Ambulatory Blood Pressure Monitoring to Diagnose and Manage Hypertension

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: closed (30 June 2023) | Viewed by 12980

Special Issue Editor

1. Department of Innovative Technologies in Medicine & Dentistry, University “Gabriele d’Annunzio”, Chieti-Pescara, Chieti, Italy
2. Department of Internal Medicine, Santissima Annunziata Hospital, Chieti, Italy
Interests: hypertension; ambulatory blood pressure monitorin; left ventricular hypertrophy; heart failure; atrial fibrillation; ischemic heart disease; cerebrovascular disease; epidemiology

Special Issue Information

Dear Colleagues, 

Clinical blood pressure measurement has long been the cornerstone of the diagnosis and management of arterial hypertension. The introduction of noninvasive ambulatory blood pressure monitoring has allowed us to expand our knowledge on hypertensive disease. Noninvasive ambulatory blood monitoring has given the opportunity to detect daytime, night-time, and 24-hour blood pressure, circadian blood pressure changes, blood pressure variability, and ambulatory blood pressure phenotypes that describe potential agreement or disagreement between clinical and out-of-office blood pressure values. The aforementioned aspects can be assessed both in untreated hypertensive patients, allowing a more accurate diagnosis, and in treated ones, allowing a more accurate assessment of blood pressure control. Various studies have shown that many parameters of ambulatory blood pressure are superior to clinical blood pressure in predicting organ damage and future cardiovascular events, both in untreated and treated patients at baseline. Some controversy still remains as to whether any of the ambulatory blood pressure parameters are superior to others in predicting prognosis in hypertensive patients. In the same way, some controversy still exists as to whether some measurements have a different prognostic impact in different age groups. Ongoing and future research will shed further light on these controversies and will help identify new potential parameters of noninvasive ambulatory blood pressure monitoring which could be useful to refine diagnosis, blood pressure control, and prognosis in hypertensive patients.

Prof. Dr. Sante Donato Pierdomenico
Guest Editor

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Keywords

  • ambulatory systolic blood pressure
  • ambulatory diastolic blood pressure
  • ambulatory pulse pressure
  • daytime blood pressure
  • night-time blood pressure
  • dippers
  • nondippers
  • extreme dippers
  • reverse dippers
  • blood pressure variability
  • sustained hypertension
  • white coat hypertension
  • masked hypertension
  • resistant hypertension

Published Papers (10 papers)

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Research

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12 pages, 3319 KiB  
Article
Effect of Cuff Inflation on Blood Pressure, Arousals, Sleep Efficiency, and Desaturations: Sub-Analysis of the VAST Pilot Study
by Thenral Socrates, Philipp Krisai, Andrea Meienberg, Michael Mayr, Thilo Burkard and Annina S. Vischer
Diagnostics 2023, 13(18), 2874; https://doi.org/10.3390/diagnostics13182874 - 07 Sep 2023
Viewed by 568
Abstract
The influence of cuff inflations on night-time measurements during 24 h ambulatory blood pressure (BP) measurements is unknown. We investigated the potential effect of cuff inflations on sleep parameters using measurements taken simultaneously with a cuffless device using pulse-transit-time (PTT). On the first [...] Read more.
The influence of cuff inflations on night-time measurements during 24 h ambulatory blood pressure (BP) measurements is unknown. We investigated the potential effect of cuff inflations on sleep parameters using measurements taken simultaneously with a cuffless device using pulse-transit-time (PTT). On the first day of measurement, standard cuff-based 24 h BP and cuffless measurements were simultaneously performed on the right and left arms (CUFF/PTT-D). In this experiment, 1–2 days after the first measurement, the cuffless device was worn alone (PTT-D). Only data from the cuffless device were analyzed. The following mean sleep parameters were analyzed: mean systolic and diastolic BP, arousals, sleep efficiency, total arousals, arousal per hour, and desaturations. In total, 21 individuals were prospectively enrolled. The mean (SD) age was 47 (±15) years, and 57% were female. The mean systolic asleep BP during CUFF/PTT-D and during PTT-D were 131 (±21) and 131 (±26) mmHg, respectively. The mean diastolic asleep BP values during CUFF/PTT-D and during PTT-D were 80 (±14) and 84 (±14) mmHg, respectively (p = 0.860, p = 0.100, respectively). Systolic and diastolic asleep mean difference was 0.1 (±18.0) and −3.6 (±9.8) mmHg, respectively. There were significantly more total arousals during PTT-D (p = 0.042). There were no significant differences seen in sleep efficiency (p = 0.339) or desaturations (p = 0.896) between the two measurement periods. We could not show any significant impact from cuff inflations during sleep, as documented by PTT-D measurements. Full article
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11 pages, 350 KiB  
Article
Systolic Blood Pressure and Pulse Pressure Are Predictors of Future Cardiovascular Events in Patients with True Resistant Hypertension
by J. Mesquita Bastos, Lisa Ferraz, Flávio G. Pereira and Susana Lopes
Diagnostics 2023, 13(10), 1817; https://doi.org/10.3390/diagnostics13101817 - 22 May 2023
Cited by 3 | Viewed by 1029
Abstract
Given the increased risk of cardiovascular events associated with resistant hypertension, predictive cardiovascular prognosis is extremely important. Ambulatory blood pressure monitoring (ABPM) is mandatory for resistant hypertension diagnosis, but its use for prognosis is scarce. This observational longitudinal study included 258 patients (mean [...] Read more.
Given the increased risk of cardiovascular events associated with resistant hypertension, predictive cardiovascular prognosis is extremely important. Ambulatory blood pressure monitoring (ABPM) is mandatory for resistant hypertension diagnosis, but its use for prognosis is scarce. This observational longitudinal study included 258 patients (mean age of 60.4 ± 11.2 years; 61.2% male), who underwent 24 h ABPM in a hypertension unit from 1999 to 2019. The outcomes were global cardiovascular events (cerebrovascular, coronary, and other cardiovascular events). The mean follow-up period was 6.0 ± 5.0 years. Sixty-eight cardiovascular events (61 nonfatal) were recorded. Patients who experienced cardiovascular events were generally older, with higher rates of chronic kidney disease and prior cardiovascular events. The 24 h systolic blood pressure (hazard ratio 1.44; 95% CI 1.10–1.88), night systolic blood pressure (1.35; 95% CI 1.01–1.80), and 24 h pulse pressure (2.07; 95% CI 1.17–3.67) were independent predictors of global cardiovascular events. Multivariate Cox analysis revealed a higher risk of future cardiovascular events, particularly in patients with a 24 h daytime and nighttime pulse pressure > 60 mm Hg with respective hazard ratios of 1.95; 95% CI 1.01–3.45; 2.15; 95% CI 1.21–3.83 and 2.07; 95% CI 1.17–3.67. In conclusion, APBM is a fundamental tool not only for the diagnosis of resistant hypertension, but also for predicting future cardiovascular events. Full article
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12 pages, 862 KiB  
Article
Ambulatory Resistant Hypertension and Risk of Heart Failure in the Elderly
by Francesca Coccina, Anna M. Pierdomenico, Chiara Cuccurullo, Jacopo Pizzicannella, Oriana Trubiani and Sante D. Pierdomenico
Diagnostics 2023, 13(9), 1631; https://doi.org/10.3390/diagnostics13091631 - 05 May 2023
Cited by 1 | Viewed by 901
Abstract
(1) Background: The aim of the study was to assess the risk of heart failure (HF) in elderly treated hypertensive patients with white coat uncontrolled hypertension (WUCH), ambulatory nonresistant hypertension (ANRH) and ambulatory resistant hypertension (ARH), when compared to those with controlled hypertension [...] Read more.
(1) Background: The aim of the study was to assess the risk of heart failure (HF) in elderly treated hypertensive patients with white coat uncontrolled hypertension (WUCH), ambulatory nonresistant hypertension (ANRH) and ambulatory resistant hypertension (ARH), when compared to those with controlled hypertension (CH). (2) We studied 745 treated hypertensive subjects older than 65 years. CH was defined as clinic blood pressure (BP) < 140/90 mmHg and 24-h BP < 130/80 mmHg; WUCH was defined as clinic BP ≥ 140/90 mmHg and 24-h BP < 130/80 mmHg; ANRH was defined as 24-h BP ≥ 130/80 mmHg in patients receiving ≤2 antihypertensive drugs; ARH was defined as 24-h BP ≥ 130/80 mmHg in patients receiving ≥3 antihypertensive drugs. (3) Results: 153 patients had CH, 153 had WUCH, 307 had ANRH and 132 (18%) had ARH. During the follow-up (8.4 ± 4.8 years), 82 HF events occurred. After adjustment for various covariates, when compared to CH, the hazard ratio (95% confidence interval) for HF was 1.30 (0.51–3.32), 2.14 (1.03–4.43) and 3.52 (1.56–7.96) in WUCH, ANRH and ARH, respectively. (4) Conclusions: among elderly treated hypertensive patients, those with ARH are at a considerably higher risk of developing HF when compared to CH. Full article
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15 pages, 1646 KiB  
Article
Prevalence and Characteristics of Isolated Nocturnal Hypertension and Masked Nocturnal Hypertension in a Tertiary Hospital in the City of Buenos Aires
by Jessica Barochiner, Romina R. Díaz and Rocío Martínez
Diagnostics 2023, 13(8), 1419; https://doi.org/10.3390/diagnostics13081419 - 14 Apr 2023
Cited by 2 | Viewed by 1108
Abstract
Isolated nocturnal hypertension (INH) and masked nocturnal hypertension (MNH) increase cardiovascular risk. Their prevalence and characteristics are not clearly established and seem to differ among populations. We aimed to determine the prevalence and associated characteristics of INH and MNH in a tertiary hospital [...] Read more.
Isolated nocturnal hypertension (INH) and masked nocturnal hypertension (MNH) increase cardiovascular risk. Their prevalence and characteristics are not clearly established and seem to differ among populations. We aimed to determine the prevalence and associated characteristics of INH and MNH in a tertiary hospital in the city of Buenos Aires. We included 958 hypertensive patients ≥ 18 years who underwent an ambulatory blood pressure monitoring (ABPM) between October and November 2022, as prescribed by their treating physician to diagnose or to assess hypertension control. INH was defined as nighttime BP ≥ 120 mmHg systolic or ≥70 diastolic in the presence of normal daytime BP (<135/85 mmHg regardless of office BP; MNH was defined as the presence of INH with office BP < 140/90 mmHg). Variables associated with INH and MNH were analyzed. The prevalences of INH and MNH were 15.7% (95% CI 13.5–18.2%) and 9.7 (95% CI 7.9–11.8%), respectively. Age, male sex, and ambulatory heart rate were positively associated with INH, whereas office BP, total cholesterol, and smoking habits showed a negative association. In turn, diabetes and nighttime heart rate were positively associated with MNH. In conclusion, INH and MNH are frequent entities, and determination of clinical characteristics such as those detected in this study is critical since this might contribute to a more appropriate use of resources. Full article
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11 pages, 1199 KiB  
Article
Prognostic Impact of 24-Hour Pulse Pressure Components in Treated Hypertensive Patients Older Than 65 Years
by Francesca Coccina, Anna M. Pierdomenico, Chiara Cuccurullo, Jacopo Pizzicannella, Oriana Trubiani and Sante D. Pierdomenico
Diagnostics 2023, 13(5), 845; https://doi.org/10.3390/diagnostics13050845 - 23 Feb 2023
Cited by 2 | Viewed by 1250
Abstract
(1) Background: The aim of this study was to assess the prognostic impact of 24-hour pulse pressure (PP), elastic PP (elPP) and stiffening PP (stPP) in elderly treated hypertensive patients; (2) Methods: In this retrospective study, we evaluated 745 treated hypertensive subjects older [...] Read more.
(1) Background: The aim of this study was to assess the prognostic impact of 24-hour pulse pressure (PP), elastic PP (elPP) and stiffening PP (stPP) in elderly treated hypertensive patients; (2) Methods: In this retrospective study, we evaluated 745 treated hypertensive subjects older than 65 years who underwent ambulatory blood pressure monitoring to assess 24-hour PP and 24-hour elPP and stPP, as calculated by a mathematical model. The association of these PP components with a combined endpoint of cardiovascular events was investigated; (3) Results: The 24-hour PP, elPP and stPP were 59 ± 12.5, 47.5 ± 9.5 and 11.5 ± 6.5 mmHg, respectively. During the follow-up (mean 8.4 years), 284 events occurred, including coronary events, stroke, heart failure hospitalization and peripheral revascularization. In the univariate Cox regression analysis, 24-hour PP, elPP and stPP were associated with the combined outcome. After the adjustment for covariates, per one standard deviation increase, 24-hour PP had a borderline association with risk (hazard ratio (HR) 1.16, 95% confidence interval (CI) 1.00–1.34), 24-hour elPP remained associated with cardiovascular events (HR 1.20, 95% CI 1.05–1.36) and 24-hour stPP lost its significance. (4) Conclusions: 24-hour elPP is a predictor of cardiovascular events in elderly treated hypertensive patients. Full article
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9 pages, 775 KiB  
Article
Reproducibility and Predictive Value of White-Coat Hypertension in Young to Middle-Age Subjects
by Paolo Palatini, Lucio Mos, Francesca Saladini, Olga Vriz, Claudio Fania, Andrea Ermolao, Francesca Battista and Marcello Rattazzi
Diagnostics 2023, 13(3), 434; https://doi.org/10.3390/diagnostics13030434 - 25 Jan 2023
Cited by 2 | Viewed by 987
Abstract
(1) Aim. The aim of the study was to investigate the reproducibility of white-coat hypertension (WCH) and its predictive capacity for hypertension needing antihypertensive treatment (HT) in young to middle-age subjects. (2) Methods. We investigated 1096 subjects from the HARVEST. Office and 24 [...] Read more.
(1) Aim. The aim of the study was to investigate the reproducibility of white-coat hypertension (WCH) and its predictive capacity for hypertension needing antihypertensive treatment (HT) in young to middle-age subjects. (2) Methods. We investigated 1096 subjects from the HARVEST. Office and 24 h blood pressures (BP) were measured at baseline and after 3 months. The reproducibility of WCH was evaluated with kappa statistics. The predictive capacity of WCH was tested in multivariate Cox models (N = 1050). (3) Results. Baseline WCH was confirmed at 3-month assessment in 33.3% of participants. Reproducibility was fair (0.27, 95%CI 0.20–0.37) for WCH, poor (0.14, 95%CI 0.09–0.19) for office hypertension, and moderate (0.47, 95%CI 0.41–0.53) for ambulatory hypertension. WCH assessed either at baseline or after 3 months (unstable WCH) was not a significant predictor of HT during 17.4 years of follow-up. However, participants who had WCH both at baseline and after 3 months (stable WCH) had an increased risk of HT compared to the normotensives (Hazard ratio, 1.50, 95%CI 1.06–2.1). (4) Conclusions. These results show that WCH has limited reproducibility. WCH diagnosed with two BP assessments but not with one showed an increased risk of future HT. Our data indicate that WCH should be identified with two sets of office and ambulatory BP measurements. Full article
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Review

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13 pages, 405 KiB  
Review
The Role of Blood Pressure Load in Ambulatory Blood Pressure Monitoring in Adults: A Literature Review of Current Evidence
by Ophir Eyal and Iddo Z. Ben-Dov
Diagnostics 2023, 13(15), 2485; https://doi.org/10.3390/diagnostics13152485 - 26 Jul 2023
Viewed by 958
Abstract
Background: The blood pressure load (BPL) is commonly defined as the percentage of readings in a 24-h ambulatory blood pressure monitoring (ABPM) study above a certain threshold, usually the upper normal limit. While it has been studied since the 1990s, the benefits of [...] Read more.
Background: The blood pressure load (BPL) is commonly defined as the percentage of readings in a 24-h ambulatory blood pressure monitoring (ABPM) study above a certain threshold, usually the upper normal limit. While it has been studied since the 1990s, the benefits of using this index have not been clearly demonstrated in adults. We present the first review on the associations of BPL with target organ damage (TOD) and clinical outcomes in adults, the major determinants for its role and utility in blood pressure measurement. We emphasize studies which evaluated whether BPL has added benefit to the average blood pressure indices on ABPM in predicting adverse outcomes. Methods: PubMed search for all English language papers mentioning ABPM and BPL. Results: While multiple studies assessed this question, the cumulative sample size is small. Whereas the associations of BPL with various TODs are evident, the available literature fails to demonstrate a clear and consistent added value for the BPL over the average blood pressure indices. Conclusions: There is a need for prospective studies evaluating the role of BPL in blood pressure measurement. The current literature does not provide sound support for the use of BPL in clinical decisions. Full article
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15 pages, 1780 KiB  
Review
Interpretation of Ambulatory Blood Pressure Monitoring for Risk Stratification in Hypertensive Patients: The ‘Ambulatory Does Prediction Valid (ADPV)’ Approach
by Fabio Angeli, Gianpaolo Reboldi, Francesco Giuseppe Solano, Antonietta Prosciutto, Antonella Paolini, Martina Zappa, Claudia Bartolini, Andrea Santucci, Stefano Coiro and Paolo Verdecchia
Diagnostics 2023, 13(9), 1601; https://doi.org/10.3390/diagnostics13091601 - 30 Apr 2023
Viewed by 2446
Abstract
Several outcome-based prospective investigations have provided solid data which support the prognostic value of 24 h ambulatory blood pressure over and beyond cardiovascular traditional risk factors. Average 24 h, daytime, and nighttime blood pressures are the principal components of the ambulatory blood pressure [...] Read more.
Several outcome-based prospective investigations have provided solid data which support the prognostic value of 24 h ambulatory blood pressure over and beyond cardiovascular traditional risk factors. Average 24 h, daytime, and nighttime blood pressures are the principal components of the ambulatory blood pressure profile that have improved cardiovascular risk stratification beyond traditional risk factors. Furthermore, several additional ambulatory blood pressure measures have been investigated. The correct interpretation in clinical practice of ambulatory blood pressure monitoring needs a standardization of methods. Several algorithms for its clinical use have been proposed. Implementation of the results of ambulatory blood pressure monitoring in the management of individual subjects with the aim of improving risk stratification is challenging. We suggest that clinicians should focus attention on ambulatory blood pressure components which have been proven to act as the main independent predictors of outcome (average 24 h, daytime, and nighttime blood pressure, pulse pressure, dipping status, BP variability). Full article
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12 pages, 724 KiB  
Review
Ambulatory Blood Pressure Monitoring for Diagnosis and Management of Hypertension in Pregnant Women
by Walter G. Espeche and Martin R. Salazar
Diagnostics 2023, 13(8), 1457; https://doi.org/10.3390/diagnostics13081457 - 18 Apr 2023
Viewed by 1596
Abstract
Hypertension disorders during pregnancy has a wide range of severities, from a mild clinical condition to a life-threatening one. Currently, office BP is still the main method for the diagnosis of hypertension during pregnancy. Despite of the limitation these measurements, in clinical practice [...] Read more.
Hypertension disorders during pregnancy has a wide range of severities, from a mild clinical condition to a life-threatening one. Currently, office BP is still the main method for the diagnosis of hypertension during pregnancy. Despite of the limitation these measurements, in clinical practice office BP of 140/90 mmHg cut point is used to simplify diagnosis and treatment decisions. The out-of-office BP evaluations are it comes to discarding white-coat hypertension with little utility in practice to rule out masked hypertension and nocturnal hypertension. In this revision, we analyzed the current evidence of the role of ABPM in diagnosing and managing pregnant women. ABPM has a defined role in the evaluation of BP levels in pregnant women, being appropriate performing an ABPM to classification of HDP before 20 weeks of gestation and second ABMP performed between 20–30 weeks of gestation to detected of women with a high risk of development of PE. Furthermore, we propose to, discarding white-coat hypertension and detecting masked chronic hypertension in pregnant women with office BP > 125/75 mmHg. Finally, in women who had PE, a third ABPM in the post-partum period could identify those with higher long-term cardiovascular risk related with masked hypertension. Full article
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Other

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13 pages, 2157 KiB  
Systematic Review
Masked Hypertension and Exaggerated Blood Pressure Response to Exercise: A Review and Meta-Analysis
by Cesare Cuspidi, Elisa Gherbesi, Andrea Faggiano, Carla Sala, Stefano Carugo, Guido Grassi and Marijana Tadic
Diagnostics 2023, 13(6), 1005; https://doi.org/10.3390/diagnostics13061005 - 07 Mar 2023
Cited by 1 | Viewed by 1389
Abstract
Aim: Whether exaggerated blood pressure response (EBPR) to exercise represents a marker of masked hypertension (MH) in individuals with no prior history of hypertension is still unclear. We investigated this issue through a review and a meta-analysis of studies providing data on this [...] Read more.
Aim: Whether exaggerated blood pressure response (EBPR) to exercise represents a marker of masked hypertension (MH) in individuals with no prior history of hypertension is still unclear. We investigated this issue through a review and a meta-analysis of studies providing data on this association in normotensive individuals undergone both to dynamic or static exercise and to 24 h blood pressure monitoring (ABPM). Design: A systematic search was performed using Pub-Med, OVID, EMBASE, and Cochrane library databases from inception up to 31 December 2022. Studies were identified by using the following search terms: “masked hypertension”, “out-of-office hypertension”, “exercise blood pressure”, “exaggerated blood pressure exercise”, “exercise hypertension”. Results: Nine studies including a total of 387 participants with MH and 406 true normotensive controls were considered. Systolic BP (SBP) and diastolic BP (DBP) at rest were significantly higher in MH individuals than in sustained normotensives: 126.4 ± 1.4/78.5 ± 1.8 versus 124.0 ± 1.4/76.3 ± 1.3 mmHg (SMD: 0.21 ± 0.08, CI: 0.06–0.37, p = 0.007 for SBP; 0.24 ± 0.07, CI: 0.08–0.39, p = 0.002 for DBP). The same was true for BP values at peak exercise: 190.0 ± 9.5/96.8 ± 3.7 versus 173.3 ± 11.0/88.5 ± 1.8 mmHg (SMD 1.02 ± 0.32, CI: 0.39–1.65, p = 0.002 for SBP and 0.97 ± 0.25, CI: 0.47–1.96, p < 0.0001 for DBP). The likelihood of having an EBPR was significantly greater in MH than in their normotensive counterparts (OR: 3.33, CI: 1.83–6.03, p < 0.0001). Conclusions: Our meta-analysis suggests that EBPR reflects an increased risk of MH and that BP measurement during physical exercise aimed to assess cardiovascular health may unmask the presence of MH. This underscores the importance of BP measured in the medical setting at rest and in dynamic conditions in order to identify individuals at high cardiovascular risk due to unrecognized hypertension. Full article
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