Clinical Usefulness of Ambulatory Blood Pressure Monitoring

Abstract

Abstract. During the past decade, several prospective studies showed that ambulatory BP (ABP) measurements provide a better prediction of major cardiovascular events when compared with clinic BP measurements. This review summarizes the available evidence supporting the use of ABP monitoring to refine prognostic stratification in hypertension. On the basis of available evidence, an operational flowchart is suggested to interpret results of ABP for better treatment of patients with elevated BP.The first device for noninvasive ambulatory BP (ABP) monitoring (ABPM) was developed in 1962 and subsequently modified by Sokolow et al. in 1966 (1). It used a microphone taped over the brachial artery, a cuff inflated by the patient, and a magnetic tape recorder for storing cuff pressure (1). During the past 20 yr, new devices have been were developed and ABPM is now widely used for research and clinical purposes. Evidence is accumulating that ABP measurements provide a better prediction of clinical outcome as compared with conventional clinic BP measurements (2-19). This review examines the evidence supporting the use of ABPM, discusses the advantages of ABPM over clinic BP to predict clinical outcome, and provides information on how to interpret ABPM profile and on when it should be used in clinical practice. Which Is the Rationale for Use of ABPM in Clinical Practice? Association between ABPM and Target Organ DamageMost studies have shown that end-organ damages associated with hypertension, including left ventricular (LV) hypertrophy, proteinuria, serum creatinine, atherosclerotic plaque, narrowing of the retinal arteries, and impaired arterial distensibility and compliance, are more strongly correlated with ABPM than with clinic BP measurements (2-16). The association between clinic BP and hypertension-related organ damage is relatively poor because the main limitations of clinic BP are those referred to the marked variability of BP measurements and the white-coat effect. ABPM and Prediction of Clinical OutcomeIn treated or untreated patients with hypertension, ABP is a significantly better predictor of cardiovascular (CV) and cerebrovascular events than clinic BP measurements (2-19). Table 1 provides an overview of event-based prognostic studies on ABP published in full-length papers by several independent groups. Each group is represented in Table 1 with its largest contribution (2-19). Even if most of the available evidence on the prognostic value of ambulatory BP relies on subjects who were untreated at the time of ABPM, a recent study from our group provided substantial evidence that achieved ambulatory BP during treatment is a potent determinant of the subsequent events and that its potency is superior to both pretreatment ABP and pretreatment and in-treatment clinic BP (17). How to Interpret ABP ProfileAn average daytime ABP Ͻ135 mmHg systolic and 85 mmHg diastolic is generally considered normal for adults; levels Ͻ130/80 mmHg may be considered optimal (20 -23). White-Coat HypertensionWhite-coat hypertension (W...

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