Review Article

Ambulatory Blood Pressure Monitoring

Authors: Michael E. Ernst PharMD, BCPS, George R. Bergus MD

Abstract

Noninvasive, 24-hour ambulatory blood pressure monitoring (ABPM) has evolved over the past 25 years from a novel research tool of limited clinical use into an important and useful modality for stratifying cardiovascular risk and guiding therapeutic decisions. Early clinical uses of ABPM were mostly focused on identifying patients with white-coat hypertension; however, accumulated evidence now points to greater prognostic significance in determining risk for hypertensive end-organ damage compared with office blood pressure measurements. Ambulatory measurement of blood pressure using automated devices has also demonstrated benefit in other indications, such as treatment resistance and borderline hypertension, and is recommended by the Joint National Committee for the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure in a number of clinical scenarios. Medicare recently announced plans to begin reimbursement for ABPM, which will likely increase demand for ABPM services. Clinicians should become familiar with the role of this technology in the care of the hypertensive patient.

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References

References 1. Staessen JA, Beilin L, Parati G, Waeber B, White W. Task Force IV: Clinical use of ambulatory blood pressure monitoring—Participants of the 1999 Consensus Conference on Ambulatory Blood Pressure Monitoring. Blood Press Monit 1999; 4: 319–331.StaessenJA]]BeilinL]]ParatiG]]WaeberB]]WhiteWTask Force IV: Clinical use of ambulatory blood pressure monitoring—Participants of the 1999 Consensus Conference on Ambulatory Blood Pressure MonitoringBlood Press Monit19994319 2. Zanchetti A. The role of ambulatory blood pressure monitoring in clinical practice. Am J Hypertens 1997; 10: 1069–1080.ZanchettiAThe role of ambulatory blood pressure monitoring in clinical practiceAm J Hypertens1997101069 3. Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med 1997; 157: 2413–2446.Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure.The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressureArch Intern Med19971572413 4. O'Brien E, Coats A, Owens P, Petrie J, Padfield PL, Littler WA, et al. Use and interpretation of ambulatory blood pressure monitoring: Recommendations of the British hypertension society. BMJ 2000; 320: 1128–1134.O'BrienE]]CoatsA]]OwensP]]PetrieJ]]PadfieldPL]]LittlerWAUse and interpretation of ambulatory blood pressure monitoring: Recommendations of the British hypertension societyBMJ20003201128 5. Pickering T. Recommendations for the use of home (self) and ambulatory blood pressure monitoring: American Society of Hypertension Ad Hoc Panel. Am J Hypertens 1996; 9: 1–11.PickeringTRecommendations for the use of home (self) and ambulatory blood pressure monitoring: American Society of Hypertension Ad Hoc PanelAm J Hypertens199691 6. Sheps SG, Clement DL, Pickering TG, Krakoff LR, White WB, Messerli FH, et al. Ambulatory blood pressure monitoring: Hypertensive Diseases Committee, American College of Cardiology. J Am Coll Cardiol. 1994; 23: 1511–1513.ShepsSG]]ClementDL]]PickeringTG]]KrakoffLR]]WhiteWB]]MesserliFHAmbulatory blood pressure monitoring: Hypertensive Diseases Committee, American College of CardiologyJ Am Coll Cardiol1994231511 7. O'Brien E, Petrie J, Littler W, de Swiet M, Padfield PL, Altman DG, et al. An outline of the revised British Hypertension Society protocol for the evaluation of blood pressure measuring devices. J Hypertens 1993; 11: 677–679.O'BrienE]]PetrieJ]]LittlerW]]de SwietM]]PadfieldPL]]AltmanDGAn outline of the revised British Hypertension Society protocol for the evaluation of blood pressure measuring devicesJ Hypertens199311677 8. Mallion JM, de Gaudemaris R, Baguet JP, Azzouzi L, Quesada JL, Sauzeau C, et al. Acceptability and tolerance of ambulatory blood pressure measurement in the hypertensive patient. Blood Press Monit 1996; 1: 197–203.MallionJM]]de GaudemarisR]]BaguetJP]]AzzouziL]]QuesadaJL]]SauzeauCAcceptability and tolerance of ambulatory blood pressure measurement in the hypertensive patientBlood Press Monit19961197 9. Dart RA, Berg RL. The clinical utility of ambulatory blood pressure monitoring in a multispecialty clinic setting. Blood Press Monit 1996; 1: 475–480.DartRA]]BergRLThe clinical utility of ambulatory blood pressure monitoring in a multispecialty clinic settingBlood Press Monit19961475 10. Gardner SF, Schneider EF. 24-hour ambulatory blood pressure monitoring in primary care. J Am Board Fam Pract 2001; 14: 166–171.GardnerSF]]SchneiderEF24-hour ambulatory blood pressure monitoring in primary careJ Am Board Fam Pract200114166 11. Pickering TG, James GD, Boddie C, Harshfield GA, Blank S, Laragh JH. How common is white coat hypertension? JAMA 1988; 259: 225–228.PickeringTG]]JamesGD]]BoddieC]]HarshfieldGA]]BlankS]]LaraghJHHow common is white coat hypertension?JAMA1988259225 12. Brown MA, Buddle ML, Martin A. Is resistant hypertension really resistant? Am J Hypertens 2001; 14: 1263–1269.BrownMA]]BuddleML]]MartinAIs resistant hypertension really resistant?Am J Hypertens2001141263 13. Waeber B, Burnier M, Heynen G, Brunner HR. Clinical utility of ambulatory blood pressure monitoring in the evaluation of patients with borderline hypertension. J Cardiovasc Risk 1994; 1: 120–126.WaeberB]]BurnierM]]HeynenG]]BrunnerHRClinical utility of ambulatory blood pressure monitoring in the evaluation of patients with borderline hypertensionJ Cardiovasc Risk19941120 14. Staessen JA, Byttebier G, Buntinx F, Celis H, O'Brien ET, Fagard R. 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.StaessenJA]]ByttebierG]]BuntinxF]]CelisH]]O'BrienET]]FagardRAntihypertensive treatment based on conventional or ambulatory blood pressure measurement: A randomized controlled trial—Ambulatory Blood Pressure Monitoring and Treatment of Hypertension InvestigatorsJAMA19972781065 15. Verdecchia P, Schillaci G, Guerrieri M, Gatteschi C, Benemio G, Boldrini F, et al. Circadian blood pressure changes and left ventricular hypertrophy in essential hypertension. Circulation 1990; 81: 528–536.VerdecchiaP]]SchillaciG]]GuerrieriM]]GatteschiC]]BenemioG]]BoldriniFCircadian blood pressure changes and left ventricular hypertrophy in essential hypertensionCirculation199081528 16. Redon J, Liao Y, Lozano JV, Miralles A, Pascual JM, Cooper RS. Ambulatory blood pressure and microalbuminuria in essential hypertension: Role of circadian variability. J Hypertens 1994; 12: 947–953.RedonJ]]LiaoY]]LozanoJV]]MirallesA]]PascualJM]]CooperRSAmbulatory blood pressure and microalbuminuria in essential hypertension: Role of circadian variabilityJ Hypertens199412947 17. Timio M, Venanzi S, Lolli S, Lippi G, Verdura C, Monarca C, et al. Night-time blood pressure and progression of renal insufficiency. High Blood Press Cardiovasc Prev 1994; 3: 39–44.TimioM]]VenanziS]]LolliS]]LippiG]]VerduraC]]MonarcaCNight-time blood pressure and progression of renal insufficiencyHigh Blood Press Cardiovasc Prev1994339 18. O'Brien E, Sheridan J, O'Malley K. Dippers and non-dippers. Lancet 1988; 2: 397(letter).O'BrienE]]SheridanJ]]O'MalleyKDippers and non-dippersLancet19882397 19. Shimada K, Kawamoto A, Matsubayashi K, Nishinaga M, Kimura S, Ozawa T. Diurnal blood pressure variations and silent cerebrovascular damage in elderly patients with hypertension. J Hypertens 1992; 10: 875–878.ShimadaK]]KawamotoA]]MatsubayashiK]]NishinagaM]]KimuraS]]OzawaTDiurnal blood pressure variations and silent cerebrovascular damage in elderly patients with hypertensionJ Hypertens199210875 20. Zachariah PK, Sheps SG, Ilstrup DM, Long CR, Bailey KR, Wiltgen CM, et al. Blood pressure load: A better determinant of hypertension. Mayo Clin Proc 1988; 63: 1085–1091.ZachariahPK]]ShepsSG]]IlstrupDM]]LongCR]]BaileyKR]]WiltgenCMBlood pressure load: A better determinant of hypertensionMayo Clin Proc1988631085 21. White WB, Dey HM, Schulman P. Assessment of the daily blood pressure load as a determinant of cardiac function in patients with mild-to-moderate hypertension. Am Heart J 1989; 118: 782–795.WhiteWB]]DeyHM]]SchulmanPAssessment of the daily blood pressure load as a determinant of cardiac function in patients with mild-to-moderate hypertensionAm Heart J1989118782 22. Verdecchia P, Schillaci G, Porcellati C. Dippers versus non-dippers. J Hypertens 1991; 9( Suppl 8): S42–S44.VerdecchiaP]]SchillaciG]]PorcellatiCDippers versus non-dippersJ Hypertens19919S42 23. Pickering TG. The clinical significance of diurnal blood pressure variations: Dippers and nondippers. C irculation 1990; 81: 700–702.PickeringTGThe clinical significance of diurnal blood pressure variations: Dippers and nondippersCirculation199081700 24. Ohkubo T, Imai Y, Tsuji I, Nagai K, Watanabe N, Minami N, et al. Relation between nocturnal decline in blood pressure and mortality: The Ohasama Study. Am J Hypertens 1997; 10: 1201–1207.OhkuboT]]ImaiY]]TsujiI]]NagaiK]]WatanabeN]]MinamiNRelation between nocturnal decline in blood pressure and mortality: The Ohasama StudyAm J Hypertens1997101201 25. Suzuki M, Guilleminault C, Otsuka K, Shiomi T. Blood pressure “dipping” and “non-dipping” in obstructive sleep apnea syndrome patients. Sleep 1996; 19: 382–387.SuzukiM]]GuilleminaultC]]OtsukaK]]ShiomiTBlood pressure “dipping” and “non-dipping” in obstructive sleep apnea syndrome patientsSleep199619382 26. Pankow W, Nabe B, Lies A, Becker H, Kohler U, Kohl FV, et al. Influence of sleep apnea on 24-hour blood pressure. Chest 1997; 112: 1253–1258.PankowW]]NabeB]]LiesA]]BeckerH]]KohlerU]]KohlFVInfluence of sleep apnea on 24-hour blood pressureChest19971121253 27. Staessen JA, Thijs L, Fagard R, O'Brien ET, Clement D, de Leeuw PW, et al. Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension: Systolic Hypertension in Europe Trial Investigators. JAMA 1999; 282: 539–546.StaessenJA]]ThijsL]]FagardR]]O'BrienET]]ClementD]]de LeeuwPWPredicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension: Systolic Hypertension in Europe Trial InvestigatorsJAMA1999282539 28. Perloff D, Sokolow M, Cowan R. The prognostic value of ambulatory blood pressures. JAMA 1983; 249: 2792–2798.PerloffD]]SokolowM]]CowanRThe prognostic value of ambulatory blood pressuresJAMA19832492792 29. Ohkubo T, Imai Y, Tsuji I, Nagai K, Watanabe N, Minami N, et al. Prediction of mortality by ambulatory blood pressure monitoring versus screening blood pressure measurements: A pilot study in Ohasama. J Hypertens 1997; 15: 357–364.OhkuboT]]ImaiY]]TsujiI]]NagaiK]]WatanabeN]]MinamiNPrediction of mortality by ambulatory blood pressure monitoring versus screening blood pressure measurements: A pilot study in OhasamaJ Hypertens199715357 30. O'Brien E, Murphy J, Tyndall A, Atkins N, Mee F, McCarthy G, et al. Twenty-four-hour ambulatory blood pressure in men and women aged 17 to 80 years: The Allied Irish Bank Study. J Hypertens 1991; 9: 355–360.O'BrienE]]MurphyJ]]TyndallA]]AtkinsN]]MeeF]]McCarthyGTwenty-four-hour ambulatory blood pressure in men and women aged 17 to 80 years: The Allied Irish Bank StudyJ Hypertens19919355 31. Ohkubo T, Imai Y, Tsuji I, Nagai K, Ito S, Satoh H, et al. Reference values for 24-hour ambulatory blood pressure monitoring based on a prognostic criterion: The Ohasama Study. Hypertension 1998; 32: 255–259.OhkuboT]]ImaiY]]TsujiI]]NagaiK]]ItoS]]SatohHReference values for 24-hour ambulatory blood pressure monitoring based on a prognostic criterion: The Ohasama StudyHypertension199832255 32. Staessen JA, Bieniaszewski L, O'Brien ET, Imai Y, Fagard R. An epidemiological approach to ambulatory blood pressure monitoring: The Belgian Population Study. Blood Press Monit 1996; 1: 13–26.StaessenJA]]BieniaszewskiL]]O'BrienET]]ImaiY]]FagardRAn epidemiological approach to ambulatory blood pressure monitoring: The Belgian Population StudyBlood Press Monit1996113 33. Mancia G, Sega R, Bravi C, De Vito G, Valagussa F, Cesana G, et al. Ambulatory blood pressure normality: Results from the PAMELA study. J Hypertens 1995; 13: 1377–1390.ManciaG]]SegaR]]BraviC]]De VitoG]]ValagussaF]]CesanaGAmbulatory blood pressure normality: Results from the PAMELA studyJ Hypertens1995131377 34. Staessen JA, O'Brien ET, Amery AK, Atkins N, Baumgart P, De Cort P, et al. Ambulatory blood pressure in normotensive and hypertensive subjects: Results from an international database. J Hypertens Suppl 1994; 12: S1–S12.StaessenJA]]O'BrienET]]AmeryAK]]AtkinsN]]BaumgartP]]De CortPAmbulatory blood pressure in normotensive and hypertensive subjects: Results from an international databaseJ Hypertens Suppl199412S1 35. Rasmussen SL, Torp-Pedersen C, Borch-Johnsen K, Ibsen H. Normal values for ambulatory blood pressure and differences between casual blood pressure and ambulatory blood pressure: Results from a Danish population survey. J Hypertens 1998; 16: 1415–1424.RasmussenSL]]Torp-PedersenC]]Borch-JohnsenK]]IbsenHNormal values for ambulatory blood pressure and differences between casual blood pressure and ambulatory blood pressure: Results from a Danish population surveyJ Hypertens1998161415 36. Anwar YA, White WB. Ambulatory monitoring of blood pressure, in White WB (ed): Blood Pressure Monitoring in Cardiovascular Medicine and Therapeutics (Contemporary Cardiology series). Totowa, NJ, Humana Press, 2001, pp 57–75. 37. Moser M. Hypertension can be treated effectively without increasing the cost of care. J Hum Hypertens 1996; 10( Suppl 2): S33–S38.MoserMHypertension can be treated effectively without increasing the cost of careJ Hum Hypertens199610S33 38. Yarows SA. Ambulatory blood pressure monitoring. JAMA 1998; 279: 196–197(letter).YarowsSAAmbulatory blood pressure monitoringJAMA1998279196 39. Krakoff LR. Ambulatory blood pressure monitoring can improve cost-effective management of hypertension. Am J Hypertens 1993; 6: 220S–224S.KrakoffLRAmbulatory blood pressure monitoring can improve cost-effective management of hypertensionAm J Hypertens19936220S 40. Pierdomenico SD, Mezzetti A, Lapenna D, Guglielmi MD, Mancini M, Salvatore L, et al. “White-coat” hypertension in patients with newly diagnosed hypertension: Evaluation of prevalence by ambulatory monitoring and impact on cost of health care. Eur Heart J 1995; 16: 692–697.PierdomenicoSD]]MezzettiA]]LapennaD]]GuglielmiMD]]ManciniM]]SalvatoreL“White-coat” hypertension in patients with newly diagnosed hypertension: Evaluation of prevalence by ambulatory monitoring and impact on cost of health careEur Heart J199516692