Circadian blood pressure profile and comparison with clinic blood pressure in patients with essential hypertension on treatment; experience from a Teaching Hospital in Sri Lanka

Background and Objectives:

Ambulatory blood pressure monitoring (ABPM) is more reflective of an individual’s Blood Pressure (BP) profile and its control, eliminating several confounding and contributory factors. The present study was intended to look at the circadian pattern of BP variation, the prognostication of patients with nocturnal BP fluctuations and to compare the clinic BP measurements over ambulatory readings in patients with essential hypertension, who are on treatment.

Methods: A Prospective study was conducted at Teaching Hospital Kandy from August 2015 to October 2015 with recruitment of 100 patients who met the inclusion criteria. It included patients who were above 18 years with stage I to III hypertension with normal renal functions and having no previous history of coronary or cerebro-vascular events. All patients underwent electrocardiograms, 2D echocardiography assessment, manual BP as well as 24-hour ABPM.

Results: There were 100 subjects with female preponderance and mean age of 61 ± 9 years. One third had uncontrolled BP according to office BP readings whereas 60% had uncontrolled BP according to ABPM. The agreement between the office BP and ABPM in diagnosing control or uncontrolled BP was low (58%, Kappa = 0.23). Significant statistical difference (p<0.001) is observed between day and night time measurements irrespective of the BP control. In the sample 70% had abnormal dipping patterns including non-dipping (45%), reverse dipping (25%) and extreme dipping (5%).

Conclusion:

ABPM is more reflective of an individual’s naïve BP pattern and its response to treatment. It captures the different types of diurnal variation of BP thus guiding the physician to treat the patient optimally. Moreover, its non-invasive and portable nature allows it to be used with ease and will gather more widespread recognition and acceptance as a more reliable diagnostic and prognostic tool in the future.