Guidance on ambulatory blood pressure monitoring: A statement from the HOPE Asia Network

Kazuomi Kario¹, Satoshi Hoshide¹, Yook-Chin Chia^{2

3}, Peera Buranakitjaroen⁴, Saulat Siddique⁵, Jinho Shin⁶, Yuda Turana⁷, Sungha Park⁸, Kelvin Tsoi⁹, Chen-Huan Chen^{10

11

12}, Hao-Min Cheng^{10

11

12

13}, Takeshi Fujiwara¹, Yan Li¹⁴, Van Minh Huynh¹⁵, Michiaki Nagai¹⁶, Jennifer Nailes¹⁷, Jorge Sison¹⁸, Arieska Ann Soenarta¹⁹, Guru Prasad Sogunuru^{20

21}, Apichard Sukonthasarn²², Jam Chin Tay²³, Boon Wee Teo²⁴, Narsingh Verma²⁵, Tzung-Dau Wang^{26

27

28}, Yuqing Zhang²⁹, Ji-Guang Wang³⁰

Affiliations

¹ Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
² Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Malaysia.
³ Department of Primary Care Medicine, Faculty of Medicine, University of Malaya Kuala, Lumpur, Malaysia.
⁴ Division of Hypertension, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
⁵ Punjab Medical Center, Lahore, Pakistan.
⁶ Faculty of Cardiology Service, Hanyang University Medical Center, Seoul, Korea.
⁷ School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia.
⁸ Division of Cardiology, Cardiovascular Hospital, Yonsei Health System, Seoul, Korea.
⁹ JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong.
¹⁰ Institute of Public Health and Community Medicine Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan.
¹¹ Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
¹² Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
¹³ Center for Evidence-based Medicine, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.
¹⁴ Centre for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
¹⁵ Department of Internal Medicine, University of Medicine and Pharmacy, Hue University, Vietnam.
¹⁶ Department of Internal Medicine, General Medicine and Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan.
¹⁷ Department of Preventive and Community Medicine and Research Institute for Health Sciences, University of the East Ramon Magsaysay Memorial Medical Center Inc, Quezon City, Philippines.
¹⁸ Section of Cardiology, Department of Medicine, Medical Center Manila, Manila, Philippines.
¹⁹ Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia-National Cardiovascular Center, Harapan Kita, Jakarta, Indonesia.
²⁰ MIOT International Hospital, Chennai, India.
²¹ College of Medical Sciences, Kathmandu University, Bharatpur, Nepal.
²² Cardiology Division, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Thailand.
²³ Department of General Medicine, Tan Tock Seng Hospital, Singapore, Singapore.
²⁴ Division of Nephrology Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore.
²⁵ Department of Physiology, King George's Medical University, Lucknow, India.
²⁶ Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.
²⁷ National Taiwan University Hospital, Taipei City, Taiwan.
²⁸ Division of Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.
²⁹ Divisions of Hypertension and Heart Failure, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
³⁰ 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.

PMID: 33319412
PMCID: PMC8029567
DOI: 10.1111/jch.14128

Review

Guidance on ambulatory blood pressure monitoring: A statement from the HOPE Asia Network

Kazuomi Kario et al. J Clin Hypertens (Greenwich). 2021 Mar.

. 2021 Mar;23(3):411-421.

doi: 10.1111/jch.14128. Epub 2020 Dec 14.

Authors

Affiliations

¹ Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
² Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Malaysia.
³ Department of Primary Care Medicine, Faculty of Medicine, University of Malaya Kuala, Lumpur, Malaysia.
⁴ Division of Hypertension, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
⁵ Punjab Medical Center, Lahore, Pakistan.
⁶ Faculty of Cardiology Service, Hanyang University Medical Center, Seoul, Korea.
⁷ School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia.
⁸ Division of Cardiology, Cardiovascular Hospital, Yonsei Health System, Seoul, Korea.
⁹ JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong.
¹⁰ Institute of Public Health and Community Medicine Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan.
¹¹ Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
¹² Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
¹³ Center for Evidence-based Medicine, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.
¹⁴ Centre for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
¹⁵ Department of Internal Medicine, University of Medicine and Pharmacy, Hue University, Vietnam.
¹⁶ Department of Internal Medicine, General Medicine and Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan.
¹⁷ Department of Preventive and Community Medicine and Research Institute for Health Sciences, University of the East Ramon Magsaysay Memorial Medical Center Inc, Quezon City, Philippines.
¹⁸ Section of Cardiology, Department of Medicine, Medical Center Manila, Manila, Philippines.
¹⁹ Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia-National Cardiovascular Center, Harapan Kita, Jakarta, Indonesia.
²⁰ MIOT International Hospital, Chennai, India.
²¹ College of Medical Sciences, Kathmandu University, Bharatpur, Nepal.
²² Cardiology Division, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Thailand.
²³ Department of General Medicine, Tan Tock Seng Hospital, Singapore, Singapore.
²⁴ Division of Nephrology Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore.
²⁵ Department of Physiology, King George's Medical University, Lucknow, India.
²⁶ Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.
²⁷ National Taiwan University Hospital, Taipei City, Taiwan.
²⁸ Division of Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.
²⁹ Divisions of Hypertension and Heart Failure, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
³⁰ 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.

PMID: 33319412
PMCID: PMC8029567
DOI: 10.1111/jch.14128

Abstract

Hypertension is an important public health issue due to its association with a number of serious diseases, including cardiovascular disease and stroke. The importance of evaluating hypertension taking into account different blood pressure (BP) profiles and BP variability (BPV) is increasingly being recognized, and is particularly relevant in Asian populations given the specific features of hypertension in the region (including greater salt sensitivity and a high rate of nocturnal hypertension). Ambulatory BP monitoring (ABPM) is the gold standard for diagnosing hypertension and assessing 24-hour BP and provides data on several important parameters that cannot be obtained using any other form of BP measurement. In addition, ABPM parameters provide better information on cardio- and cerebrovascular risk than office BP. ABPM should be used in all patients with elevated BP, particularly those with unstable office or home BP, or who are suspected to have white-coat or masked hypertension. ABPM is also an important part of hypertension diagnosis and monitoring in high-risk patients. ABPM needs to be performed using a validated device and good practice techniques, and has a role both in hypertension diagnosis and in monitoring the response to antihypertensive therapy to ensure strict BP control throughout the 24-hour period. Use of ABPM in clinical practice may be limited by cost and accessibility, and practical education of physicians and patients is essential. The ABPM evidence and practice points in this document are based on the Hypertension Cardiovascular Outcome Prevention and Evidence (HOPE) Asia Network expert panel consensus recommendations for ABPM in Asia.

Keywords: ambulatory blood pressure monitoring; blood pressure control; clinical practice; guidelines; hypertension.

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Conflict of interest statement

K Kario reports research grants from Omron Healthcare, Fukuda Denshi, A&D, and Pfizer Japan, and honoraria from Omron Healthcare. YC Chia has received speaker honorarium and sponsorship to attend conferences and seminars from Boehringer Ingelheim, Pfizer, Omron, Servier, and Xepa‐Soul, and investigator‐initiated research grants from Pfizer and Omron. S Siddique has received honoraria from Bayer, Novartis, Pfizer, ICI, and Servier; and travel, accommodation, and conference registration support from Hilton Pharma, Atco Pharmaceutical, Highnoon Laboratories, Horizon Pharma, and ICI. J Shin has received lecture honoraria from Pfizer Inc, Hanmi Pharm. Co. Ltd., Yuhan Co. Ltd., and Boryung Pharmaceutical Co. Ltd.; consulting fees from Hanmi Pharm. Co. Ltd. And Handok Kalos Medical Inc; and research grants from Sanofi Pharm. and Hanmi Pharm. Co. Ltd. CH Chen reports personal fees from Novartis, Sanofi, Daiichi Sankyo, Servier, Bayer, and Boehringer Ingelheim Pharmaceuticals, Inc HM Cheng received speakers’ honorarium and sponsorship to attend conferences and CME seminars from Eli Lilly and AstraZeneca; Pfizer Inc; Bayer AG; Boehringer Ingelheim Pharmaceuticals, Inc; Daiichi Sankyo, Novartis Pharmaceuticals, Inc; Servier; Co., Pharmaceuticals Corporation; Sanofi; TAKEDA Pharmaceuticals International; Menarini Co., Ltd.; and served as an advisor or consultant for ApoDx Technology, Inc JM Nailes has received honorarium and sponsorship to attend conferences and seminars from Pfizer and Omron, and received an investigator‐initiated research grant from Pfizer. JG Wang reports having received research grants from Chengdu Di‐Ao and Omron, and lecture and consulting fees from AstraZeneca, Novartis, Omron, Servier, and Takeda. All other authors report no potential conflicts of interest in relation to this article.

Figures

**Figure 1**
Ambulatory blood pressure monitoring (ABPM) practice points. BP, blood pressure; BPV, blood pressure variability; CCBs, calcium channel blockers; CV, cardiovascular; CVD, cardiovascular disease; TOD, target organ damage

**Figure 2**
Blood pressure measures determined using ambulatory blood pressure monitoring. BP, blood pressure (adapted from Kario et al 2003) ⁴¹

**Figure 3**
Hypertension classifications based on office and ambulatory blood pressure. Source: Kario K. et al, ³² J Clin Hypertens (Greenwich). 2019; 21:1250‐1283

See this image and copyright information in PMC

References

1. World Health Organization . Global Health Observatory (GHO) data. Raised blood pressure. Available from: http://www.who.int/gho/ncd/risk_factors/blood_pressure_prevalence_text/en/ Last accessed: 16 Sep 2020.
1. World Health Organization . A global brief on hypertension. Silent killer, global public health crisis. (2013). Available from: https://www.who.int/cardiovascular_diseases/publications/global_brief_hy.... Last accessed 16 Sep 2020
1. Kario K. Evidence and perspectives on the 24‐hour management of hypertension: hemodynamic biomarker‐Initiated ‘anticipation medicine' for zero cardiovascular event. Prog Cardiovasc Dis. 2016;59:262‐281. - PubMed
1. Kario K, Chen CH, Park S, et al. Consensus document on improving hypertension management in Asian patients, taking Into account Asian characteristics. Hypertension. 2018;71:375‐382. - PubMed
1. Ueshima H, Sekikawa A, Miura K, et al. Cardiovascular disease and risk factors in Asia: a selected review. Circulation. 2008;118:2702‐2709. - PMC - PubMed

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Guidance on ambulatory blood pressure monitoring: A statement from the HOPE Asia Network

Affiliations

Guidance on ambulatory blood pressure monitoring: A statement from the HOPE Asia Network

Authors

Affiliations

Abstract

Conflict of interest statement

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References

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