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Abstract: SA-PO525

The Role of Blood Pressure Load in Ambulatory Blood Pressure Monitoring in Adults: A Review of Current Evidence

Session Information

Category: Hypertension and CVD

  • 1602 Hypertension and CVD: Clinical


  • Eyal, Ophir, Hadassah University Medical Center, Jerusalem, Jerusalem, Israel
  • Ben-Dov, Iddo Z., Hadassah University Medical Center, Jerusalem, Jerusalem, Israel

In the field of ambulatory blood pressure monitoring (ABPM), the concept of the blood pressure load (BPL), defined as the percentage of readings above a certain threshold, has been in general use since the 1990s. However, the benefits of using this index in adults have not been clearly demonstrated, and accordingly it has not been integrated into the major blood pressure diagnosis and treatment guidelines. In this manuscript, we present the first comprehensive review of the current evidence regarding the possible associations of BPL with target organ damage and clinical outcomes, the major determinants for its role and utility in blood pressure measurement. We put a particular emphasis on studies exploring whether BPL has added benefit to the mean blood pressure indices.


Our review is based on a search of PubMed for all articles containing the combination of the MeSH term “Blood Pressure Monitoring, Ambulatory” and “blood pressure load” or “BP load”, last performed on April 13th, 2023. We also scanned the references from articles found on the PubMed search. We included all the articles for which we could find full text in English examining the associations of BPL as defined above with clinical outcomes or organ damage.


While a couple dozen studies aimed to assess the association of the blood pressure load with target organ damage, the cumulative sample size is small. Almost all of the studies are retrospective, and none are interventional.
Though the associations of the BPL with various measures of target organ damage are evident, the available literature fails to demonstrate a clear and consistent added value for the BPL over the mean blood pressure indices.


The BPL has been a part of the ABPM report for more than 3 decades worldwide, yet we have found no previous paper reviewing the evidence for its use. Based on our analysis, we summarize that while the associations of BPL with target organ damage are clear, it is inconclusive whether the addition of BPL to the mean blood pressure indices has any advantage. There is a clear need for further research in this field, including large-scale prospective trials with long-term follow-up to elucidate the possible benefits of incorporating BPL into clinical practice.