Blood pressure measurement: clinic, home, ambulatory, and beyond

Abstract

Blood pressure traditionally has been measured in the clinic setting using the auscultatory method and a mercury sphygmomanometer. Technologic advances have led to improvements in measuring clinic blood pressure and allowed for measuring blood pressures outside the clinic. This review outlines various methods for evaluating blood pressure and the clinical utility of each type of measurement. Home blood pressures and 24-hour ambulatory blood pressures have improved our ability to evaluate the risk of target-organ damage and hypertension-related morbidity and mortality. Measuring home blood pressures may lead to more active participation in health care by patients and has the potential to improve blood pressure control. Ambulatory blood pressure monitoring enables measuring nighttime blood pressures and diurnal changes, which may be the most accurate predictors of risk associated with elevated blood pressure. Additionally, reducing nighttime blood pressure is feasible and may be an important component of effective antihypertensive therapy. Finally, estimating central aortic pressures and pulse wave velocity are 2 of the newer methods for assessing blood pressure and hypertension-related target-organ damage.

Figure 1

Ambulatory blood pressure monitoring results for a patient with hypertension Legend: ABPM results indicate elevated daytime blood pressures with a normal dipping pattern (night/day ratio < 0.90) and a morning surge in blood pressure between 0500 and 0700.

Figure 2

Clinic and nighttime blood pressure by dipping status in AASK. Legend. Average clinic (grey) and nighttime blood pressure (black bars) in reverse dippers (night/day BP ratio > 1), nondippers (night/day ratio ≤1 and >0.9), and dippers (night/day ratio < 0.9). Adapted and reproduced from Pogue et al with permission of Wolters Kluwer Health.

Figure 3

Algorithm for incorporating home and ambulatory blood pressure measures in the management of hypertension Legend. Adapted and reproduced from Pickering et al with permission of the American Society of Hypertension.