Optimizing blood pressure control in hypertension: The need to use ABPM

Figures & data

Figure 1. The relative predictive power of different blood pressure measurements for 5-year risk of cardiovascular death (11). Reproduced with permission from Dolan et al. (11).

Table I. Approximate blood pressure threshold values for definition of hypertension with different types of measurement: guidelines of the European Society of Hypertension and European Society of Cardiology (1).

	SBP (mmHg)	DBP (mmHg)
Office or clinic	140	90
24-h	125–130	80
Day	130–135	85
Night	120	70
Home	130–135	85

DBP, diastolic blood pressure; SBP, systolic blood pressure.

Figure 2. Twenty-four-hour ambulatory blood pressure measurement showing a typical dip in night-time blood pressure and a rise in early morning blood pressure (53). Reproduced with permission from Kario et al. (53).

Table II. Classifications of hypertension that may be differentially diagnosed with ambulatory blood pressure monitoring (ABPM) versus clinic blood pressure (BP) measurement.

Pattern	Characterization	Comments
White-coat hypertension	Clinic BP≥ 140/90 mmHg AND average daytime BP< 135/85 mmHg or 24-h BP< 130/80 mmHg (1)	•Not necessarily benign, especially in the elderly in whom it is associated with increased CV morbidity. •Not directly associated with increased CV risk in younger patients but may predispose to development of sustained hypertension; requires careful monitoring but not necessarily treatment except in high-risk cases. •May be mistaken for resistant hypertension in treated patients.
Masked hypertension	Clinic BP < 140/90 mmHg AND average daytime BP ≥ 135/85 mmHg or 24-h BP ≥ 130/80 mmHg (1)	•More consistently reported as being associated with increased CV risk than is white-coat hypertension. •May predispose to the development of sustained hypertension and should be treated. •May be “masking” poorly controlled or resistant hypertension because clinic BP is normal. •Difficult to identify but more likely in patients with declining organ function despite apparently well-controlled BP or in patients with kidney disease or diabetes or those otherwise at increased CV risk (e.g. smokers).

CV, cardiovascular.

Dolan E, Stanton A, Thijs L, Hinedi K, Atkins N, McClory S, . Superiority of ambulatory over clinic blood pressure measurement in predicting mortality: The Dublin outcome study. Hypertension 2005;46:156–161.

 PubMed Web of Science ®Google Scholar

Mancia G, De BG, Dominiczak A, Cifkova R, Fagard R, Germano G, . 2007 ESH-ESC Practice guidelines for the management of arterial hypertension: ESH-ESC Task Force on the Management of Arterial Hypertension. J Hypertens 2007;25:1751–1762.

 PubMed Web of Science ®Google Scholar

Kario K, Pickering TG, Umeda Y, Hoshide S, Hoshide Y, Morinari M, . Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives: A prospective study. Circulation 2003;107: 1401–1406.

 PubMed Web of Science ®Google Scholar