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Worldwide, millions of patients are affected by arterial hypertension and its associated cardiovascular complications.1 According to the European Society of Cardiology (ESC): Cardiovascular Disease Statistics 2017, approximately 15–25% of the adult population in Germany have high blood pressure (BP).2 Despite the wide availability and easy accessibility of effective and well-tolerated antihypertensive drugs and recommended although rarely implemented lifestyle strategies, rates of adequate BP control remain unsatisfactorily low.3 The 2018 ESC/European Society of Hypertension (ESH) guidelines provide pragmatic recommendations to improve the detection of uncontrolled hypertension, enhance patients’ compliance to BP treatments, and prevent therapeutic inertia of physicians.4

The ESC/ESH guidelines not only recommend repeated office BP measurements to screen for hypertension and review for treatment effects, but also to perform ambulatory blood pressure monitoring (ABPM) and/or home blood pressure monitoring (HBPM). These out-of-office BP measurements facilitate the detection of white coat hypertension (high office but normal ABP) and masked hypertension (normal office but high ABP).4 The prognostic value of ABPM has been recently investigated by the Spanish Ambulatory Blood Pressure Registry.5 The outcome analysis of 63 910 patients indicated that after a median follow-up of 4.7 years, ABP is a stronger predictor of all-cause and cardiovascular mortality than clinic BP values. Interestingly, uncontrolled masked hypertension and also white coat hypertension, both phenotypes of hypertension that can be diagnosed by ABPM only, were associated with worse outcomes. Ambulatory blood pressure monitoring also allows the determination of night-time BP and dipping profiles, which have been shown to provide additional prediction for cardiovascular events.6

Issue Section:
CardioPulse
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