Page 2 - hypertension_newsletter (5)
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REFLECTIONS rtensio n
Hypertension Global Newsletter #2 Hype
Hypen oisnetr
This update considers new evidence, including a recent
statement by the American Heart Association, as well as New Indications for the Clinical Application of HBPM
technological developments which have occurred in the past 20
years. Key differences from the previous position statements • Re-definition of diagnostic thresholds for hypertension:
published in 2008–2010 include information on the devices HBP at least 135/85 mmHg corresponds to at least 140/90
themselves (e.g., cuff size, cuffless devices, validated, and mmHg clinic BP in ESC-ESH guidelines), whereas HBP
preferred devices, clinical validation protocols), monitoring at least 130/80 mmHg may correspond to at least 130/80
schedule and interpretation, diagnostic thresholds, therapeutic mmHg clinic BP threshold for grade I hypertension in ACC/
targets, specific patient populations (e.g., children, pregnancy, AHA guidelines
CKD on dialysis, and arrhythmias), nocturnal HPBM and home
BP variability. • Therapeutic targets: Systolic HBP between 125–130
mmHg and diastolic HBP less than 80 mmHg are now
HBPM has several potential advantages over both OBP and considered reasonable goals. Such targets do not apply in
ABPM, including user convenience and acceptance, and the the very elderly where higher systolic HBP values might be
ability to obtain multiple measurements over several days, considered for SBP
weeks, or months.
• Recent technologies have now made nocturnal HBPM
feasible. Studies are needed to explore where nocturnal
HBPM can improve the prognostic stratification of patients
with hypertension
Comparison of Clinical Advantages and Disadvantages of HBPM vs. ABPM
ABPM HBPM
Advantages Advantages
• Can identify white-coat and masked hypertension • Can identify white-coat and masked hypertension
• Stronger prognostic evidence
• Night-time readings • Cheap and widely available
• Measurement in real-life settings
• Additional prognostic BP phenotypes • Patient engagement in BP evaluation, which improves
• Abundant information from a single measurement session, compliance with treatment and BP control
including short-term BP variabilit • Easily repeated and used over longer periods to assess day-
to-day BP variability
• Preferred to ABPM by most patients, particularly for repeated use
Disadvantages Disadvantages
• Expensive and sometimes limited availability • Only BP at home and at rest is evaluated
• Can be uncomfortable, particularly at night • Potential for measurement and reporting errors
• Cannot be repeated too frequently • Many HBPM devices on the market have not been validated
• No nocturnal readings (with most devices)
• HBPM may lead to excessive anxiety about BP levels
CLINICAL PEARLS FROM THE FACULTY Compared with the last 2008–2010 position papers, there has
WATCH been a considerable increase in the number of articles published
PROF. ADRIANA CAMARGO in the field of HBPM with clarifications on the use of HBPM in
DISCUSS HER THOUGHTS ON THE clinical practice and research. Additional evidence is still needed
CLINICAL APPLICATION OF HBPM from population studies and randomized trials to determine if
hypertension management based on HBPM leads to better
outcomes than hypertension management guided by OBP.
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