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Original Article

Value of Ambulatory Blood Pressure Monitoring in Evaluation of Blood Pressure Control in Patients on Antihypertensive Treatment

Volume 1, Jul 2012

Manish Bansal, MD, DNB, Ravi R Kasliwal, MD, DM, Rahul Mehrotra, MD, DNB, Arun Rawat, MSc, Naresh Trehan, MD, Gurgaon, Haryana, India

Background: The conventional method of single, office measurement of blood pressure (BP) may not be accurate for assessing the adequacy of BP control,
which is vital to reduce morbidity and mortality associated with hypertension. Ambulatory blood pressure (ABP) monitoring, by allowing prolonged BP monitoring, may provide incremental information for this purpose.
Methods: In this retrospective study, ABP monitoring records of 158 consecutive hypertensive subjects on antihypertensive treatment were analyzed and correlated
with office BP recordings.
Results: The mean age of the subjects was 50.5 ± 16.1 years and 74.7% were males. Of the 158 subjects, 62 (39.2%) had “controlled office BP” (BP <140/90
mmHg) and the remaining 96 (60.8%) had “uncontrolled office BP” (BP > 140/90 mmHg). Overall, ABP monitoring was performed for an average of 25.7 ± 7.3 h, which
included 15.7 ± 4.5 h of day-time recording and 9.9 ± 3.1 h of night-time recording. As compared to the patients with uncontrolled office BP, those with controlled
office BP had lower 24-h BP, day-time BP, night-time BP, and the overall BP load. However, despite apparently controlled office BP, a significant proportion of these
patients (24.2%) had increased 24-h average ABP and 58.1% patients had at least 40% day-time BP values above the normal range. Similarly, 10.4% patients with
uncontrolled office BP actually had normal 24-h average BP and normal BP load (<40% day-time BP values above the normal range). In addition, patients with
controlled office BP had less marked nocturnal fall in BP with nearly half of the subjects showing inadequate fall or even paradoxical increase in diastolic BP during
night-time as compared to only 26% of those with uncontrolled office BP (p value= 0.014).
Conclusions: Although, compared to the patients with uncontrolled office BP, those with controlled office BP had lower BP readings on ABP monitoring, a
substantial proportion of them still had uncontrolled 24-h BP and elevated overall BP load. In addition, the physiological, nocturnal drop in BP was blunted or even
reversed in these patients. The ABP monitoring could potentially alter treatment in almost one-fourth of all patients. (J Clin Prev Cardiol 2012;1(3):101-7)
 Key Words: BP load; dipper; nondipper.

Volume 1, Number 3, Pages: 101-7

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