LETTER

TO

THE

EDITOR

Ambulatory Blood Pressure Measurement Provides True and Prognostic Information on Blood Pressure Variability in Hypertensive Patients Dear Editor: We read the article “Ambulatory Blood Pressure Monitoring to Assess the White-Coat Effect in an Elderly East African Population” written by Ivy and colleagues1 with great interest. They aimed to investigate the influence of the white-coat effect (WCE) on conventional blood pressure (BP) measurement (CBPM)– recorded hypertension rates in a cohort of elderly people living in rural Tanzania and found a significant difference between mean CBPM and ambulatory blood pressure monitoring (ABPM) readings in their study cohort. Thanks to the authors for their contributions to their country’s people. The results of studies investigating the effects of WCE on CBPM in elderly people living in rural Tanzania may be insufficient. BP is not a constant and during mental and physical activity and sleep, BP changes from moment to moment in response to autonomic, humoral, mechanical, myogenic, and environmental stimuli.2 BP measurement may be affected by several factors such as smoking, temperature, emotional stress, and environmental stimuli. In order to investigate the effects of these factors on BP levels, BP variability is a good tool obtained by visit-to-visit or ambulatory monitoring. ABPM not only provides information on BP level but also on the diurnal changes in BP. Both daytime and nighttime BP consistently predicted the composite endpoint of all cardiovascular events.3–5 Twenty-four–hour ABPM is the best way of excluding white-coat hypertension in laboring patients with higher BP measurements in the doctor’s office. It is also wellknown that 24-hour BP is superior to only one BP measurement in the association of target organ damage and in the prediction of future cardiovascular events and mortality.6,7 It is also currently recommended by the latest guidelines of the European Society of Hypertension.8 Through 24-hour BP monitoring, BP variability can be derived and provide significant prognostic information, independent of mean BP. Some parameters are often used for BP variability such as standard deviation day-night and 24-hour, coefficient of variation,

doi: 10.1111/jch.12585

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The Journal of Clinical Hypertension

Vol 17 | No 10 | October 2015

variability independent of the mean, and average real variability derived from ABPM. In conclusion, the subject is important for firstly diagnosed hypertension. It would be useful in evaluating the BP variability parameters derived from both ABPM records and visit-to-visit BP measurements in the present study. Disclosures: There is no conflict of interests.

Cengiz Ozturk, MD;1 Serdar Sadir, MD;2 Ahmet Ozturk, MD;3 Mustafa Aparci, MD4 1 Department of Cardiology, Gulhane Medical Faculty, Ankara, Turkey; 2Department of Physiology, Gulhane Medical Faculty, Ankara, Turkey; 3Department of Geriatric Medicine, Gulhane Medical Faculty, Ankara, Turkey; 4Department of Cardiology, Kasimpasa Military Hospital, Istanbul, Turkey References 1. Ivy A, Tam J, Dewhurst MJ, et al. Ambulatory blood pressure monitoring to assess the white-coat effect in an elderly east African population. J Clin Hypertens (Greenwich). 2015;17:389–394. 2. Floras JS. Blood pressure variability: a novel and important risk factor. Can J Cardiol. 2013;29:557–563. 3. Tai C, Sun Y, Dai N, et al. Prognostic significance of visit-to-visit systolic blood pressure variability: a meta-analysis of 77,299 patients. J Clin Hypertens. 2015;17:107–115. 4. Diaz KM, Tanner RM, Falzon L, et al. Visit-to-visit variability of blood pressure and cardiovascular disease and all-cause mortality: a systematic review and meta-analysis. Hypertension. 2014;64:965– 982. 5. Hansen TW, Thijs L, Li Y, et al; International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes Investigators. Prognostic value of reading to reading blood pressure variability over 24 hours in 8938 subjects from 11 populations. Hypertension. 2010;55:1049–1057. 6. Clement DL, De Buyzere ML, De Bacquer DA, et al. Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension. N Engl J Med. 2003;348:2407–2415. 7. Dolan E, Stanton A, Thijs L, et al. Superiority of ambulatory over clinic blood pressure measurement in predicting mortality: the Dublin Outcome Study. Hypertension. 2005;46:156–161. 8. Mancia G, Fagard R, Narkiewicz K, et al. ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31:1281–1357.

Ambulatory Blood Pressure Measurement Provides True and Prognostic Information on Blood Pressure Variability in Hypertensive Patients.

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