European Heart Journal (1992) 13 {Supplement G), 43-47
Ambulatory blood pressure monitoring and antihypertensive treatment G. MANCIA, C. GIANNATTASIO AND S. OMBONI
Cattedra di Medicina Interna, Ospedale S. Gerardo Monza, Universita di Milano; Centro di Fisiologia Clinica e Ipertensione, Ospedale Maggiore, Milano; Centro Auxologico Italiano, Milano, Italy KEY WORDS: Ambulatory blood pressure monitoring, hypertension, antihypertensive drugs.
Introduction Ambulatory blood pressure monitoring (ABPM) represents a major tool for investigating normal and deranged mechanisms of cardiovascular control, particularly if computerized analysis of beat-to-beat blood pressure and heart rate recordings is employed. It may also offer useful information for the diagnosis of essential and secondary hypertension, although it should by no means be routinely used for this purpose'11. A further application of this approach is in thefieldof antihypertensive treatment. This paper will examine this third issue, with particular reference to the effect of diuretic treatment on 24 h blood pressure.
Automatic cuff inflation
-
ABPI
0 2OO
mmmmm
0 90 HR ~
—j*-
• * /
30
Semi-automatic cuff inflation
ABPM and evaluation of antihypertensive treatment „
ABPM is useful in the evaluation of antihypertensive treatment because it helps to determine whether treatment lowers blood pressure in daily life and whether hypotensive episodes occur which may lead to vital organ ischaemia'21. In addition, there is evidence that the end organ damage of hypertension bears a closer relationship with 24 h blood pressure mean than with office blood pressure. In subjects in whom elevated office blood pressures are accompanied by low 24 h blood pressure values, no organ abnormalities related to hypertension are apparent'3' and this possibly implies a benign prognosis'41. Thus ABPM may spare unnecessary treatment in a number of individuals labelled as hypertensive by conventional blood pressure measurements. It may also provide clinically important information as to the treatment-related achievement of blood pressure values more thoroughly protective for the patient. However, this needs a few important caveats. First, because the profile of normal ambulatory blood pressure
-_ 150
MAP"
-•
MAP~
ABP|
'
~ _
, — ^ ^
— 150 c
*v^
0 200
wmmm
0 90 HR r"
o Cuff inflation- 30 Contro 0 i
-i
0
GO
1 min
Figure I Original tracing showing brachial artery blood pressure and heart rate in a subject in whom a non-invasive blood pressure monitoring device was applied on the contralateral arm. Note that neither before nor after the beginning of the cuff inflation (arrow) did blood pressure and heart rate increase. This occurred both when inflation was triggered automatically (upper panel) and when it was started by the patient's command, i.e. semi-automatically (lower arterial pressure; Correspondence: Professor Giuseppe Mancia, Centro Fisiologia Clinica e panel). ABP = arterial blood pressure; MAP = mean HR = heart rate. (Reproduced with permission191). Ipertensione, Via F. Sforza 35 — 20122 Milano, Italy. 0I95-668X/92/0GOO43 + 05 $08.00/0
© 1992 The European Society of Cardiology
Downloaded from http://eurheartj.oxfordjournals.org/ by guest on June 6, 2016
This paper outlines the advantages of ambulatory blood pressure monitoring (ABPM) in the evaluation of the efficacy of antihypertensive drugs. The main advantage is that ABPM allows the antihypertensive effect of a drug or drug regimen to be determined in daily life conditions and to uncover whether the treatment employed is associated with untoward hypotensive episodes. Furthermore, ABPM facilitates the design ofstudies on antihypertensive drug efficacy because the 24 h mean blood pressure is devoid of a placebo effect and its reproducibility is much greater than office blood pressure. This has permitted demonstration of the efficacy of several antihypertensive drug regimens, including diuretic studies, based on relatively small numbers ofsubjects. A further advantage of ABPM is that it allows drug treatment efficacy to be evaluated in relation to blood pressure variability, another possible determinant of the organ damage related to hypertension.
44 G. Mancia eta\.
Automatic cuff inflation n = l
Semi-automatic cuff inflation n = 20
160 „
140
CP
I
|
120
CD
3
100
•o
80
CD
60
8
H+H
IIIIIIIIIM i n IH-H-}D
40 _ 7
80
I
70
o
Ambulatory blood pressure monitoring and antihypertensive treatment G. MANCIA, C. GIANNATTASIO AND S. OMBONI
Cattedra di Medicina Interna, Ospedale S. Gerardo Monza, Universita di Milano; Centro di Fisiologia Clinica e Ipertensione, Ospedale Maggiore, Milano; Centro Auxologico Italiano, Milano, Italy KEY WORDS: Ambulatory blood pressure monitoring, hypertension, antihypertensive drugs.
Introduction Ambulatory blood pressure monitoring (ABPM) represents a major tool for investigating normal and deranged mechanisms of cardiovascular control, particularly if computerized analysis of beat-to-beat blood pressure and heart rate recordings is employed. It may also offer useful information for the diagnosis of essential and secondary hypertension, although it should by no means be routinely used for this purpose'11. A further application of this approach is in thefieldof antihypertensive treatment. This paper will examine this third issue, with particular reference to the effect of diuretic treatment on 24 h blood pressure.
Automatic cuff inflation
-
ABPI
0 2OO
mmmmm
0 90 HR ~
—j*-
• * /
30
Semi-automatic cuff inflation
ABPM and evaluation of antihypertensive treatment „
ABPM is useful in the evaluation of antihypertensive treatment because it helps to determine whether treatment lowers blood pressure in daily life and whether hypotensive episodes occur which may lead to vital organ ischaemia'21. In addition, there is evidence that the end organ damage of hypertension bears a closer relationship with 24 h blood pressure mean than with office blood pressure. In subjects in whom elevated office blood pressures are accompanied by low 24 h blood pressure values, no organ abnormalities related to hypertension are apparent'3' and this possibly implies a benign prognosis'41. Thus ABPM may spare unnecessary treatment in a number of individuals labelled as hypertensive by conventional blood pressure measurements. It may also provide clinically important information as to the treatment-related achievement of blood pressure values more thoroughly protective for the patient. However, this needs a few important caveats. First, because the profile of normal ambulatory blood pressure
-_ 150
MAP"
-•
MAP~
ABP|
'
~ _
, — ^ ^
— 150 c
*v^
0 200
wmmm
0 90 HR r"
o Cuff inflation- 30 Contro 0 i
-i
0
GO
1 min
Figure I Original tracing showing brachial artery blood pressure and heart rate in a subject in whom a non-invasive blood pressure monitoring device was applied on the contralateral arm. Note that neither before nor after the beginning of the cuff inflation (arrow) did blood pressure and heart rate increase. This occurred both when inflation was triggered automatically (upper panel) and when it was started by the patient's command, i.e. semi-automatically (lower arterial pressure; Correspondence: Professor Giuseppe Mancia, Centro Fisiologia Clinica e panel). ABP = arterial blood pressure; MAP = mean HR = heart rate. (Reproduced with permission191). Ipertensione, Via F. Sforza 35 — 20122 Milano, Italy. 0I95-668X/92/0GOO43 + 05 $08.00/0
© 1992 The European Society of Cardiology
Downloaded from http://eurheartj.oxfordjournals.org/ by guest on June 6, 2016
This paper outlines the advantages of ambulatory blood pressure monitoring (ABPM) in the evaluation of the efficacy of antihypertensive drugs. The main advantage is that ABPM allows the antihypertensive effect of a drug or drug regimen to be determined in daily life conditions and to uncover whether the treatment employed is associated with untoward hypotensive episodes. Furthermore, ABPM facilitates the design ofstudies on antihypertensive drug efficacy because the 24 h mean blood pressure is devoid of a placebo effect and its reproducibility is much greater than office blood pressure. This has permitted demonstration of the efficacy of several antihypertensive drug regimens, including diuretic studies, based on relatively small numbers ofsubjects. A further advantage of ABPM is that it allows drug treatment efficacy to be evaluated in relation to blood pressure variability, another possible determinant of the organ damage related to hypertension.
44 G. Mancia eta\.
Automatic cuff inflation n = l
Semi-automatic cuff inflation n = 20
160 „
140
CP
I
|
120
CD
3
100
•o
80
CD
60
8
H+H
IIIIIIIIIM i n IH-H-}D
40 _ 7
80
I
70
o
