Review Article
Ambulatory Blood Pressure Monitoring in Primary Care
Abstract
The accurate assessment and appropriate management of blood pressure (BP) is critical for primary care physicians. Traditional office-based BP measurement has limitations that can be addressed, in part, through the use of ambulatory BP monitoring (ABPM). Because BP readings are provided at specific time intervals throughout a 24-hour period, ABPM represents a better picture of the normal fluctuations in BP levels associated with daily activities, including sleep. Blood pressure values obtained by 24-hour ABPM are a better predictor of cardiovascular risk than office-based BP measurements, and the technique can be used to discern white-coat hypertension and to evaluate masked, resistant, and pseudoresistant hypertension. It can also be helpful in the assessment of autonomic dysfunction and monitoring of a patient's response to antihypertensive therapy. Ambulatory BP monitoring is also being increasingly used in clinical trials that assess the antihypertensive effects of medications.This content is limited to qualifying members.
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References
1. Chobanian AV, Bakris GL, Black HR, et al. Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program Coordinating Committee. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003;42:1206–1252.
2. Vasan RS, Larson MG, Leip EP, et al. Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med 2001;345:1291–1297.
3. Lewington S, Clarke R, Qizilbash N, et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002;360:1903–1913.
4. Julius S, Kjeldsen SE, Weber M, et al; VALUE trial group. Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial. Lancet 2004;363:2022–2031.
5. Major cardiovascular events in hypertensive patients randomized to doxazosin vs chlorthalidone: the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). ALLHAT Collaborative Research Group. JAMA 2000;283:1967–1975.
6. Whelton PK, He J, Appel LJ, et al; National High Blood Pressure Education Program Coordinating Committee. Primary prevention of hypertension: clinical and public health advisory from the National High Blood Pressure Education Program. JAMA 2002;288:1882–1888.
7. National Diabetes Information Clearinghouse. National Diabetes Statistics 2007. Available at: http://diabetes.niddk.nih.gov/dm/pubs/statistics/#preventing. Accessed July 28, 2009.
8. Floras JS. Ambulatory blood pressure: facilitating individualized assessment of cardiovascular risk. J Hypertens 2007;25:1565–1568.
9. O'Brien E. Ambulatory blood pressure measurement: the case for implementation in primary care. Hypertension 2008;51:1435–1441.
10. Pickering TG, Shimbo D, Haas D. Ambulatory blood-pressure monitoring. N Engl J Med 2006;354:2368–2374.
11. O'Brien E, Asmar R, Beilin L, et al; European Society of Hypertension Working Group on Blood Pressure Monitoring. European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure measurement. J Hypertens 2003;21:821–848.
12. Pickering TG, Miller NH, Ogedegbe G, et al; American Heart Association; American Society of Hypertension; Preventive Cardiovascular Nurses Association. Call to action on use and reimbursement for home blood pressure monitoring: a joint scientific statement from the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association. Hypertension 2008;52:10–29.
13. Hansen TW, Kikuya M, Thijs L, et al. Prognostic superiority of daytime ambulatory over conventional blood pressure in four populations: a meta-analysis of 7,030 individuals. J Hypertens 2007;25:1554–1564.
14. Kain HK, Hinman AT, Sokolow M. Arterial blood pressure measurements with a portable recorder in hypertensive patients. I. Variability and correlation with “casual” pressures. Circulation 1964;30:882–892.
15. White WB. Relating cardiovascular risk to out-of-office blood pressure and the importance of controlling blood pressure 24 hours a day. Am J Med 2008;121:S2–S7.
16. Pickering TG, Hall JE, Appel LJ, et al; Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Hypertension 2005;45:142–161.
17. Krakoff LR. Cost-effectiveness of ambulatory blood pressure: a reanalysis. Hypertension 2006;47:29–34.
18. American Heart Association. Heart Disease and Stroke Statistics–2007 Update. Dallas, TX, American Heart Association, 2007.
19. Pickering TG, White WB; American Society of Hypertension Writing Group. ASH Position Paper: home and ambulatory blood pressure monitoring. When and how to use self (home) and ambulatory blood pressure monitoring. J Clin Hypertens (Greenwich) 2008;10:850–855.
20. Clement DL, De Buyzere ML, De Bacquer DA, et al; Office versus Ambulatory Pressure Study Investigators. Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension. N Engl J Med 2003;348:2407–2415.
21. Dolan E, Stanton A, Thijs L, et al. Superiority of ambulatory over clinic blood pressure measurement in predicting mortality: the Dublin outcome study. Hypertension 2005;46:156–161.
22. Mancia G, Zanchetti A, Agabiti-Rosei E, et al. Ambulatory blood pressure is superior to clinic blood pressure in predicting treatment-induced regression of left ventricular hypertrophy. SAMPLE Study Group. Study on Ambulatory Monitoring of Blood Pressure and Lisinopril Evaluation. Circulation 1997;95:1464–1470.
23. Uallachain GN, Murphy G, Avalos G. The RAMBLER study: the role of ambulatory blood pressure measurement in routine clinical practice: a cross-sectional study. Ir Med J 2006;99:276–279.
24. Banegas JR, Segura J, Sobrino J, et al; Spanish Society of Hypertension Ambulatory Blood Pressure Monitoring Registry Investigators. Effectiveness of blood pressure control outside the medical setting. Hypertension 2007;49:62–68.
25. Dart RA, Berg RL. The clinical utility of ambulatory blood pressure monitoring in a multispecialty clinic setting. Blood Press Monit 1996;1:475–480.
26. Gardner SF, Schneider EF. 24-Hour ambulatory blood pressure monitoring in primary care. J Am Board Fam Pract 2001;14:166–171.
27. Marchiando RJ, Elston MP. Automated ambulatory blood pressure monitoring: clinical utility in the family practice setting. Am Fam Physician 2003;67:2343–2350.
28. Sarafidis PA, Bakris GL. Resistant hypertension: an overview of evaluation and treatment. J Am Coll Cardiol 2008;52:1749–1757.
29. Manger WM, Gifford RW. Pheochromocytoma. J Clin Hypertens (Greenwich) 2002;4:62–72.
30. Kaufmann H. Neurally mediated syncope and syncope due to autonomic failure: differences and similarities. J Clin Neurophysiol 1997;14:183–196.
31. Pierdomenico SD, Lapenna D, Bucci A, et al. Cardiovascular outcome in treated hypertensive patients with responder, masked, false resistant, and true resistant hypertension. Am J Hypertens 2005;18:1422–1428.
32. Staessen JA, Byttebier G, Buntinx F, et al. Antihypertensive treatment based on conventional or ambulatory blood pressure measurement. A randomized controlled trial. Ambulatory Blood Pressure Monitoring and Treatment of Hypertension Investigators. JAMA 1997;278:1065–1072.
33. Little P, Barnett J, Barnsley L, et al. Comparison of acceptability of and preferences for different methods of measuring blood pressure in primary care. BMJ 2002;325:258–259.
34. Ernst ME, Bergus GR. Favorable patient acceptance of ambulatory blood pressure monitoring in a primary care setting in the United States: a cross-sectional survey. BMC Fam Pract 2003;4:15.
35. Tropeano AI, Roudot-Thoraval F, Badoual T, et al. Different effects of ambulatory blood pressure monitoring on subjective and objective sleep quality. Blood Press Monit 2006;11:315–320.
36. Mancia G, Parati G. Office compared with ambulatory blood pressure in assessing response to antihypertensive treatment: a meta-analysis. J Hypertens 2004;22:435–445.
37. White WB. Ambulatory Blood Pressure Monitoring for the Evaluation of Antihypertensive Therapy, in White WB, (ed): Blood Pressure Monitoring in Cardiovascular Medicine and Therapeutics. Totawa, NJ, Humana Press, 2007, ed 2, pp 437–462.
38. Mancia G, Omboni S, Parati G, et al. Lack of placebo effect on ambulatory blood pressure. Am J Hypertens 1995;8:311–315.
39. Verdecchia P, Angeli F, Mazzotta G, et al. Home blood pressure measurements will not replace 24-hour ambulatory blood pressure monitoring. Hypertension 2009;54:188–195.
