Role of Ambulatory Blood Pressure Monitoring in Resistant Hypertension
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THERAPEUTIC TRIALS (G MANCIA, SECTION EDITOR)
Role of Ambulatory Blood Pressure Monitoring in Resistant Hypertension Guido Grassi & Michele Bombelli & Gino Seravalle & Gianmaria Brambilla & Raffaella Dell’Oro & Giuseppe Mancia
Published online: 14 April 2013 # Springer Science+Business Media New York 2013
Abstract Ambulatory blood pressure monitoring has gained growing popularity in the diagnosis and treatment of essential hypertension for several reasons, such as the lack of the so-called white-coat effect, the greater reproducibility as compared with clinic blood pressure, the ability to provide information on blood pressure phenomena of prognostic value and the closer relationship with the risk of cardiovascular morbidity and mortality. All the abovementioned main features of ambulatory blood pressure monitoring are also true for resistant hypertension. In addition, however, in resistant hypertension, blood pressure monitoring allows one to precisely define the diagnosis of this clinical condition, by excluding the presence of white-coat hypertension, which is responsible for a consistent number of “false” resistant hypertensive cases. The approach also allows one to define the patterns of blood pressure variability in this clinical condition, as well as its relationships with target organ damage. Finally, it allows one to assess the effects of therapeutic interventions, such as renal nerves ablation, aimed at improving blood pressure control in this hypertensive state. The present paper will critically review the main features of ambulatory blood pressure monitoring in resistant hypertension, with particular emphasis on the diagnosis and treatment of this high-risk hypertensive state. Keywords Ambulatory blood pressure monitoring . ABPM . Blood pressure variability . Renal denervation . G. Grassi (*) : M. Bombelli : G. Seravalle : G. Brambilla : R. Dell’Oro : G. Mancia Clinica Medica, Dipartimento di Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Università Milano-Bicocca, Ospedale San Gerardo, Via Pergolesi, 33, 20052, Monza, Milan, Italy e-mail: [email protected] G. Grassi IRCCS Multimedica, Sesto San Giovanni, Milan, Italy
White coat hypertension . Organ damage . Resistant hypertension
Introduction During the past 20 years, use of ambulatory and home blood pressure monitoring has allowed one to gain a large amount of important information on the behavior of blood pressure profile over the 24-hour period, as well as on the main features of the blood pressure load to the heart during the daytime, nighttime or morning hours [1–4]. Additionally, it has also allowed one to determine the superiority of ambulatory blood pressure values as compared to clinic blood pressure in 1) reflecting the hypertension-related organ damage and its modifications induced by antihypertensive drug treatment; 2) predicting the development and progression of end-organ damage as well as the occurrence of cardiovascular events both in treated and untreated hypertensive patients; and 3) monitoring the blood pressure-low
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