noninvasive ambulatory blood pressure monitoring techniques. Pressures were transformed to z-scores using the subject's daily mean pressure and standard deviation to assess the relative elevation during the various effects. Separate but identical ANOVA models were run for each sex. The results show that there were differences between men and women in the parameters associated with the level of systolic and diastolic pressure. Men's systolic pressure varied by situation of measurement ( P <0.0001) and emotional state ( P <0.0001), while that of women varied by posture ( P <0.0005) and situation of measurement ( P <0.0001). The diastolic pressure of men varied by emotional state as did that of women, except that men's diastolic pressure tended to be highest during reported anger while that of women tended to be highest during reported anxiety. Differences in occupation or environment, hormones, or in behavioral patterns related to the socialization process may all contribute to the differences between the sexes. While there are limitations with regard to the interpretation of the data, the findings are consistent with the concept that both the factors which influence blood pressure variation and the degree of variation associated with these factors are different between the sexes.

Automated ambulatory blood pressure monitoring: A study in age-matched normotensive and hypertensive men

Noninvasive automated techniques have been used in this study in 29 ambulatory normotensive and hypertensive men to monitor blood pressure during a full 24-hour period. The two groups of men were carefully matched for age. The data were analyzed with respect to possible differences in the circadian pattern of blood pressure, in the variability of blood pressure, and differences in the prevalence of abnormal blood pressures between the two groups. The circadian pattern of blood pressure in hypertensive patients was displayed parallel to that in normotensive control subjects but at a significantly higher level. The difference between daytime and nighttime systolic blood pressure was greater in normotensive than in hypertensive men. However, variability of blood pressure was not different between the two subgroups. Hypertensive men showed on average a greater incidence of abnormal blood pressures than normotensive subjects. However, nine of the normotensive control subjects showed more than 25% of abnormal readings of systolic or diastolic blood pressures during a 24-hour recording period. In contrast, fewer than 25% of abnormal blood pressure readings were found in nine of the hypertensive patients. The data reported here may help to better define the use of ambulatory blood pressure monitoring techniques in the diagnosis of hypertension.

Definition of normalcy in whole-day ambulatory blood pressure monitoring.

In this study we have performed 24-hour ambulatory blood pressure monitorings in age-matched normotensive and hypertensive male subjects. The data have been analyzed in an attempt to define standards for the clinical use of ambulatory blood pressure monitoring in the diagnosis of hypertension. The data were analyzed with respect to possible differences in the averages of the whole-day, daytime and nighttime blood pressures, and differences in the prevalence of abnormal blood pressures between the two groups. A considerable overlap was found between the two groups with respect to the various blood pressure averages. The overlap in blood pressures occurred in fewer patients for diastolic than for systolic blood pressure, and less often when nighttime pressures were considered. Hypertensive men showed on average a greater incidence of abnormal blood pressures than normotensive subjects. However, nine of the normotensive control subjects showed more than 25 percent of abnormal readings of systolic or diastolic blood pressures during a 24-hour recording period. In contrast, fewer than 25 percent of abnormal blood pressure readings were found in 9 of the hypertensive patients. The data reported here may help to better define the use of ambulatory blood pressure monitoring techniques in the diagnosis of hypertension.