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Current Cardiology Reports

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01-05-2019 | Blood Pressure Measurement | Ischemic Heart Disease (D Mukherjee, Section Editor)

Relationship Between Outpatient Clinic and Ambulatory Blood Pressure Measurements and Mortality

Authors: KoKo Aung, Thwe Htay

Published in: Current Cardiology Reports | Issue 5/2019

Abstract

Purpose of Review

This review aims to summarize and discuss the relationship between outpatient clinic and ambulatory blood pressure (BP) measurements and cardiovascular morbidity and mortality.

Recent Findings

Contemporary clinical practice guidelines worldwide recommend ambulatory blood pressure monitoring (ABPM) to confirm the diagnosis of hypertension. Recent epidemiological studies and systematic reviews showed ABPM predicts cardiovascular events and mortality independent of clinic BP. Ambulatory BP appears to be prognostically superior to clinic BP.

Summary

ABPM characterizes BP phenotypes that would not have otherwise identified with clinic BP measurement only. Identification of white coat hypertension, which carries a prognosis almost similar to normotension, and masked hypertension, which carries a prognosis almost similar to sustained hypertension, can be accomplished only by ABPM. Randomize controlled trials to assess the cardiovascular effects of hypertensive patients managed with ABPM vs. clinic BP measurement and cost-effective studies of ABPM are warranted.

•• Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American Society of Hypertension: JASH. 2018;12(8):579.e1–e73. https://doi.org/10.1016/j.jash.2018.06.010 The most recent US clinical practice guidelines for diagnosis and management of hypertension in adults, prepared by the ACC/AHA Task Force on Clinical Practice Guidelines in collaboration with other multiple relevant professional organizations.CrossRef

•• Final update summary: high blood pressure in adults: screening - US Preventive Services Task Force [Internet]. Uspreventiveservicestaskforce.org. 2016 [cited 15 October 2018]. Available from: https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/high-blood-pressure-in-adults-screening. The most recent final recommendation statement of the USPSTF on screening for high blood pressure in adults aged 18 years or older, where it recommends obtaining ambulatory blood pressure measurement for diagnostic confirmation before starting treatment for hypertension.

•• Leung AA, Nerenberg K, Daskalopoulou SS, McBrien K, Zarnke KB, Dasgupta K, et al. Hypertension Canada’s 2016 Canadian Hypertension Education Program Guidelines for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. Can J Cardiol. 2016;32(5):569–88. https://doi.org/10.1016/j.cjca.2016.02.066 The most recent Canadian clinical practice guidelines for diagnosis and treatment of hypertension.CrossRefPubMed

Hypertension in adults: diagnosis and management | guidance and guidelines | NICE [Internet]. Nice.org.uk. 2011 [cited 15 October 2018]. Available from: https://www.nice.org.uk/guidance/CG127.

•• Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018;39(33):3021–3104. https://doi.org/10.1093/eurheartj/ehy339. Update of the 2013 ESC/ESH Guidelines for the management of arterial hypertension, jointly issued by the two societies, to evaluate and incorporate new evidence into the recommendations.

•• Guideline for the diagnosis and management of hypertension in adults. Melbourne: National Heart Foundation of Australia; 2016. The most recent Australian clinical practice guidelines on diagnosis and treatment of hypertension, including indications for ambulatory blood pressure measurement.

Shimamoto K, Ando K, Fujita T, Hasebe N, Higaki J, Horiuchi M, et al. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2014). Hypertens Res. 2014;37(4):253–390. https://doi.org/10.1038/hr.2014.20. CrossRefPubMed

Hodgkinson J, Wood S, Martin U, McManus R. ABPM is best for diagnosing hypertension in primary care. Practitioner. 2011;255(1744):21–3 2.PubMed

Pickering TG, James GD, Boddie C, Harshfield GA, Blank S, Laragh JH. How common is white coat hypertension? JAMA. 1988;259(2):225–8.CrossRef

10.

Piper MA, Evans CV, Burda BU, Margolis KL, O’Connor E, Whitlock EP. Diagnostic and predictive accuracy of blood pressure screening methods with consideration of rescreening intervals: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2015;162(3):192–204. https://doi.org/10.7326/m14-1539.CrossRefPubMed

11.

Mancia G, Bombelli M, Brambilla G, Facchetti R, Sega R, Toso E, et al. Long-term prognostic value of white coat hypertension: an insight from diagnostic use of both ambulatory and home blood pressure measurements. Hypertension (Dallas, Tex : 1979). 2013;62(1):168–74. https://doi.org/10.1161/hypertensionaha.111.00690.CrossRef

12.

•• Banegas JR, Ruilope LM, de la Sierra A, Vinyoles E, Gorostidi M, de la Cruz JJ, et al. Relationship between clinic and ambulatory blood-pressure measurements and mortality. N Engl J Med. 2018;378(16):1509–20. https://doi.org/10.1056/NEJMoa1712231 Analysis of data from the Spanish Ambulatory Blood Pressure Registry to assess whether ambulatory blood pressure measurements added predictive value to clinic blood pressure measurement on the cardiovascular outcomes of the registry participants.CrossRefPubMed

13.

Asayama K, Thijs L, Li Y, Gu YM, Hara A, Liu YP, et al. Setting thresholds to varying blood pressure monitoring intervals differentially affects risk estimates associated with white-coat and masked hypertension in the population. Hypertension (Dallas, Tex : 1979). 2014;64(5):935–42. https://doi.org/10.1161/hypertensionaha.114.03614.CrossRef

14.

Gorostidi M, Vinyoles E, Banegas JR, de la Sierra A. Prevalence of white-coat and masked hypertension in national and international registries. Hypertens Res. 2015;38(1):1–7. https://doi.org/10.1038/hr.2014.149. CrossRefPubMed

15.

•• Wang YC, Shimbo D, Muntner P, Moran AE, Krakoff LR, Schwartz JE. Prevalence of masked hypertension among US adults with nonelevated clinic blood pressure. Am J Epidemiol. 2017;185(3):194–202. https://doi.org/10.1093/aje/kww237 The first estimate of the prevalence of masked hypertension in the USA, finding nearly 1 in 8 adults with nonelevated clinic BP having masked hypertension, thereby suggesting millions of US adults being potentially misclassified as not having hypertension.CrossRefPubMedPubMedCentral

16.

• Sheppard JP, Fletcher B, Gill P, Martin U, Roberts N, McManus RJ. Predictors of the home-clinic blood pressure difference: a systematic review and meta-analysis. Am J Hypertens. 2016;29(5):614–25. https://doi.org/10.1093/ajh/hpv157 A systematic review and meta-analysis of studies examining the association between patient factors and the home-clinic blood pressure difference.

17.

• Trudel X, Brisson C, Gilbert-Ouimet M, Duchaine CS, Dalens V, Talbot D, et al. Masked hypertension incidence and risk factors in a prospective cohort study. Eur J Prev Cardiol. 2018:2047487318802692. https://doi.org/10.1177/2047487318802692 A cohort study of normotensive participants determining the incidence of masked hypertension and its related risk factors.

18.

• Ozkan S, Ata N, Yavuz B. Increased masked hypertension prevalence in patients with obesity. Clinical and experimental hypertension (New York, NY : 1993). 2018:1–4. https://doi.org/10.1080/10641963.2018.1431262 A study of consecutive outpatient participants without overt hypertension comparing prevalence of masked hypertension in obesity and non-obese participants.

19.

Stergiou GS, Asayama K, Thijs L, Kollias A, Niiranen TJ, Hozawa A, et al. Prognosis of white-coat and masked hypertension: International Database of HOme blood pressure in relation to Cardiovascular Outcome. Hypertension (Dallas, Tex : 1979). 2014;63(4):675–82. https://doi.org/10.1161/hypertensionaha.113.02741.CrossRef

20.

Li Y, Staessen JA, Lu L, Li LH, Wang GL, Wang JG. Is isolated nocturnal hypertension a novel clinical entity? Findings from a Chinese population study. Hypertension (Dallas, Tex : 1979). 2007;50(2):333–9. https://doi.org/10.1161/hypertensionaha.107.087767.CrossRef

21.

Wang C, Deng WJ, Gong WY, Zhang J, Tang H, Peng H, et al. High prevalence of isolated nocturnal hypertension in Chinese patients with chronic kidney disease. J Am Heart Assoc. 2015;4(6):e002025. https://doi.org/10.1161/jaha.115.002025. CrossRefPubMedPubMedCentral

22.

Boggia J, Li Y, Thijs L, Hansen TW, Kikuya M, Bjorklund-Bodegard K, et al. Prognostic accuracy of day versus night ambulatory blood pressure: a cohort study. Lancet (London, England). 2007;370(9594):1219–29. https://doi.org/10.1016/s0140-6736(07)61538-4.CrossRef

23.

Hansen TW, Li Y, Boggia J, Thijs L, Richart T, Staessen JA. Predictive role of the nighttime blood pressure. Hypertension (Dallas, Tex : 1979). 2011;57(1):3–10. https://doi.org/10.1161/hypertensionaha.109.133900.CrossRef

24.

Fan HQ, Li Y, Thijs L, Hansen TW, Boggia J, Kikuya M, et al. Prognostic value of isolated nocturnal hypertension on ambulatory measurement in 8711 individuals from 10 populations. J Hypertens. 2010;28(10):2036–45. https://doi.org/10.1097/HJH.0b013e32833b49fe.CrossRefPubMed

25.

Staessen JA, Bieniaszewski L, O’Brien E, Gosse P, Hayashi H, Imai Y, et al. Nocturnal blood pressure fall on ambulatory monitoring in a large international database. The “Ad Hoc” Working Group. Hypertension (Dallas, Tex : 1979.). 1997;29(1 Pt 1):30–9.CrossRef

26.

White WB. Ambulatory blood pressure monitoring: dippers compared with non-dippers. Blood pressure monitoring. 2000;5(Suppl 1):S17–23.CrossRef

27.

Routledge FS, McFetridge-Durdle JA, Dean CR. Night-time blood pressure patterns and target organ damage: a review. Can J Cardiol. 2007;23(2):132–8.CrossRef

28.

•• Presta V, Figliuzzi I, D’Agostino M, Citoni B, Miceli F, Simonelli F, et al. Nocturnal blood pressure patterns and cardiovascular outcomes in patients with masked hypertension. Journal of clinical hypertension (Greenwich, Conn). 2018;20(9):1238–46. https://doi.org/10.1111/jch.13361 Analysis of data from a large cohort evaluating clinical characteristics and cardiovascular outcomes of different nocturnal patterns of masked hypertension.CrossRef

29.

• Zhang H, Cui Y, Zhao Y, Dong Y, Wang J, Duan D, et al. Association of circadian rhythm of blood pressure and cerebral small vessel disease in community-based elderly. J Gerontol A Biol Sci Med Sci. 2018. https://doi.org/10.1093/gerona/gly212 A community-based study of older adults examining the frequency of cerebral small vessel disease among different categories of nocturnal circadian patterns of blood pressure: extreme dippers, nondippers, and reverse dippers.

30.

Mahabala C, Kamath P, Bhaskaran U, Pai ND, Pai AU. Antihypertensive therapy: nocturnal dippers and nondippers. Do we treat them differently? Vasc Health Risk Manag. 2013;9:125–33. https://doi.org/10.2147/vhrm.S33515.CrossRefPubMedPubMedCentral

31.

Hoshino A, Nakamura T, Matsubara H. The bedtime administration ameliorates blood pressure variability and reduces urinary albumin excretion in amlodipine-olmesartan combination therapy. Clin Exp Hypertens (New York, NY: 1993). 2010;32(7):416–22. https://doi.org/10.3109/10641961003667948.CrossRef

32.

Hermida RC, Calvo C, Ayala DE, Fernandez JR, Covelo M, Mojon A, et al. Treatment of non-dipper hypertension with bedtime administration of valsartan. J Hypertens. 2005;23(10):1913–22.CrossRef

33.

Hermida RC, Ayala DE, Fernandez JR, Calvo C. Comparison of the efficacy of morning versus evening administration of telmisartan in essential hypertension. Hypertension (Dallas, Tex : 1979). 2007;50(4):715–22. https://doi.org/10.1161/hypertensionaha.107.094235.CrossRef

34.

Hermida RC, Ayala DE, Mojon A, Fernandez JR. Influence of circadian time of hypertension treatment on cardiovascular risk: results of the MAPEC study. Chronobiol Int. 2010;27(8):1629–51. https://doi.org/10.3109/07420528.2010.510230.CrossRefPubMed

35.

Salles GF, Leite NC, Pereira BB, Nascimento EM, Cardoso CR. Prognostic impact of clinic and ambulatory blood pressure components in high-risk type 2 diabetic patients: the Rio de Janeiro Type 2 Diabetes Cohort Study. J Hypertens. 2013;31(11):2176–86. https://doi.org/10.1097/HJH.0b013e328364103f.CrossRef

36.

Hansen TW, Kikuya M, Thijs L, Bjorklund-Bodegard K, Kuznetsova T, Ohkubo T, et al. Prognostic superiority of daytime ambulatory over conventional blood pressure in four populations: a meta-analysis of 7,030 individuals. J Hypertens. 2007;25(8):1554–64. https://doi.org/10.1097/HJH.0b013e3281c49da5.CrossRefPubMed

37.

Hansen TW, Jeppesen J, Rasmussen S, Ibsen H, Torp-Pedersen C. Ambulatory blood pressure and mortality: a population-based study. Hypertension (Dallas, Tex : 1979). 2005;45(4):499–504. https://doi.org/10.1161/01.HYP.0000160402.39597.3b.CrossRef

38.

Ohkubo T, Kikuya M, Metoki H, Asayama K, Obara T, Hashimoto J, et al. Prognosis of “masked” hypertension and “white-coat” hypertension detected by 24-h ambulatory blood pressure monitoring 10-year follow-up from the Ohasama study. J Am Coll Cardiol. 2005;46(3):508–15. https://doi.org/10.1016/j.jacc.2005.03.070.CrossRefPubMed

39.

Staessen JA, Thijs L, Fagard R, O’Brien ET, Clement D, de Leeuw PW, et al. Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension. Systolic Hypertension in Europe Trial Investigators. JAMA. 1999;282(6):539–46.CrossRef

40.

Salles GF, Cardoso CR, Muxfeldt ES. Prognostic influence of office and ambulatory blood pressures in resistant hypertension. Arch Intern Med. 2008;168(21):2340–6. https://doi.org/10.1001/archinte.168.21.2340.CrossRefPubMed

41.

Dolan E, Stanton A, Thijs L, Hinedi K, Atkins N, McClory S, et al. Superiority of ambulatory over clinic blood pressure measurement in predicting mortality: the Dublin outcome study. Hypertension (Dallas, Tex : 1979). 2005;46(1):156–61. https://doi.org/10.1161/01.HYP.0000170138.56903.7a.CrossRef

42.

•• Wing LMH, Chowdhury EK, Reid CM, Beilin LJ, Brown MA. Night-time ambulatory blood pressure is the best pretreatment blood pressure predictor of 11-year mortality in treated older hypertensives. Blood Press Monit. 2018;23(5):237–43. https://doi.org/10.1097/mbp.0000000000000331 A study of treated elderly hypertensives participating in a comparative outcome trial to evaluate whether pretreatment ambulatory BP was a better predictor of mortality than clinic BP over long-term follow-up.CrossRefPubMed

43.

• Mortensen RN, Gerds TA, Jeppesen JL, Torp-Pedersen C. Office blood pressure or ambulatory blood pressure for the prediction of cardiovascular events. Eur Heart J. 2017;38(44):3296–304. https://doi.org/10.1093/eurheartj/ehx464 Analysis of data from a large international database of multiple cohorts from selected European, South American and Asian countries examining cardiovascular risk prediction based on office and ambulatory blood pressure measurement.

44.

•• Banegas JR, Ruilope LM, Williams B. Ambulatory blood pressure and mortality. N Engl J Med. 2018;379(13):1287–8. https://doi.org/10.1056/NEJMc1809851 Analysis of data from a registry-based, multicenter, national cohort examining relationship between clinic and 24-hour ambulatory blood-pressure and mortality.

45.

•• O’Brien E, Dolan E. Ambulatory blood pressure monitoring for the effective management of antihypertensive drug treatment. Clin Ther. 2016;38(10):2142–51. https://doi.org/10.1016/j.clinthera.2016.08.006 A review of current international guidelines on ABPM highlighting evidence supporting its clinical use managing antihypertensive therapy.CrossRefPubMed

46.

Dolan E, Stanton AV, Thom S, Caulfield M, Atkins N, McInnes G, et al. Ambulatory blood pressure monitoring predicts cardiovascular events in treated hypertensive patients--an Anglo-Scandinavian cardiac outcomes trial substudy. J Hypertens. 2009;27(4):876–85. https://doi.org/10.1097/HJH.0b013e328322cd62.CrossRefPubMed

47.

Kario K, Shimada K. Risers and extreme-dippers of nocturnal blood pressure in hypertension: antihypertensive strategy for nocturnal blood pressure. Clin Exp Hypertens (New York, NY : 1993.). 2004;26(2):177–89.

48.

•• Araujo S, Rouxinol-Dias A, Mesquita-Bastos J, Silva J, Barbosa L, Polonia J. Ambulatory blood pressure monitoring profiles in a cross-sectional analysis of a large database of normotensive and true or suspected hypertensive patients. Rev Port Cardiol. 2018;37(4):319–27. https://doi.org/10.1016/j.repc.2017.07.009 Analysis of a large database of normotensive and true or suspected hypertensive patients examining circadian patterns of blood pressure and concordance or discordance between different patterns.

49.

•• Soranna D, Zambon A, Corrao G, Zanchetti A, Parati G, Mancia G. Different effects of antihypertensive treatment on office and ambulatory blood pressure: a meta-analysis. J Hypertens. 2018. https://doi.org/10.1097/HJH.0000000000001914 A meta-analysis of randomized clinical trials on hypertensive patients treated with at least one drug to quantify differences in treatment-induced changes in clinic and ambulatory BP and identify associated factors.

50.

• Hinderliter AL, Voora RA, Viera AJ. Implementing ABPM into clinical practice. Curr Hypertens Rep. 2018;20(1):5. https://doi.org/10.1007/s11906-018-0805-y A review article summarizing the data supporting the use of ambulatory blood pressure monitoring and to providing practical guidance for practitioners who are establishing an ambulatory monitoring service.

51.

Kent ST, Shimbo D, Huang L, Diaz KM, Viera AJ, Kilgore M, et al. Rates, amounts, and determinants of ambulatory blood pressure monitoring claim reimbursements among Medicare beneficiaries. J Am Soc Hypertens. 2014;8(12):898–908. https://doi.org/10.1016/j.jash.2014.09.020. CrossRefPubMedPubMedCentral

52.

Lovibond K, Jowett S, Barton P, Caulfield M, Heneghan C, Hobbs FD, et al. Cost-effectiveness of options for the diagnosis of high blood pressure in primary care: a modelling study. Lancet (London, England). 2011;378(9798):1219–30. https://doi.org/10.1016/s0140-6736(11)61184-7.CrossRef

53.

• Final research plan: high blood pressure in adults: screening - US Preventive Services Task Force [Internet]. Uspreventiveservicestaskforce.org. 2018 [cited 15 October 2018]. Available from: https://www.uspreventiveservicestaskforce.org/Page/Document/final-research-plan/high-blood-pressure-in-adults-screening1 Recommendation by the U.S. Preventive Services Task Force to provide a guidance for the researchers at an Evidence-based Practice Center in producing a sy stematic review of the evidence, which will form the basis of the USPSTF Recommendation Statement on screening for high blood pressure in adults, including the accuracy of office-based blood pressure measurement during a single encounter as initial screening for high blood pressure compared with ambulatory blood pressure measurement.

Title: Relationship Between Outpatient Clinic and Ambulatory Blood Pressure Measurements and Mortality
Authors: KoKo Aung
Thwe Htay
Publication date: 01-05-2019
Publisher: Springer US
Keywords: Blood Pressure Measurement
Hypertension
Hypertension
Published in: Current Cardiology Reports / Issue 5/2019
Print ISSN: 1523-3782
Electronic ISSN: 1534-3170
DOI: https://doi.org/10.1007/s11886-019-1114-z

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