Affiliation:
1. Department of Nephrology and Hypertension, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112001, Israel
Abstract
Background: The blood pressure load (BPL) is commonly defined as the percentage of readings in a 24-h ambulatory blood pressure monitoring (ABPM) study above a certain threshold, usually the upper normal limit. While it has been studied since the 1990s, the benefits of using this index have not been clearly demonstrated in adults. We present the first review on the associations of BPL with target organ damage (TOD) and clinical outcomes in adults, the major determinants for its role and utility in blood pressure measurement. We emphasize studies which evaluated whether BPL has added benefit to the average blood pressure indices on ABPM in predicting adverse outcomes. Methods: PubMed search for all English language papers mentioning ABPM and BPL. Results: While multiple studies assessed this question, the cumulative sample size is small. Whereas the associations of BPL with various TODs are evident, the available literature fails to demonstrate a clear and consistent added value for the BPL over the average blood pressure indices. Conclusions: There is a need for prospective studies evaluating the role of BPL in blood pressure measurement. The current literature does not provide sound support for the use of BPL in clinical decisions.
Reference35 articles.
1. Blood pressure load—A better determinant of hypertension;Zachariah;Mayo Clin. Proc.,1988
2. Usefulness of ambulatory monitoring of blood pressure in assessing antihypertensive therapy;White;Am. J. Cardiol.,1989
3. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines;Whelton;Circulation,2018
4. Hypertension Canada’s 2020 Comprehensive Guidelines for the Prevention, Diagnosis, Risk Assessment, and Treatment of Hypertension in Adults and Children;Rabi;Can. J. Cardiol.,2020
5. Diagnosis and management of hypertension in adults: NICE guideline update 2019;Jones;Br. J. Gen. Pract.,2020