Impact of ambulatory blood pressure monitoring in hypertensive patients

摘要

Background: Hypertension remains the most common, readilyidentifiable, and reversible risk factor for various cardiovasculardiseases. ABPM has advantages compared to office BP andis mainly used to diagnose white coat hypertension, masked hypertension, and nocturnal hypertension which have adversecardiovascular outcomes.Aims and objectives: (1) To evaluate in diagnosed hypertensivepatients of prevalence of white coat hypertension, masked hypertension,dipping status, white coat effect, resistant hypertension,hypotensive episodes and diurnal variation of blood pressure. (2)To study co-morbidities, markers of end organ damage and efficacyof anti-hypertensive regimen.Material and methods: This is a single center prospective observationalstudy. Total of 360 hypertensive patients with predecidedinclusion and exclusion criteria were enrolled in this study andABPM was performed on them by admitting them for one day.Results: In this study, mean patient age was 53 years and majority(75.6%) were males. Mean BMI was 24.94 4.47 kg/m2. Theprevalence of white coat hypertension was 39.7% and maskedhypertension was 17.5%. In this study, 30.1% had pseudoresistant hypertension/white coat effect and 69.9% subjects hadtrue resistant hypertension. Amongst hypertensive patients ontreatment, prevalence of non-dippers was 46.7%, reverse dippers(risers) was 16.7%, and extreme dippers was 0.6%. Mean 24 haverage heart rate was 74.11 11.45. Associated co-morbiditieswere diabetes in 28.6%, ischemic heart disease in 36.9%, peripheralvascular disease in 3.1%, stroke in 3.9%, CKD in 4.4% of patients.21.7% patients had evidence of LVH in ECG and 35.6% had evidenceof LVH in echocardiogram. 12.8% subjects had albuminuria. Mostcommon group of anti-hypertensive drug was CCB in 55% ofpatients followed by Beta blockers in 51.3% and ARB in 34.4%.Conclusion: ABPM should be used in hypertensive patients todiagnose white coat hypertension, masked hypertension, drugresistant hypertension, night time dipping status of blood pressure,monitoring the efficacy of anti-hypertensive drugs, 24 h bloodpressure variability. Nocturnal hypertension (non dippers) isrelated to adverse cardiovascular outcomes and can only be measuredby ABPM or home blood pressure monitoring.