PubMed · 16981521
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Osamu Tochikubo. 2006. [Development of micro-ABPM device].. https://pubmed.ncbi.nlm.nih.gov/16981521/
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In the past 30 years or so, the introduction of 24-h ambulatory blood pressure monitoring (ABPM) has enabled a more comprehensive estimate of a patient's true blood pressure (BP) and its changes. Although this tool has been used in the general population for the diagnosis of white coat hypertension, its role in the clinical management of patients with chronic and end-stage kidney disease is less well defined. In patients with kidney disease, routine clinic and dialysis center BP measurements may be poor indicators of BP control. Loss of the normal nocturnal decline in BP is also common. Moreover, there is increasing evidence that this loss, which ABPM alone can detect, is associated with poor renal and cardiovascular outcomes. To slow the progression of renal disease and lessen cardiovascular morbidity and mortality in patients with kidney disease, tight BP control is needed. However, the traditional methods of measuring BP intermittently in the medical setting may fail to provide an accurate picture of BP load. Ambulatory or some form of home BP monitoring should be more widely adopted in patients with chronic and end-stage renal disease.
A patient has masked hypertension when his office blood pressure is less than 140/90 mmHg but his ambulatory or home blood pressure readings are in the hypertensive range. Several recent studies have demonstrated that cardiovascular risk is similar between those with masked hypertension and those with sustained hypertension. The prevalence of masked hypertension in Canada is not known, but data from other countries suggest rates greater than 8%. Physicians need to use careful clinical judgment to identify and treat subjects with masked hypertension. The present review discusses masked hypertension, its importance to clinical practice and some aspects of patient management.
INTRODUCTION: There are no existing studies that appraise cardiovascular morbidity-mortality in patients diagnosed with isolated clinical hypertension (HCA) through self-measurement of blood pressure (AMPA). OBJECTIVE: To find the prognostic value of AMPA for diagnosing HCA, by means of assessment of cardiovascular morbidity-mortality in clinical and out-patient measurement (MAPA) of blood pressure. METHOD: Prospective study with 3 cohorts: 1) hypertense patients; 2) patients with HCA, and 3) patients with normal blood pressure. All patients seen at 14 primary care centres with newly diagnosed essential hypertension will be included. AMPA will distinguish who has HCA. One in every four patients will have a MAPA. In parallel, a cohort of people with normal pressure will be selected. The follow-up period will be 3 years. We calculate that the sample needed will be 1400 people. The main measurements will be the prevalence of lesions in the target organ and mortality due to cardiovascular disease in the 3 cohorts. The prevalence of HCA will also be worked out. DISCUSSION: If the AMPA technique is shown to be as valid as MAPA, then it can be used to diagnose HCA, which would be beneficial because of its accessibility, lower cost and greater comfort for patients.