Cardiology Letters 2015, 24(4):251-256

Ambulatory blood pressure monitoring in relation to daily routine activities

Regecová V, Kellerová E

Ústav normálnej a patologickej fyziológie, Slovenská akadémia vied, Bratislava, Slovenská republika

Objective: The aim of this study was to quantify the impact of various factors of everyday life in children, adolescents and young adults which may distort the 24-hour profile of BP, classification of hypertension and identification of non-dipping.

Subjects and methods: ABPM was requested on clinical grounds for hypertension in 98 patients, aged 10-24 yrs, by physicians of the outpatient Department of Cardiology. Laboratory blood pressure (BP) measurements at rest and during a mental arithmetic test and 24-h ABPM were performed using oscillometric devices (OMRON resp. SUN-TECH). ABPM was recorded under normal everyday conditions, excluding vigorous physical activity. The BP reactivity caused by different daily activities was calculated as the change from baseline level, defined as the minimal 2 - hour BP average of the waking period. Diurnal and nocturnal BP was assessed by the diary method, compared to the fixed-time software. Analysis of variance was used to test the different parameters among subgroups.

Results: Based on ESH classification, using results of ABPM and casual laboratory BP, patients were divided into subgroups: hypertension (HT) 28.6%, white-coat hypertension (WHT) - 11.2%, masked hypertension (MHT) - 13.3%, high normal BP - 35% and normotensives - 12.2%. Except for normotensives and MHT, all hypertensive subgroups were characterized by high prevalence of obesity (22.2%) and overweight (20.4%). The rigid fixed-time definition of nocturnal time identified 44.8% of non-dippers. The patient´s diary method documented in 66 subjects shifts of the real sleep time by 1-5 hours and considerably decreased the percentage of non-dippers to 26.6% .The reactivity caused by daily activities significantly influenced the BP level and variability during the waking hours. Interestingly watching television significantly increased systolic BP in average by 12 mm Hg (p <0.01), close to the increase caused by studying for an exam.

Conclusions: Our study shows that using ABPM and detailed diaries it is possible to obtain information about the BP reactivity to different activities and specific situations to which the patient was exposed, and possibly use them as an argument for lifestyle changes.

Keywords: Ambulatory BP monitoring; BP reactivity; non-dipping; masked hypertension; white-coat hypertension

Published: April 1, 2015  Show citation