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J Clin Hypertens (Greenwich). 2019 Nov 7. doi: 10.1111/jch.13724. [Epub ahead of print]

Current status of ambulatory blood pressure monitoring in Asian countries: A report from the HOPE Asia Network.

Author information

1
Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, Korea.
2
Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
3
Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Malaysia.
4
Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
5
Faculty of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia.
6
Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
7
Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
8
University of the East Ramon Magsaysay Memorial Medical Center Inc., Quezon City, Philippines.
9
Fatima Memorial Hospital, Lahore, Pakistan.
10
Section of Cardiology, Department of Medicine, Medical Center Manila, Manila, Philippines.
11
Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia-National Cardiovascular Center, Harapan Kita, Jakarta, Indonesia.
12
MIOT International Hospital, Chennai, India.
13
College of Medical Sciences, Kathmandu University, Bharatpur, Nepal.
14
Department of General Medicine, Tan Tock Seng Hospital, Singapore City, Singapore.
15
Division of Nephrology Department of Medicine, Yong Loo Lin School of Medicine, Singapore City, Singapore.
16
Divisions of Hypertension and Heart Failure, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
17
Division of Cardiology, Cardiovascular Hospital, Yonsei Health System, Seoul, Korea.
18
Department of Internal Medicine, University of Medicine and Pharmacy, Hue University, Hue City, Vietnam.
19
Indian Society of Hypertension, King George's Medical University, Lucknow, India.
20
Department of Internal Medicine, National Taiwan University College of Medicine, Taipei City, Taiwan.
21
Department of Hypertension, Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.

Abstract

Ambulatory blood pressure monitoring (ABPM) can measure 24-hour blood pressure (BP), including nocturnal BP and diurnal variations. This feature of ABPM could be of value in Asian populations for preventing cardiovascular events. However, no study has yet investigated regarding the use of ABPM in actual clinical settings in Asian countries/regions. In this study, 11 experts from 11 countries/regions were asked to answer questionnaires regarding the use of ABPM. We found that its use was very limited in primary care settings and almost exclusively available in referral settings. The indications of ABPM in actual clinical settings were largely similar to those of home BP monitoring (HBPM), that is, diagnosis of white-coat or masked hypertension and more accurate BP measurement for borderline clinic BP. Other interesting indications, such as nighttime BP patterns, including non-dipper BP, morning BP surge, and BP variability, were hardly adopted in daily clinical practice. The use of ABPM as treatment guidance for detecting treated but uncontrolled hypertension in the Asian countries/regions didn't seem to be common. The barrier to the use of ABPM was primarily its availability; in referral centers, patient reluctance owing to discomfort or sleep disturbance was the most frequent barrier. ABPM use was significantly more economical when it was reimbursed by public insurance. To facilitate ABPM use, more simplified indications and protocols to minimize discomfort should be sought. For the time being, HBPM could be a reasonable alternative.

KEYWORDS:

Asian patient; ambulatory blood pressure/home blood pressure monitor; clinical management of high blood pressure (HBP); cost/economics; primary care issues

PMID:
31696632
DOI:
10.1111/jch.13724
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