Blood pressure elevation patterns, measurement methods, and prediction of cardiovascular outcomes in patients with arterial hypertension (literature review)

In clinical practice, the diagnosis of arterial hypertension (AH) and the monitoring of antihypertensive therapy are predominantly based on office blood pressure (BP) measurements in the seated position. This approach remains the standard due to its accessibility and simplicity. However, the isolated use of office measurements fails to reflect the phenotypic diversity of AH and is associated with an underestimation of cardiovascular risk. The present literature review assesses the relationship between blood pressure (BP) elevation patterns and cardiac pathology, as well as cardiovascular events, in patients with AH. The review was performed in accordance with the general principles of writing analytical reviews. A search for relevant publications was conducted in the electronic databases PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar. The search covered a 20-year period (from 2005 to 2025). When necessary, earlier works of fundamental importance were also analyzed. Search queries were constructed using combinations of keywords and MeSH terms, including: “arterial hypertension”, “phenotypes of hypertension”, “ambulatory blood pressure monitoring”, “ambulatory blood pressure profiles”, “isolated nocturnal hypertension”, “blood pressure in the sitting and lying position”, and “cardiovascular complications”. The search strategies were adapted to the requirements of each specific database. Considerable attention is given to results demonstrating the unfavorable prognostic value and insufficient reduction in blood pressure levels at night, as measured by 24-hour blood pressure monitoring. Limitations in the informativeness of this method, primarily due to the variability of study results, are also noted. It is convincingly demonstrated that insufficient reduction in blood pressure levels and their increase in the supine position, compared to the sitting position, correlates with 24-hour blood pressure profiles using the night picker method. Furthermore, this method, with its high information content and reproducible results, is more readily available for use in clinical practice. This allows us to recommend it for widespread use to identify patients with hypertension and a prognostically unfavorable type of disease with an increased risk of cardiovascular complications.

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