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20-11-2011 | Cardiology | Article

Type of BP measurement to predict organ damage differs according to target


Free abstract

MedWire News: The clinical significance of ambulatory blood pressure monitoring (ABP) and home blood pressure (HBP) monitoring for predicting target organ damage may differ for each target organ, an analysis suggests.

Further prospective studies that directly compare the use of ABP, HBP, and clinic blood pressure monitoring (CBP) values for predicting associated target organ damage and prognosis are necessary, say Takayoshi Ohkubo (Shiga University of Medical Science, Otsu, Japan) and colleagues.

They compared the usefulness of ABP, HBP, and CBP measurements to predict subclinical cerebrovascular disease (silent cerebrovascular lesions [SCL] and carotid atherosclerosis) in 1007 participants aged 55 years or over. Of these, 583 underwent carotid ultrasound examination to evaluate the extent of carotid atherosclerosis.

The findings, revealed in the journal Hypertension, showed that 24-hour, daytime, and nighttime ABP and HBP levels were significantly associated with the risk for subclinical cerebrovascular disease (p<0.05).

When HBP and ABP values were included in the same regression model, each of the ABP values (24-hour, daytime, and nighttime) remained a significant predictor of SCL, whereas HBP lost its predictive value.

Of the ABP values, nighttime blood pressure was the most significant predictor for SCL.

When HBP and one of the ABP values were simultaneously included in another regression model, HBP was more significantly associated with risk for carotid atherosclerosis than any of the ABP values.

In contrast, CBP had no significant association with risk for subclinical cerebrovascular disease.

"The findings of the current study suggest that the nighttime ABP value is the strongest predictor for SCLs, whereas the HBP value is the strongest predictor for carotid atherosclerosis among several ABP, HBP, and CBP values," report the authors.

"Although the clinical indications for ABP monitoring and HBP measurements may overlap, the clinical significance of each method for predicting target organ damage may differ among different target organs."

In a related commentary, editorialist Paolo Palatini (University of Padova, Italy) writes: "The choice of ABP monitoring or self (at home) monitoring is not… a question of respective diagnostic accuracy but rather one of availability of the technique, characteristics of the patients, and cost."

He concludes: "Whenever possible, it is advisable that clinic, home, and ambulatory BPs are all used for the diagnosis and management of hypertension."

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By Piriya Mahendra

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