Hypertension is a major cause of mortality worldwide. out-of-office/clinic blood pressure (BP) measurements (ambulatory BP monitoring [ABPM] and home BP monitoring [HBPM]) are superior to office/clinic measurements for the accurate diagnosis and risk-stratification of hypertensive patients. ABPM is able to provide additional information regarding prognostically important circadian rhythm abnormalities. HBPM is the preferred choice of patients. When used in conjunction with telemonitoring, it has the potential to improve treatment compliance and overcome treatment inertia resulting in better BP control. Challenges remain in implementation of universal HBPM monitoring.
Support: The publication of this article was funded by Omron Healthcare Singapore Pte Ltd.
Hypertension has been shown to be a major cause of death worldwide.1 A clear relationship exists between hypertension (HTN) and cardiovascular (CV) events, with an increase in risk of total mortality, mortality due to heart disease, stroke, chronic kidney disease (CKD) and heart failure (HF) as well as morbidity associated with non-fatal CV disease.2 Despite there being clear demonstrable CV benefits from blood pressure (BP) reduction in large clinical trials,3-5 BP control remains poor worldwide6 and mortality due to hypertension rates are high.
BP exhibits a circadian pattern.7 BP tends to be lowest between 2 and 4am, with systolic and diastolic readings approximately 13 and 17% lower than daytime values. After 4am there is an 'early morning surgeÔÇÖ in BP readings, reaching a peak at about 6am. There is then a gradual decline towards the evening, followed by lower readings at night. The 'early morning surgeÔÇÖ is associated with an increase in CV events8,9 including acute myocardial infarction, ischaemic and haemorrhagic stroke and sudden cardiovascular death.10,11 An office/clinic BP reading only offers an instantaneous reading or snapshot of a patients BP in a day and cannot give a true reflection of BP readings throughout the day or abnormalities in the circadian rhythms.
However, in the past most clinical studies have used conventional cuff BP measurements at clinic/office visits to measure BP and still demonstrated CV outcome benefits. With better understanding of circadian BP changes, should we be looking at BP measurement away from the clinic/office in order to improve patient outcomes?
This article aims to outline the options available for clinicians in daily practice and the potential benefits of adopting out-of-office/clinic BP measurements in clinical practice with regards to accurate diagnosis of hypertension, risk stratification and how these techniques may be utilised to improve BP control and CV outcomes.
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