The clinical role of daily blood pressure monitoring for the management of patients at the ambulatory stage
DOI:
https://doi.org/10.14739/mmt.2025.2.324147Keywords:
hypertension, ambulatory blood pressure monitoring, ambulatory blood pressure system, white coat hypertension, masked hypertensionAbstract
The aim of the work is to analyze and evaluate the clinical role of daily blood pressure monitoring for the management of patients with arterial hypertension.
Materials and methods. We analyzed the scientometric databases Scopus, Web of Science, PubMed and conducted a retrospective analysis of literature sources for 2019–2024. The most relevant sources on this topic were selected for analysis. Based on the review of article abstracts and their full text, 29 sources were selected.
Results. Blood pressure (BP) measured by the method of ambulatory blood pressure monitoring (ABPM) provides prognostic information about cardiovascular disease to a greater extent than “office blood pressure” and is more associated with predicting cardiovascular risk. The most clinically important are 24-hour and nighttime BP levels, while other BP indices, in addition to 24-hour and nighttime BP levels, contribute little to risk stratification or treatment of hypertension. ABPM provides a more physiologically accurate measurement of “true” blood pressure and its changes during the day. In most cases, values are considered normal if the 24-hour average BP is 130/80 mm Hg or less, daytime BP is 135/85 mm Hg or less, or nighttime BP is 120/70 mm Hg or less. The European guidelines for the treatment of hypertension support the use of out-of-office BP measurements to confirm the diagnosis of hypertension and to identify hypertension phenotypes such as “white coat” hypertension and masked hypertension. White-coat hypertension is associated with an increased long-term risk of persistent hypertension and mortality, so patients at high risk of cardiovascular disease should be treated with pharmacological therapy along with nonpharmacological approaches. Masked hypertension carries a risk, adjusted for many factors, almost equivalent to resistant hypertension. There are 3 subtypes: masked effect, masked hypertension, and masked uncontrolled hypertension. It is advisable to consider pharmacologic treatment in patients with masked hypertension after treating risk factors such as obesity, diabetes, alcohol consumption, smoking, and stress.
Conclusions. The main contribution of ABPM to the diagnosis and treatment of hypertension is the cross-classification between office and ambulatory BP measurement. Current data suggest that 24-hour ABPM should be an integral part of the management of patients with hypertension.
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