Ambulatory blood pressure monitoring in clinical practice

Abstract

Being one of the most widely prevalent diseases throughout the world, hypertension has emerged as one of the leading causes of global premature morbidity and mortality. Hence, blood pressure (BP) measurements are essential for physicians in the diagnosis and management of hypertension. Current American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend initiating antihypertensive medications on the basis of office BP readings. However, office BP readings provide a snapshot evaluation of the patient's BP, which might not reflect patient's true BP, with the possibility of being falsely elevated or falsely low. Recently, there is ample evidence to show that ambulatory blood pressure monitoring (ABPM) is a better predictor of major cardiovascular events than BP measurements at clinic settings. ABPM helps in reducing the number of possible false readings, along with the added benefit of understanding the dynamic variability of BP. This article will focus on the significance of ambulatory BP, its advantages and limitations compared with the standard office BP measurement and a brief outlook on its use and interpretation to diagnose and treat hypertension.

Keywords: Ambulatory blood pressure; Dipping; Masked hypertension; Nocturnal hypertension; White coat hypertension.

Fig. 1

Normotension with preserved nocturnal dipping. Average daytime and nighttime systolic and diastolic blood pressure values within normal limits.

Fig. 2

Systo-diastolic hypertension with reduced nocturnal dipping. Average daytime and nighttime systolic and diastolic blood pressure values more than normal limits.

Fig. 3

Systo-diastolic hypertension with reduced nocturnal dipping. Average daytime and nighttime systolic and diastolic blood pressure values more than normal limits.