Ambulatory blood pressure monitoring in the management of hypertension
- Correspondence to:
Professor Eoin O’Brien, Blood Pressure Unit and ADAPT Centre, Beaumont Hospital, Dublin 9, Ireland;
Ambulatory blood pressure measurement (ABPM) is being used increasingly in clinical practice. In recognition of this the British Hypertension Society has published recommendations for the use and interpretation of ABPM in clinical practice,1 and the European Society of Hypertension has published recommendations on blood pressure measuring devices, including devices for ABPM.2 Importantly, the technique has finally been approved for reimbursement in the USA.3 So with worldwide acceptance of the technique, it is timely to reappraise the reasons why ABPM has at last become an indispensable technique for the management of hypertension, and to summarise current recommendations for its use in clinical practice.
WHY IS ABPM SUPERIOR TO CONVENTIONAL BP MEASUREMENT?
The evidence that ABPM gives information over and above conventional blood pressure measurement (CBPM) has been growing steadily over the past 25 years.w1 There are a number of obvious advantages: the technique simply gives more measurements than CBPM, and the real blood pressure is reflected more accurately by repeated measurements4; ABPM provides a profile of blood pressure away from the medical environment, thereby allowing identification of individuals with a white coat response5; ABPM shows blood pressure behaviour over a 24 hour period rather then giving a snapshot of blood pressure; ABPM can demonstrate the efficacy of antihypertensive medication over a 24 hour period rather than making a decision based on one or a few CBPMs confined to a short period of the diurnal cycle4; ABPM can identify patients whose blood pressure does not reduce at night-time—the non-dippers—who are probably at high risk6; and finally, the technique can demonstrate a number of patterns of blood pressure behaviour that may be relevant to clinical management—isolated systolic hypertension, hypotension, dipping and non-dipping, etc.w2 These advantages should have brought ABPM into much wider clinical use many years ago. However, …