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Interpreting treatment-induced blood pressure reductions measured by ambulatory blood pressure monitoring

Journal of Human Hypertension volume 27, pages 715–720 (2013)Cite this article

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Abstract

It is well known that 24-h ambulatory blood pressure monitoring (ABPM) provides a more accurate picture of a patient’s blood pressure (BP) compared with clinic BP measurement. Twenty-four-hour ABPM better predicts hypertension-related risks such as end-organ damage including left ventricular hypertrophy, cardiovascular (CV) events and mortality. Threshold BP values for hypertension based on 24-h ABPM results have been established, including daytime and night-time averages. Nevertheless, the relationship between 24-h ABPM and clinic BP measurement in patients on antihypertensive therapy, and in particular how each may change in response to antihypertensive therapy, is less clear. This review will provide an overview of current knowledge on the relation between clinic BP and ambulatory BP reductions in clinical trials on antihypertensive therapies. Reduction in CV risk and its correlation with the magnitude of reduction in both clinic and ambulatory BP are explored. The most striking result is that reduction in clinic BP and ambulatory BP do not correspond in a 1:1 fashion, that is, smaller changes in 24-h ABPM correspond to significantly larger changes in clinic BP.

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Authors and Affiliations

  1. Department of Nephrology and Hypertension, University Hospital, University Erlangen/Nuremberg, Erlangen, Germany

    R E Schmieder & C Ott

  2. Complutense University, Hypertension Unit, Madrid, Spain

    L M Ruilope

  3. Kardiologie, Angiologie, und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland, Germany

    F Mahfoud & M Böhm

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  1. R E Schmieder
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  2. L M Ruilope
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  4. F Mahfoud
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  5. M Böhm
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Correspondence to R E Schmieder.

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Competing interests

RES has received grants from the University, advisory and speaker honorarium from Astra-Zeneca, Berlin Chemie, Boerhinger Ingelheim, Bristol-Myers Squibb, Daiichi-Sankyo, Medtronic, Novartis, Servier and Takeda. LR has been advisor/speaker for Astra-Zeneca, Bayer, Boehringer-Ingelheim BMS, Daiichi-Sankyo, GSK, Menarini, Medtronic, Novartis, Servier and Takeda. CO was supported by Deutsche Hochdruckliga. FM has received grants from the University, advisory and speaker honorarium from Berlin Chemie, Boerhinger Ingelheim, Medtronic, Novartis, ReCor, St Jude Medical, Takeda, and Vessix. FM was supported by Deutsche Hochdruckliga, Deutsche Gesellschaft für Kardiologie und Deutsche Forschungsgemeinschaft (KFO 196). MB was supported by the Deutsche Forschungsgemeinschaft. Grant and research support was provided by Medtronic, St Jude Medical, Boehringer-Ingelheim, Bayer, Pfizer, Novartis. No other relationships or activities that could appear to have influenced the submitted work.

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Schmieder, R., Ruilope, L., Ott, C. et al. Interpreting treatment-induced blood pressure reductions measured by ambulatory blood pressure monitoring. J Hum Hypertens 27, 715–720 (2013). https://doi.org/10.1038/jhh.2013.39

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