Ambulatory Blood Pressure Monitoring: Recent Evidence and Clinical Pharmacy Applications

Abstract

Conventional office blood pressure readings are a well-established surrogate for the prediction of cardiovascular risk. It is assumed that these readings reflect an underlying average level of blood pressure exposure occurring in an individual over a period of time. But because blood pressure is not static, important additional prognostic information about the diurnal blood pressure profile, including within-day and between-day variability, is not easily ascertained from conventional measurements. Ambulatory blood pressure monitoring provides a more thorough depiction of the underlying blood pressure level and predicts cardiovascular risk more robustly than do conventional blood pressure measurements. Although the technology has been available for more than 30 years, there has been an expansion of the research base in the past decade supporting its role in the evaluation and management of patients with hypertension and as an important surrogate in research trials. This review summarizes recent evidence supporting the predictive ability of ambulatory blood pressure monitoring and briefly highlights opportunities for clinical pharmacists to adopt this important clinical and research tool.

Home monitoring of blood pressure: patients’ perception and role of the pharmacist

“…Previous research has highlighted opportunities for clinical pharmacists to adopt a role in supporting the use of blood pressure home measuring monitors [20]. Pharmacists are in a pivotal position for providing pharmaceutical care services including measurements of blood pressure, education on the medical condition and medication use.…”

“…In this study, the pharmacist was identified as the health care professional to counsel patients on the proper use of the blood pressure home measuring monitors (56 %), followed by the specialist. We recommend collaborative practice models between pharmacists and physicians as they have been found to optimize medication management and lead to improvements in hypertension outcomes [20].…”

Amlodipine+Benazepril is Superior to Hydrochlorothiazide+Benazepril Irrespective of Baseline Pulse Pressure: Subanalysis of the ACCOMPLISH Trial

“…The lack of significant differences between PP tertiles for the relative treatment effect in the current study could be the result of a type 2 error. Further, a categorization of PP based on standard BP measurements may be inferior in comparison to 24‐hour and central pressure measurements . In the ACCOMPLISH trial, the difference in SBP between the two treatment groups was <1 mm Hg.…”

The use of ambulatory blood pressure monitoring to confirm a diagnosis of high blood pressure by primary-care physicians in Oregon

“…Ambulatory blood pressure monitoring is considered the best method for confirming an office-based hypertension diagnosis [21] because of its strong predictive ability of future cardiovascular risk [22][23][24] and its ability to better describe blood pressure variability [25]. This method is better at identifying individuals with white-coat hypertension [25] and is well received among patients [26][27][28].…”