Ambulatory blood pressure measurement to manage hypertension in India: The India ABPM study


Ambulatory blood pressure (BP) measurement (ABPM) has demonstrated to be a more effective predictor of cardiovascular disease-related mortality than office BP measurement (OBPM). BP measurements taken in non-clinical settings have the potential to reduce the “white coat effect” on patients’ BP and to lower healthcare costs associated with hypertension misdiagnosis. In India, a recent survey found that most physicians performed ABPMs in only <5% of their patients.

The aim of this study was to investigate the prevalence of ABPM-related parameters for hypertension management in a sample population visiting primary care physicians.

32,808 patients who attended 574 primary care clinics between January 2017 and November 2018 participated in this study. OBPMs were performed as usual by the physicians, and patients were referred for ABPMs if deemed necessary by the physicians. The BP measurements were categorized according to the following threshold values:

  • Hypertensive OBPM (SBP ≥140 mmHg and/or DBP ≥90 mmHg)
  • Hypertensive 24-hour ABPM (24-h SBP ≥130 mmHg and/or DBP ≥80 mmHg)
  • Hypertensive daytime ABPM (SBP ≥135 mmHg and/or DBP ≥85 mmHg)
  • Hypertensive nighttime ABPM (SBP ≥120 mmHg and/or DBP ≥70 mmHg)

The results showed that the OBPM values were significantly higher than the daytime, 24-hour, and nighttime ABPM values for both systolic and diastolic BPs (p<0.0001). There was also a contradiction between the OBPMs and 24-hour ABPMs for diagnosing hypertension in 31.3% of the participants. 11.9% of the study participants had isolated nighttime hypertension. Masked hypertension (MH) was found in 23.0% of the study participants who were not receiving treatment for hypertension.

Therefore, ABPM may be superior to OBPM for standard hypertension management due to the following reasons: (1) it can prevent hypertension misdiagnosis, (2) it can reduce unnecessary treatment for white coat hypertension, and (3) it can increase detection of MH and nighttime hypertension and in turn, improve treatment outcomes in these patients.