Journal of Cardiovascular Risk

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Mancia, Giuseppe

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Traditional sphygmomanometric techniques are heavily affected by the ‘white-coat’ effect and cannot be used to assess blood pressure variability over the 24 h period. These limitations can be overcome in part using ambulatory monitoring, which (1) quantifies both the mean and the variability of blood pressure over 24 h, including blood pressure fluctuations between day and night, (2) does not trigger any alerting reaction in the patient, (3) provides reproducible 24 h blood pressure means and (4) allows the action of antihypertensive drugs to be assessed over 24 h without interference from a placebo effect. Moreover, ambulatory blood pressure values are more closely related to the end-organ damage associated with hypertension than are isolated clinic readings. However, the limited accuracy of ambulatory monitoring in ambulant individuals, the lack of normal reference values for 24 h blood pressure and the need for a longitudinal demonstration of the prognostic value of the technique do not permit the recommendation of its widespread use in clinical hypertension. Although the clinical use of ambulatory monitoring should be restricted to selected cases, there is general agreement on its usefulness in clinical pharmacology trials and in studies aimed at assessing cardiovascular regulation through the analysis of 24 h blood pressure and heart rate fluctuations.

Brunner, Hans R.

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Blood pressures measured in the physician's office often differ considerably from those recorded during everyday activities away from the medical environment. This fact is particularly important in patients whose office blood pressures are only mildly elevated because, in a large proportion of these people, the elevation is observed only when blood pressures are measured in the physician's office and not when they are measured during normal activities. There is little evidence that this ‘white-coat’ hypertension is associated with increased cardiovascular risk, but patients with the condition are prone to develop sustained hypertension over time. It is therefore advisable to monitor these individuals regularly so that antihypertensive therapy can be initiated when appropriate.

Guilleminault, Christian

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Patients with obstructive sleep apnea and other sleep-related breathing disorders that cause sleep disruption frequently present with abnormal circadian blood pressure patterns or frank hypertension. Ambulatory blood pressure monitoring has been useful in research documenting nocturnal hypertension and the normalization of blood pressure when sleep apnea is treated. In practice, similar measurements can provide a clue to the presence of an undiagnosed sleep disorder and can be valuable in following the blood pressure response to the treatment of sleep-disordered breathing.

Murphy, Michael B.

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Ethnic differences in 24 h blood pressure profiles exist, and 24 h ambulatory blood pressure monitoring shows that blacks have a higher nocturnal blood pressure associated with a small diurnal change in pressure. Studies in adolescents suggest that these diurnal differences antedate adulthood. Nocturnal blood pressure may be independently important in the pathogenesis of left ventricular hypertrophy.

White, William B.

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Ambulatory blood pressure monitoring is an accepted method of blood pressure measurement in hypertension trials. It is more reproducible than office blood pressure, does not show a placebo effect, and excludes white-coat hypertensive people, therefore offering significant advantages over office-based measurement. Investigators are aware of these advantages, and the use of ambulatory monitoring in hypertension trials is increasing.

Horowitz, John D.

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These results suggest that ST-segment depression on ambulatory electrocardiographic monitoring in asymptomatic subjects may not represent myocardial ischaemia. The use of this parameter to screen asymptomatic populations for ischaemic heart disease is therefore highly questionable.

Villa, Gianmarco

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This study confirms the strong association between fibrinogen levels and smoking and the weaker association with age and total-cholesterol levels. Mean fibrinogen level was not significantly related to blood pressure, although the distribution of fibrinogen levels appeared to be J-shaped in hypertensive men.

Ferro, José M.

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These results indicate that hypertension and smoking are both involved in the growth or rupture of cerebral aneurysms.

James, Jack E.

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Habitual consumption diminished, but did not eliminate, the pressor effects of caffeine. Considering the almost universal consumption of caffeine beverages, the persistent pressor effects of the drug could have important implications for cardiovascular health.