Twenty-four-hour blood pressure control: a brief review of aspects of target-organ protection
Myers, M.G.
Journal of Hypertension. Supplement Official Journal of the International Society of Hypertension 14(6): S7-10
1996
ISSN/ISBN: 0952-1178 PMID: 9023708 Document Number: 458756
Background: The increasing availability of ambulatory blood pressure monitoring has shifted interest in blood pressure measurement from the doctor's office to the entire 24-h period. Routine office blood pressure recordings correlate poorly with left ventricular mass, a sign of early target-organ damage. In contrast ambulatory blood pressure or estimates of 24-h blood pressure load show a good correlation with left ventricular mass. Study findings: Circadian blood pressure rhythms may be important in determining future cardiovascular events. For example, patients who maintain high nocturnal blood pressures (non-dippers) experience more cardiovascular sequelee than do nocturnal dippers, with women non-dippers having the greatest risk. Longer-acting antihypertensive drugs may return circadian blood pressure rhythms to normal by converting non-dippers to dippers. Adequate control of blood pressure toward the end of each 24-h cycle may reduce the early morning rise in cardiovascular events associated with awakening and ambulation. Recent advances: Recent improvements in the estimation of trough to peak ratio have provided a useful arithmetic index for comparing the antihypertensive effects of different compounds over 24-h dosing intervals. Long-acting agents have now been identified in each of the major classes of antihypertensive drugs, making it now possible to maximize target-organ protection by achieving good 24-h blood pressure control in most hypertensive patients.