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Ambulatory BP Monitoring in Clinical Practice

Ambulatory BP Monitoring in Clinical Practice. William B. White, MD Professor of Medicine Chief, Hypertension and Clinical Pharmacology Pat and Jim Calhoun Cardiology Center University of Connecticut School of Medicine Farmington, Connecticut. ABPM Provides Detailed Reports.

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Ambulatory BP Monitoring in Clinical Practice

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  1. Ambulatory BP Monitoring in Clinical Practice William B. White, MD Professor of Medicine Chief, Hypertension and Clinical Pharmacology Pat and Jim Calhoun Cardiology Center University of Connecticut School of Medicine Farmington, Connecticut

  2. ABPM Provides Detailed Reports Example of ABPM results provided by SunTech Medical, Inc. Research Triangle Park, NC. ABPM=ambulatory blood pressure monitoring.

  3. Suggested Values for the Upper Limit of Normal Ambulatory Pressure Pickering TG, et al. Hypertension. 2005;45:142-161.

  4. The Case of the White-Coat Effect • 65-year-old woman on hydrochlorothiazide, amlodipine, and lisinopril has 3 seated office BPs averaging 162/88 mm Hg • Self-monitored BPs averaged 126/84 mm Hg during a 2-week period using an Omron 714 automated device • Physical and laboratory exam: mild arteriolar narrowing,+S4, otherwise normal; renal function, urinalysis, and electrocardiogram are normal • 24-hour ABP results: • 24-hour mean: 118/74 mm Hg • Awake mean: 129/81 mm Hg • Sleep mean: 110/68 mm Hg • How do we manage this type of patient?

  5. The Case of Masked Hypertension in an Older Man • 73-year-old man with office BP of 134/74 mm Hg at his 1:00 PM checkup on hydrochlorothiazide, valsartan, and nifedipine GITS • Self-monitored BPs were 180-190/100 mm Hg in the morning and 140-150/80-90 mm Hg in the afternoon • Physical and laboratory exam: obese, arteriolar narrowing and nicking, +S4, trace peripheral edema; normal renal function and urinalysis; ECG shows tall R waves in V4-6 with no ST-T changes • 24-hour ABP results: • 24-hour mean: 140/88 mm Hg • Awake mean: 144/92 mm Hg • Nighttime mean: 130/84 mm Hg • For hours 18-24: 166/102 mm Hg • What is the appropriate management plan for this patient? GITS=gastrointestinal therapeutic system.

  6. Use of ABP in Hypertension Management Office BP >140/90 mm Hg in low-risk patients (no target-organ disease) >130/80 mm Hg in high-risk patients (target-organ disease, diabetes) Self-monitored* BP <135/85 mm Hg Self-monitored BP 135/85 mm Hg Perform ABP monitoring 24-h BP <130/80 mm Hg 24-h BP 130/80 mm Hg Initiate antihypertensive therapy Follow up with nondrug therapy for 6-12 months. Repeat ABP measurement every 1- 2 years T R E A T E D 24-h BP <130/80 mm Hg 24-h BP 130/80 mm Hg Maintain present therapy. Follow up with ABP every 1-2 years Change antihypertensive therapy to improve control *Self-monitoring should include at least 1 week of recording by patient twice daily at home, in the work environment, or both. Follow up with ABP every 1-2 years White WB. N Engl J Med. 2003;348:2377-2378.

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