Emerging Role of ambulatory ECG monitoring in the Diagnosis of resistant hypertension
DOI:
https://doi.org/10.5281/zenodo.22814502Keywords:
resistant hypertension, ambulatory blood pressure monitoring, masked hypertension, white-coat effect, ambulatory ECGAbstract
Background: Office measurement misclassifies many patients labeled as resistant hypertension, since white-coat effect inflates cuff readings while masked hypertension conceals poor control.
Objective: This review examines ambulatory blood pressure monitoring, paired with ambulatory ECG surveillance, in confirming true treatment-resistant hypertension and identifying candidates for escalation.
Methods: We synthesized outcome cohorts, diagnostic-accuracy studies, and guidelines addressing ambulatory monitoring, white-coat and masked phenomena, dipping patterns, and ambulatory ECG correlates in resistant hypertension.
Findings: Ambulatory monitoring reclassifies roughly a third of apparent resistant cases as white-coat or masked hypertension, non-dipping and reverse-dipping carry elevated risk, and ambulatory ECG strain and heart-rate-variability changes track ambulatory pressure load more closely than office readings.
Conclusions: Ambulatory blood pressure monitoring, integrated with ambulatory ECG where cardiac risk stratification is needed, should precede diagnostic labeling and escalation of therapy in suspected resistant hypertension.
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