Table Of ContentClinical Hypertension and Vascular Diseases
Series Editor: William B. White
William B. White Editor
Blood Pressure
Monitoring in
Cardiovascular
Medicine
and Therapeutics
Third Edition
Clinical Hypertension and Vascular Diseases
Series Editor: William B. White
More information about this series at h ttp://www.springer.com/series/7673
Other titles in this series
Blood Pressure Monitoring in Cardiovascular Medicine and Therapeutics,
Third Edition
White, William B. (Ed.), 2016
Hypertension in High Risk African Americans
Ferdinand, Keith C. (Ed.), 2015
Chronic Kidney Disease and Hypertension
Weir, Matthew R, Lerma, Edgar V. (Eds.), 2015
Pediatric Hypertension, Third Edition
Flynn, Joseph T, Ingelfi nger, Julie R, Portman, Ronald J. (Eds.), 2013
Hypertension and Stroke
Aiyagari, Venkatesh, Gorelick, Philip B. (Eds.), 2011
Pediatric Hypertension, Second Edition
Flynn, Joseph T, Ingelfi nger, Julie R, Portman, Ronald J. (Eds.), 2011
Blood Pressure Monitoring in Cardiovascular Medicine and Therapeutics,
Second Edition
White, William B. (Ed.), 2007
Lower Extremity Arterial Disease
Caralis, Dennis G, Bakris, George L. (Eds.), 2005
Hypertension in the Elderly
Prisant, L. Michael (Ed.), 2005
Pediatric Hypertension
Portman, Ronald J, Sorof, Jonathan M, Ingelfi nger, Julie R. (Eds.), 2004
Secondary Hypertension
Mansoor, George A. (Ed.), 2004
Blood Pressure Monitoring in Cardiovascular Medicine and Therapeutics
White, William B. (Ed.), 2000
William B. White
Editor
Blood Pressure Monitoring
in Cardiovascular Medicine
and Therapeutics
Third Edition
Editor
William B. White, M.D., F.A.S.H., F.A.H.A., F.A.C.P.
Calhoun Cardiology Center
University of Connecticut School of Medicine
Farmington , CT , USA
Clinical Hypertension and Vascular Diseases
ISBN 978-3-319-22770-2 ISBN 978-3-319-22771-9 (eBook)
DOI 10.1007/978-3-319-22771-9
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Foreword
This T hird Edition of Blood Pressure Monitoring in Cardiovascular Medicine and
Therapeutics extends the tradition of excellence in this area and is now entering its
16th year. The editor, Dr. William B. White, has assembled a group of well-respected
authors to cover the entire spectrum of how ambulatory blood pressure monitoring
(ABPM) has changed the face of clinical trials and clinical medicine. It also helps
the reader understand how to interpret data in different clinical settings. For those
with an interest in blood pressure variability and 24 h ABPM, this book is an indis-
pensable resource. ABPM is now recommended for initial evaluation of hyperten-
sion by some national guidelines, while all guidelines recommend its use for
conditions such as masked hypertension, white coat hypertension, and adequacy of
blood pressure control while sleeping.
T he technology available in the most recent monitors is quite sophisticated and
can assess changes in vascular compliance as well as overall blood pressure pat-
terns. For this reason both the clinical and research use of these devices have
expanded dramatically over the past 6–8 years since the book’s last edition was
published. The third edition covers all aspects of blood pressure monitoring includ-
ing review of the epidemiology and methodology used in outcome and blood pres-
sure studies, comprehensive assessment of home blood pressure monitoring research
and its translation into clinical practice, and a discussion of its use in the general
management of patients.
The pathophysiology of circadian rhythms is discussed with fi ve chapters dedi-
cated to this topic covering the spectrum of chronobiology. A new chapter on rele-
vance of blood pressure variability as a potential determinant of cardiovascular
morbidity and mortality is an important addition to this edition of the book.
Additionally, a new chapter covering the importance of neurohormonal activity,
sodium and other cations, as well as renin–angiotensin system, obstructive sleep
apnea, and the environment on blood pressure variability has been added. Another
new and interesting chapter deals with ABPM and stroke outcomes. Moreover,
there is a new chapter on the use of ABPM in clinical practice. This is a case-based
chapter with nearly a dozen different clinical examples demonstrating the utility of
ambulatory monitoring as an adjunct to the rest of the diagnostic work-up.
v
vi Foreword
A whole section of the book has been dedicated to s pecial populations including
children, older people, and those with kidney disease as well as ischemic heart
disease and outcomes based on ambulatory blood pressure readings.
There is no question that this is the quintessential text on blood pressure monitor-
ing in clinical medicine and is second to none for its authoritative chapters and
practical advice to clinicians as well as its perspective on understanding the ABPM
results of a given patient. I highly recommend it to all who have an interest in this
topic as “The Book on the Subject.”
Chicago , IL , USA George L. Bakris, M.D., F.A.S.H.
Pref ace
The third edition of B lood Pressure Monitoring in Cardiovascular Medicine and
Therapeutics is devoted to the topic of circadian variation in cardiovascular disease,
with a special emphasis on blood pressure and the clinical evaluation and treatment
of hypertension. Clinical investigation related to home and ambulatory monitoring
of the blood pressure has led to signifi cant improvements in our ability to confi rm
hypertension as well as to identify clinical entities in patients with hypertension and
vascular complications. This research is important not only because hypertension is
so ubiquitous among adults around the globe, but also because the attributable car-
diovascular morbidity and mortality associated with the hypertensive disease pro-
cess are so substantial.
S ince the fi rst edition of this book in 2000 and its second edition in 2007, research
efforts in basic and clinical hypertension have progressed, and work devoted to the
measurement of blood pressure and blood pressure variability has been a major part
of this scientifi c advancement with new measurement devices, novel drug and
device therapies, and outcomes research in observational studies and clinical trials.
During the past 8 years, numerous important research papers in the fi elds of ambula-
tory and home blood pressure monitoring have been published, and regular consen-
sus conferences have been held at the European and/or International Society of
Hypertension meetings as well as at the American Society of Hypertension annual
meeting and expositions. Thus, it remains important and clinically relevant to have
an updated third edition of my book that cohesively aggregates research fi ndings
involving blood pressure monitoring in clinical medicine and in cardiovascular
therapeutics.
The volume has been organized into four major sections which cover broad areas
in blood pressure measurement or monitoring as it relates to epidemiology, method-
ology, clinical associations and outcomes, and practical utility. The fi ve chapters in
Part I describe the methodology of clinical, home, and ambulatory blood pressure
monitoring in research and clinical practice. Dr. Myers presents a concise chapter
on different means to accurately measure the blood pressure in the medical care
environment based on his many years of work in this area in Toronto. A comprehen-
sive assessment of home blood pressure monitoring research as it translates into
vii
viii Preface
clinical practice including review of the epidemiologic data and other outcome
fi ndings, the importance of blood pressure variability, and discussing its use for the
general management of patients was provided by Dr. Parati and colleagues from
Milan. My former colleague, Dr. Mansoor from St. John’s, Antigua, explains the
importance of the environment and physical activity recordings in cardiovascular
disease. These techniques may be helpful for obtaining meaningful data during
ambulatory blood pressure recordings in clinical trials. Advances in actigraphy
research have allowed investigators to pinpoint changes in physical activity that
may directly impact on blood pressure variability. Vanessa Barber and I from
Farmington, Connecticut, have updated an overview of ambulatory monitoring of
the blood pressure, including descriptions of device validation, patterns of blood
pressure variation discovered with the advent of this technique, and usefulness of
the methodology in clinical hypertension practice. Drs. Atkins and O’Brien have
updated their chapter on the importance of device validation and their reliability.
While seemingly an unexciting topic, the importance of device validation cannot be
overestimated as it is a requirement for investigators to confi rm the overall validity
of these recorders being used in clinical trial research and clinical practice.
The fi ve chapters in Part II bring in new information related to our understanding
of the pathophysiology of the circadian biology of cardiovascular disorders. A num-
ber of prior authors from the second edition as well as new authors and topics com-
prise this section. Drs. Smolensky, Portaluppi, and Hermida begin with an overview
of the chronobiology of blood pressure regulation in humans. This chapter lays the
groundwork for the rest of this section with its comprehensive discussion of the
progress that has been made in research involving the chronophysiology of human
disease with major emphases on hypertension, coronary artery disease, and stroke.
Dr. Asayama and colleagues from Leuven have written a new chapter on relevance
of blood pressure variability as a potential determinant of cardiovascular morbidity
and mortality. During the past two decades, there has been substantial controversy
over the independent relevance of short-term blood pressure variability derived
from ambulatory monitoring versus longer-term variability that is associated with
weekly or monthly clinical visits—these topics are covered in this balanced chapter.
Dr. Burnier and coworkers from Lausanne have also written a new chapter covering
the importance of neurohormonal activity, sodium and other cations, renin–angio-
tensin system, obstructive sleep apnea, and the environment on blood pressure vari-
ability. Drs. Angeli and Verdecchia from Perugia have once again provided a
state-of-the-art chapter on the prognostic value of ambulatory blood pressure moni-
toring based on their long-term research in this fi eld as well as through other data-
bases from around the world. To wrap up this section, Dr. Gorelick and colleagues
from Grand Rapids, Michigan, have written a new chapter for the book on ambula-
tory blood pressure and stroke—the authors are experts in vascular neurology who
have had a long-standing interest in the relationships among blood pressure, stroke,
and cognitive function, and their chapter is a welcome addition to this book.
There are eight chapters in Part III which focus on ambulatory blood pressure in
special populations of patients with hypertension: Drs. Gulati and White from
Hartford and Farmington, Connecticut, cover the older patient with systolic
Preface ix
hypertension from the perspective of clinical cardiology and their longitudinal work
on small vessel brain disease as it relates to out-of-offi ce blood pressure; Dr. Flynn
from Seattle comprehensively covers children and adolescents from the perspective
of a leader in pediatric nephrology and hypertension; Drs. Hermida and Ayala from
Vigo, Spain, comprehensively evaluate data during pregnancy from the perspective
of experts in physiology and maternal–fetal medicine; Dr. Peixoto and coworkers
from New Haven, Connecticut, and Rio de Janeiro provide us with a substantially
updated and complete chapter on patients with chronic kidney disease and those on
dialysis from the perspective of experts in clinical nephrology.
T here are also four new chapters in Part III: a focus on ambulatory blood pres-
sure in patients with ischemic heart disease and heart failure by Drs. Campbell and
Javed from Little Rock and New Orleans from their perspective as experts in heart
failure and hypertension; Dr. Viera from Chapel Hill, North Carolina, has an update
on masked hypertension based on his own research as well as that of others in this
important new fi eld, while Dr. Krakoff from New York has written an update on
white coat hypertension from the perspective of a hypertension specialist and a
long-time researcher in out-of-offi ce blood pressure monitoring. Finally, Dr.
Lemmer from Heidelberg has written a new chapter on the importance of gender
from the perspective of a clinical pharmacologist using examples from both animal
models and clinical data.
I n Part IV, there are three chapters, with two new authors for the book’s third
edition. The focus of the section is on the applications of home and ambulatory
monitoring in clinical research and hypertension management. Drs. Stergiou and
Ntineri from Athens have written a very comprehensive review of the use of home
(or self) monitoring of the blood pressure in clinical research with a particular focus
on therapeutic trials—at the time of publication of the prior edition of this book,
there were very few studies published in this area. We welcome this new chapter by
dedicated experts in this area. Drs. White and Malha from Farmington and New York
have developed an updated, extensive review of the usefulness of ambulatory blood
pressure monitoring during antihypertensive drug development as well as in novel
trials of device therapy, such as renal denervation. Ambulatory blood pressure mon-
itoring elucidates the effi cacy of new antihypertensive therapies versus placebo as
well as in comparator trials of two therapies. It also is an important tool to assess
device therapy of hypertension to reduce the impact of observer bias. In the fi nal
chapter, Dr. Townsend, a hypertension specialist from Philadelphia, has written a
new chapter on the use of ambulatory blood pressure monitoring in clinical practice.
This is case-based chapter with nearly a dozen different clinical examples demon-
strating the utility of ambulatory monitoring as an adjunct to the rest of the diagnos-
tic work-up.
T he clinicians and investigators who contributed to this textbook have written
comprehensive and up-to-date information from a fi eld in hypertension and vascular
medicine that is dynamic and in which knowledge is advancing at a rapid pace. Just
20 years ago, most research in the fi eld of ambulatory monitoring of the blood pres-
sure was descriptive and did not correlate the data to target organ disease or cardio-
vascular outcomes. Hence, practicing physicians were not provided with enough
