Clinical utility of ambulatory blood pressure monitoring in the management of hypertension

Abstract

Accurate blood pressure (BP) measurement is essential for the diagnosis, monitoring and management of hypertension. However, conventional office-based BP readings have several limitations that include a low reproducibility, the white-coat effect and the existence of masked hypertension. These limitations can be addressed through the use of ambulatory BP monitoring. Because ambulatory monitoring provides measurements at specific time intervals throughout a 24-hour period, this technique represents a better picture of the normal fluctuations in BP levels associated with daily activities and sleep. In addition, end-organ damage associated with hypertension is more closely related to ambulatory BP than office BP measurements and ambulatory BP profile give better prediction of clinical outcome than conventional BP measurements.

Keywords::

• ambulatory blood pressure monitoring
• hypertension
• prognosis
• risk stratification
• target organ damage
• therapy

Financial & competing interests disclosure

This study was funded in part by the Fondazione Umbra Cuore e Ipertensione - ONLUS, Perugia, Italy. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Office-based blood pressure (BP) readings are limited in the amount of information they provide as they represent a single snapshot in time.

• Ambulatory BP monitoring (ABPM) represents a better picture of the fluctuations in BP levels and enables clinicians to obtain a more precise estimation of a patient’s BP to asses BP levels in the outpatient setting and to study BP variability and circadian profile.

• End organ damage associated with hypertension is more closely related to ambulatory BP than clinic or casual BP measurements.

• Ambulatory BP measurements give better prediction of clinical outcome than conventional BP measurements.

• Evidence supporting the prognostic value of ambulatory BP is remarkable, and based mostly on outcome cohort studies in which the qualifying ABPM had been carried out in untreated or treated subjects with essential hypertension.

• Diagnostic and management decisions based on the interpretation of ABPM patterns are complex.

• Standardization of data presentation for cardiovascular risk assessment should concentrate on the components of ABPM, which demonstrated additive prognostic value in multiple independent studies.

• Average ambulatory BP should remain the first-line procedure to identify subjects needing antihypertensive drug treatment. In addition, a nondipping pattern, an elevated 24-h pulse pressure as well as an increased nighttime systolic BP variability are additional markers of added cardiovascular risk.

Notes