The hemodynamic burden imposed on the arterial walls by BP varies significantly from daytime (awake) to nocturnal (asleep) levels, but to a different extent in individual patients. There is no other practical way to estimate the total pro-atherogenic impact of BP in a given individual than to perform ambulatory blood pressure monitoring (ABPM) throughout the entire day and night. Medicine is full of similar situations, so that nobody would seriously assess melatonin or growth hormone function —just to make a couple of examples— by measuring only their daytime plasma levels. Believe it or not, most of the current international guidelines, including the European and the American ones, still do not recommend the routine use of ABPM in clinical practice, which makes routine users appear as some kind of poachers. At least one large, prospective, clinical trial has already demonstrated that an antihypertensive treatment guided by routine use of ABPM and aimed to preserve or restore the physiologic nocturnal fall of BP by selecting appropriate times of drug administration, is able to significantly reduce CV morbidity and mortality. Not only are the findings of that study a serious challenge to a number of current clinical concepts and therapeutic recommendations, but an increasing number of scientific evidence already available in the international literature strongly indicates that reliance upon static daytime diagnostic BP thresholds based solely on occasional office cuff assessment clearly necessitates urgent reconsideration. It is like being poachers killing elephants to get their hair while discarding all the rest, ivory tusks included! We need to stop this unwise attitude and start taking advantage of all ABPM-derived information to further improve the clinical management of arterial hypertension.
Ambulatory blood pressure monitoring: killing the elephant to get its hair? No more, please!
PORTALUPPI, Francesco;
2013
Abstract
The hemodynamic burden imposed on the arterial walls by BP varies significantly from daytime (awake) to nocturnal (asleep) levels, but to a different extent in individual patients. There is no other practical way to estimate the total pro-atherogenic impact of BP in a given individual than to perform ambulatory blood pressure monitoring (ABPM) throughout the entire day and night. Medicine is full of similar situations, so that nobody would seriously assess melatonin or growth hormone function —just to make a couple of examples— by measuring only their daytime plasma levels. Believe it or not, most of the current international guidelines, including the European and the American ones, still do not recommend the routine use of ABPM in clinical practice, which makes routine users appear as some kind of poachers. At least one large, prospective, clinical trial has already demonstrated that an antihypertensive treatment guided by routine use of ABPM and aimed to preserve or restore the physiologic nocturnal fall of BP by selecting appropriate times of drug administration, is able to significantly reduce CV morbidity and mortality. Not only are the findings of that study a serious challenge to a number of current clinical concepts and therapeutic recommendations, but an increasing number of scientific evidence already available in the international literature strongly indicates that reliance upon static daytime diagnostic BP thresholds based solely on occasional office cuff assessment clearly necessitates urgent reconsideration. It is like being poachers killing elephants to get their hair while discarding all the rest, ivory tusks included! We need to stop this unwise attitude and start taking advantage of all ABPM-derived information to further improve the clinical management of arterial hypertension.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
