Comparative informative value of three blood pressure measurement methods in antihypertensive therapy effectiveness assessment

Aim. To compare informative value of various blood pressure self-control (BPSC) and 24-hour BP monitoring (BPM) characteristics in long-term antihypertensive therapy effectiveness assessment. Material and methods. A cross-over, randomized trial of enalapril (E) and diltiazem (D) included 22 menopausal women with arterial hypertension (AH). Daily doses were 5-20 mg for E, and 180-360 mg for D. 24-hour BPM was performed at baseline, at the end of each treatment phase, and between the phases; BPSC was performed during the whole study period. Dispersion sources were examined, to assess baseline data reproducibility. Informative values for individual BP parameters were investigated with Mahalonobis distance and t-test ranging. Results. «Error» prevalence for dispersion of averaged 24-hour BPM data was 19-40%, averaged BPSC data – 7-22%. T test values were 3,2-1,2 for averaged 24-hour BPM data, 1,6-0,6 – for averaged BPSC data, 1,7-0,6 – for final/peak effect indices, 3,6-3,0 and 1,3-0,4 - for smoothness index, respectively. In logistic regression analysis, the following independent informative parameters were identified: averaged mean BP for BPSC (p=0,003); time index for mean BP (p=0,0007) and diastolic BP, DBP (p=0,02) (24-hour BPM); clinical DBP (p=0,003). BPSC was more «specific» than 24-hour BPM in diagnosing masked treatment ineffectiveness in the morning hours. Conclusion. The benefits of 24-hour BPM include high formal informative value and a chance for assessing evenness of antihypertensive medication effects. BPCS facilitates more precise diagnostics of masked treatment ineffectiveness, and also provides highly reproducible results.