Expert panel consensus recommendations for ambulatory blood pressure monitoring in Asia: The HOPE Asia Network

Kazuomi Kario, Jinho Shin, Chen-Huan Chen, Peera Buranakitjaroen, Yook-Chin Chia, Romeo Divinagracia, Jennifer Nailes, Satoshi Hoshide, Saulat Siddique, Jorge Sison, Arieska Ann Soenarta, Guru Prasad Sogunuru, Jam Chin Tay, Boon Wee Teo, Yuda Turana, Yuqing Zhang, Sungha Park, Huynh Van Minh, Ji-Guang Wang, Kazuomi Kario, Jinho Shin, Chen-Huan Chen, Peera Buranakitjaroen, Yook-Chin Chia, Romeo Divinagracia, Jennifer Nailes, Satoshi Hoshide, Saulat Siddique, Jorge Sison, Arieska Ann Soenarta, Guru Prasad Sogunuru, Jam Chin Tay, Boon Wee Teo, Yuda Turana, Yuqing Zhang, Sungha Park, Huynh Van Minh, Ji-Guang Wang

Abstract

Hypertension is an important public health issue because of its association with a number of significant diseases and adverse outcomes. However, there are important ethnic differences in the pathogenesis and cardio-/cerebrovascular consequences of hypertension. Given the large populations and rapidly aging demographic in Asian regions, optimal strategies to diagnose and manage hypertension are of high importance. Ambulatory blood pressure monitoring (ABPM) is an important out-of-office blood pressure (BP) measurement tool that should play a central role in hypertension detection and management. The use of ABPM is particularly important in Asia due to the specific features of hypertension in Asian patients, including a high prevalence of masked hypertension, disrupted BP variability with marked morning BP surge, and nocturnal hypertension. This HOPE Asia Network document summarizes region-specific literature on the relationship between ABPM parameters and cardiovascular risk and target organ damage, providing a rationale for consensus-based recommendations on the use of ABPM in Asia. The aim of these recommendations is to guide and improve clinical practice to facilitate optimal BP monitoring with the goal of optimizing patient management and expediting the efficient allocation of treatment and health care resources. This should contribute to the HOPE Asia Network mission of improving the management of hypertension and organ protection toward achieving "zero" cardiovascular events in Asia.

Keywords: Asia; ambulatory blood pressure monitoring; blood pressure variability; cardiovascular risk; hypertension; nocturnal hypertension.

Conflict of interest statement

K Kario received research grants from Omron Healthcare, Fukuda Denshi, A&D, Pfizer Japan, and honoraria from Omron Healthcare. S Park has received research grants and honoraria from Pfizer. S Siddique has received honoraria from Bayer, Novartis, Pfizer, ICI, and Servier; and travel, accommodation and conference registration support from Atco Pharmaceutical, Highnoon Laboratories, Horizon Pharma, ICI, Pfizer and CCL. YC Chia has received honoraria and sponsorship to attend conferences and CME seminars from Abbott, Bayer, Boehringer Ingelheim, GlaxoSmithKline, Menarini, Merck Sharp & Dohme, Novartis, Orient Europharma, Pfizer, and Sanofi; and a research grant from Pfizer. J Shin has received honoraria and sponsorship to attend seminars from Daiichi Sankyo, Takeda, Menarini, MSD, Bristol‐Myers Squibb, and Sanofi. CH Chen has served as an advisor or consultant for Novartis Pharmaceuticals Corporation; has served as a speaker or a member of a speakers bureau for AstraZeneca; Pfizer Inc; Bayer AG; Bristol‐Myers Squibb Company; Boehringer Ingelheim Pharmaceuticals, Inc; Daiichi Sankyo, Inc; Novartis Pharmaceuticals Corporation; SERVIER; Merck & Co., Inc; Sanofi; TAKEDA Pharmaceuticals International; and has received grants for clinical research from Microlife Co., Ltd. R Divinagracia has received honoraria as a member of speaker's bureaus for Bayer, Novartis, and Pfizer. J Sison has received honoraria from Pfizer, AstraZeneca, Boehringer Ingelheim and Novartis. GP Sogunuru has received a research grant related to hypertension monitoring and treatment from Pfizer. JC Tay has received advisory board and consultant honoraria from Pfizer. BW TEO has received honoraria for lectures and consulting fees from Astellas, AstraZeneca, Boehringer Ingelheim, Servier, MSD, and Novartis. JG Wang has received research grants from Bayer, Merck Sharp & Dohme, Pfizer, and Phillips; and lecture and consulting fees from Bayer, Daiichi‐Sankyo, Merck Sharp & Dohme, Pfizer, Servier, and Takeda. Y Zhang has received research grants from Bayer, Novartis, and Shuanghe; and lecture fees from Bayer, Daiichi Sankyo, Novartis, Pfizer, Sanofi, Servier, and Takeda. All other authors report no potential conflicts of interest in relation to this article.

©2019 Wiley Periodicals, Inc.

Figures

Figure 1
Figure 1
Blood pressure measures evaluated by ambulatory blood pressure monitoring. ABPM, ambulatory blood pressure monitoring; BP, blood pressure (adapted from Kario et al114 with permission)
Figure 2
Figure 2
Hypertension classifications based on office and ambulatory blood pressure
Figure 3
Figure 3
Different types of masked hypertension and contributing factors. BP, blood pressure; CKD, chronic kidney disease; HTN, hypertension (modified from Kario102)
Figure 4
Figure 4
Influences on nocturnal and morning blood pressure, and different classifications of nighttime dipping. BP, blood pressure (reproduced from Kario90 with permission)
Figure 5
Figure 5
Triad of optimal 24‐h BP control (reproduced from Kario et al56)
Figure 6
Figure 6
New information communication technology‐based multisensor approach to ambulatory blood pressure monitoring. ABPM, ambulatory blood pressure monitoring; BP, blood pressure; BPV, blood pressure variability; CVD, cardiovascular disease; HBPM, home blood pressure monitoring; SBP, systolic blood pressure (reproduced from Kario et al242 with permission)
Figure 7
Figure 7
Classification of high‐risk groups stratified by actisensitivity and thermosensitivity. SBP, systolic blood pressure. Actisensitivity is defined as the slope of SBP change vs physical activity (eg, actisensitive hypertension [hyperactisensitivity] could be defined as a ≥30 mm Hg increase in SBP when physical activity increases from 100G [resting] to 1000G [walking]). Thermosensitivity is defined as the slope of SBP change vs change in temperature (eg, cold thermosensitive hypertension [hyperthermosenstivity] could be defined as a ≥20 mm Hg increase in SBP when temperature decreases by 10°C) (reproduced from Kario et al243 with permission)
Figure A1
Figure A1
Typical ambulatory blood pressure monitoring profile for a patient with white‐coat hypertension. ABP, ambulatory blood pressure; BP, blood pressure; bpm, beats/minute; DBP, diastolic blood pressure; SBP, systolic blood pressure (reproduced from Kario, 2018)56
Figure A2
Figure A2
Typical ambulatory blood pressure monitoring profile for a patient with normotension. ABP, ambulatory blood pressure; BP, blood pressure; bpm, beats/minute; DBP, diastolic blood pressure; SBP, systolic blood pressure (reproduced from Kario, 2018) 56
Figure A3
Figure A3
Typical ambulatory blood pressure monitoring profile for a patient with a dipper pattern. ABP, ambulatory blood pressure; BP, blood pressure; bpm, beats/minute; DBP, diastolic blood pressure; SBP, systolic blood pressure (reproduced from Kario, 2018) 56
Figure A4
Figure A4
Typical ambulatory blood pressure monitoring profile for a patient a non‐dipper pattern. ABP, ambulatory blood pressure; BP, blood pressure; bpm, beats/minute; DBP, diastolic blood pressure; SBP, systolic blood pressure (reproduced from Kario, 2018) 56
Figure A5
Figure A5
Typical ambulatory blood pressure monitoring profile for a patient with an extreme‐dipper pattern. ABP, ambulatory blood pressure; BP, blood pressure; bpm, beats/minute; DBP, diastolic blood pressure; SBP, systolic blood pressure (reproduced from Kario, 2018) 56
Figure A6
Figure A6
Typical ambulatory blood pressure monitoring profile for a patient with a riser pattern. ABP, ambulatory blood pressure; BP, blood pressure; bpm, beats/minute; DBP, diastolic blood pressure; SBP, systolic blood pressure (reproduced from Kario, 2018)56

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