April 18, 2018

expert reaction to study looking at blood pressure measurement method and predicting risk of heart disease

Researchers assessed 63,000 doctors’ patients, and found that measuring blood pressure using an ABPM device was 50% more accurate than the traditional way blood pressure is measured in the clinic, this study is published in the New England Journal Medicine.

Prof Anna Dominiczak FMedSci, Regius Professor of Medicine, Vice Principal and Head of College, University of Glasgow, said:

“This is a good quality study on a large number of patients and the conclusions are based on solid data.  It shows that in the Ambulatory Blood Pressure Monitoring (ABPM) over 24 hrs is a better predictor of cardiovascular mortality as compared with clinic blood pressure measurements.

“This is in line with previous small studies and confirms previous observations but with a larger numbers of patients and thus stronger evidence.  The data on masked hypertension and white coat hypertension are particularly important.

“However, it is relevant to note that this is an observational study, there was no intervention as part of this study and therefore no direct inference can be made regarding the benefit of basing treatment on the ABPM.  The authors acknowledge this in the paper.”

Prof Mark Caulfield, Co-Director of the William Harvey Research Institute and Professor of Cardiovascular Genetics, Queen Mary University of London, said:

“This important paper confirms that 24 hour ambulatory blood pressure which makes many more measurements compared to conventional clinic blood pressure is superior in defining patients risk of adverse outcome from heart disease and stroke. It also highlights that masked hypetertension, where a person has normal clinic blood pressure but in reality it is high blood pressure on ambulatory record, is associated with high risk of heart disease.  In 2011 the National Institute of Health and Clinical Excellence recommended that ambulatory blood pressure be used for diagnosis of hypertension.  The UK will now need to consider whether it should also be used routinely for monitoring alongside home monitoring.”

* ‘Relationship between Clinic and Ambulatory Blood-Pressure Measurements and Mortality’ by J.R. Banegas et al. published in the New England Journal of Medicine on Wednesday 18 April 2018.

Declared interests

Prof Anna Dominiczak: “Editor in Chief, Hypertension, the Journal of the American Heart Association and Trustee, the British Heart Foundation.”

Prof Mark Caulfield: “I was the hospital specialist on the NICE Guideline Development Group for Hypertension 2011-2017 and co-wrote the NICE Hypertension Guideline 2011.  No other conflicts.”