title: Around-the-clock ambulatory blood pressure monitoring is required to properly diagnose resistant hypertension and assess associated vascular risk.
abstract: Diagnosis of resistant hypertension (RH) is currently based upon awake-time office blood pressure (BP). An increasing number of studies have documented abnormally elevated sleep-time BP in most RH patients, indicating that diagnosis of true RH cannot be determined solely by comparison of office BP with either patient awake-time BP self-measurements or awake-BP mean from ambulatory monitoring (ABPM), as is customary in the published literature. Moreover, the ABPM-determined sleep-time BP mean is an independent and stronger predictor of cardiovascular and cerebrovascular disease (CVD) risk than either daytime office/ABPM-derived awake or 24-hour means. Results of the recently completed MAPEC (Monitorización Ambulatoria para Predicción de Eventos Cardiovasculares) prospective outcomes study, which included a large cohort of RH patients, established that time of treatment relative to circadian rhythms constituted a critically important yet often neglected variable with respect to BP control. The study found that bedtime versus morning ingestion of the full dose of ≥1 BP-lowering medications resulted in both better therapeutic normalization of sleep-time BP and reduced CVD morbidity and mortality, including in RH patients. Accordingly, ABPM is highly recommended to properly diagnose and manage true RH, with a bedtime hypertension medication regimen as the therapeutic scheme of choice.
authors.affiliation: Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (AtlantTIC), University of Vigo, Vigo, Spain, rhermida@uvigo.es.
authors.forename: Ramón C
authors.initials: RC
authors.lastname: Hermida
authors.forename: Diana E
authors.initials: DE
authors.lastname: Ayala
authors.forename: María T
authors.initials: MT
authors.lastname: Ríos
authors.forename: José R
authors.initials: JR
authors.lastname: Fernández
authors.forename: Artemio
authors.initials: A
authors.lastname: Mojón
authors.forename: Michael H
authors.initials: MH
authors.lastname: Smolensky
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D012306:Risk; D012890:Sleep / Q000502:physiology; D013997:Time Factors
chemical_list: D000959:Antihypertensive Agents