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Clinical Utility of Ambulatory Blood Pressure Monitoring (ABPM) in Newly Diagnosed Hypertensive Patients.

Background
Ambulatory Blood Pressure Monitoring (ABPM) has an upper hand in diagnosing hypertension accurately. Parameters obtained by ABPM helps us in diagnosing white coat hypertension, BP variability, dipping status and blood pressure load on organs (Hyperbaric Index) reflecting possible end organ damage.


Objectives
To evaluate clinical utility of ABPM in stage 1 newly diagnosed hypertensive subjects, to compare ABPM readings with clinic blood pressure (Clinic BP), to study dipping pattern and White Coat Hypertension (WCH) in newly labeled hypertensives.


Methodology
After institutional ethics committee approval and written informed consent from participants, an observational cross sectional prospective study was conducted in hypertension clinic of tertiary care hospital over a period of one and half years on 138 newly diagnosed stage I hypertensive patients. ABPM results were analyzed and compared with clinic BP.


Results
86/138 (62.32%) patients were diagnosed to have true HT by ABPM. WCH was detected in 52/138 (37.68%) which is higher than that reported in international studies (21%). The mean pulse, mean systolic/diastolic BP, mean pulse pressure and MAP were significantly higher (p<0.0001) by clinic BP than ABPM. True hypertensive patients were having higher weight (p <0.001), had higher fasting blood sugar values (p=0.008) and BUN levels (p=0.034) than WCH patients. Hyperbaric Index was significantly higher for systolic and diastolic BP in true hypertensive patients as compared to WCH patients. Patients with WCH were predominantly males (71.15%), were younger (41.82 ± 12.77 years) than true hypertensives (46.45 ± 12.20years), (p =0.037). Dipping was detected in 33 (38.37%), non-dipping in 44 (51.16%) and reverse dipping in 9 (10.47%) patients.


Conclusion
Our study reflects the clinical utility of ambulatory blood pressure monitoring not only for accurate diagnosis of hypertension but also for assessing the various parameters of blood pressure.