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The clinical value of ambulatory blood pressure monitoring
  1. C R GIBBS,
  2. S MURRAY,
  1. Department of Medicine,
  2. City Hospital NHS Trust,
  3. Dudley Road,
  4. Birmingham, B18 7QH, UK

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1996 marked the centenary of the invention of the mercury sphygmomanometer by Scipione Rive-Rivocci1 and a symposium in his honour was held at a recent satellite meeting to the International Society of Hypertension biannual meeting in Glasgow. It is perhaps, therefore, a good time to take stock of the current status of blood pressure measurement, in particular the increasing interest in the value of ambulatory blood pressure monitoring.

The increasing availability and improved reliability of ambulatory devices has lead to a dramatic increase in their use over recent years. This article reviews the implications of ambulatory blood pressure monitoring for our knowledge of the pathogenesis of hypertension, its clinical usefulness, and the evidence for its use in the routine management of hypertensive patients.

Development of ambulatory blood pressure monitoring devices

The first non-invasive blood pressure monitor, the Remler M2000, was developed in 1962 and research using this device subsequently revealed that ambulatory blood pressure monitoring was a more sensitive predictor of morbidity and mortality than casual office blood pressure readings2 ,3 although there was some concern regarding the accuracy of the machine.4 Since this early model there have been significant technological developments and there are now over 15 commercially available automated non-invasive systems.

The use of ambulatory monitoring has demonstrated the enormous variation in blood pressure and provided data for the characterisation of both nocturnal blood pressure and the diurnal pressure pattern. Ambulatory monitoring has also made it possible to determine the efficacy and duration of action of antihypertensive drugs,5 often with a relatively small numbers of patients. However, a number of technical and clinical aspects remain unresolved.

Reference values

The diagnosis of an abnormality requires the definition of normality and one problem associated with the use of ambulatory blood pressure monitoring in clinical practice has been the lack of internationally accepted reference values. …

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