Ambulatory blood pressure (ABP) variability: A review

High blood pressure (BP) has cropped up as a prominent reason for worldwide untimely deaths. In India also numbers are increasing sharply & becoming a crucial risk factor for cardiovascular diseases (CVD). Significant heart care demands regular BP measurements. As per American heart association recommendations, office BP readings are used to start antihypertensive medicines.

Limitations

Provide only BP snapshot report
Chances of showing falsely manipulated high or low BP value
No throughout-the-day BP variation data availability
Not able to monitor the antihypertensive medication effect on the BP variation
What is Ambulatory BP measurement (ABPM)?

It is a more accurate BP measuring standard which offers 24 hours reading (every 15-30 mins), accesses BP variability along with diurnal rhythmic changes, nocturnal dipping & morning surge, and predicts potential heart disease risk & antihypertensive drug impact.

Ambulatory blood pressure variability (ABPV)

Increased ABPV is a risk factor for CVD & cognitive dysfunction. Not offers details more than ABP mean comparisons between systolic and diastolic ABP. Thorough work is required to find the right comparison between day & night ABPV. 

ABPV dependability

The mean values of ABPV show stability. Contextual factors like eating, and walking affects ABPV values. Test-retest data of more diverse activities is limited. BP varies with each heartbeat & shows the change in a short duration. ABPV only calculates the Standard deviation (SD) of all BP observations during the measurement period & ignores measurement order leading to very different patterns of BP changes with the same SD variability. Average real variability allows getting absolute differences of consecutive measurements to find out the right measurement variability.

ABPV predictors

High ABPV predictors are age, ethnicity, mental disorders (depression, anger, pessimistic & anxious nature), low social support, stress, dietary changes, physical inactivity & environmental conditions.

Common remedies to reduce ABPV

The mean BP & ABPV gets affected & CVD events reduce by using BP-lowering medicines like β-blockers, calcium-channel blockers, and diuretics. In clinical practice, it is still not established well. Lifestyle changes like increased physical activity, healthy eating habits, stress management & right sleep hygiene improve ABPV values further. Physicians can use early identification of high ABPV as a supportive solution to prevent heart disease onset & underlying disease.

Future research

Examining contextual variables and momentary perceptions relations with ABP levels
Determining causes of ABP variation & how higher variability predicts CVD
Establishing the relationship between systolic ABPV and C-reactive protein (a key marker of inflammation), high ABPV & CVD risk. Finding the link between the HPA axis regulating hormones like adrenal glands, and estrogen with ABPV

Conclusions

With the help of ABPV, the development & prognosis of CVD can be understood well. This can assure superior proactive CVD prevention & treatment quality. It is mandatory to enhance ABP monitoring usage in clinical setup & analyse ABPV values.