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Doctors newspaper online, 15.08.2019
Monitoring in Comparison
What is the most reliable method of blood pressure measurement to predict the risk of cardiovascular events and death of a patient? Two measurements performed best in a recent study.
By Joana Schmidt
Blood Pressure Monitoring: The 24 Hour Measurement and the Nocturnal
Measurement provided the most accurate risk predictions.
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American researchers compared different methods of blood pressure measurement. They studied the association of mortality rates and cardiovascular events with the type of blood pressure monitoring over almost 14 years. Nocturnal measurements and ambulatory blood pressure measurement over 24 hours (ABPM) appeared to have the best predictive value ( JAMA 2019; 322: 409-420 ).
ABPM procedure controversial
According to study author Dr. Jan Staessen of the University of Leuven in Belgium, the ABPN procedure should be used more often to measure blood pressure. Dr. Philip Greenland of Northwestern University in Chicago, on the other hand, is more cautious on the results in his accompanying commentary. There are strong correlations between all measurement methods, whether they are performed on an outpatient basis or in the doctor's office ( JAMA. 2019; 322: 420-421 ).
It is not surprising that the outpatient method improves the risk prediction, because the more measured data available, the more accurate the prognosis of the patient could be. The result does not necessarily mean that ABPM should be used on a larger scale.
The researchers around Dr. Wen-Yi Yang University of Leuven use data from the international database for ambulatory blood pressure measurement in correlation to cardiovascular events (IDACO). Their analysis included 13 cohorts with more than 11,000 participants.
On average, they were 54.7 years old, 49.3 percent were women. 43.7 percent had hypertension (limit: 140/90 mm Hg), 46.5 percent of whom took antihypertensive medication.
Nocturnal and ambulatory measurements were most accurate
The working group investigated the association between different blood pressure measurement methods such as conventional and automated measurements in the doctor's office, outpatient for 24 hours, day and night, with mortality rates and cardiovascular events (cardiovascular mortality, non-fatal cardiovascular events, heart failure and stroke) .
Both endpoints were most associated with increased blood pressure in both night and 24-hour measurements. For every 20/10 mm Hg increase in blood pressure measured at night, the risk of mortality increased by 23 percent and the risk of cardiovascular events by 36 percent.
The authors consider outpatient blood pressure monitoring to be the optimal method that allows for more accurate risk stratification in patients with or without suspected hypertension compared to blood pressure measurement in the doctor's office. Especially the nocturnal measurements are efficient, because the values are not affected by physical activity or nutrition of the patients.
Further information from cardiology under www.kardiologie.org
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