Open AccessHow should ambulatory blood pressure measurement be used in general practice?
Author(s) -
Dolan Eamon,
O'Brien Eoin
Publication year - 2017
Publication title -
the journal of clinical hypertension
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.909
H-Index - 67
eISSN - 1751-7176
pISSN - 1524-6175
DOI - 10.1111/jch.12952
Subject(s) - medicine , masked hypertension , white coat hypertension , reimbursement , ambulatory blood pressure , intensive care medicine , blood pressure , ambulatory , clinical practice , antihypertensive drug , pediatrics , physical therapy , health care , economics , economic growth
Current guidelines on hypertension now accept that ambulatory blood pressure (BP) measurement (ABPM) is the measurement method of choice for diagnosing hypertension. The technique has been shown to be more accurate and more cost effective than office BP (OBPM) or selfmeasurement of BP (SBPM). The diagnostic superiority of ABPM derives mainly from the ability of the technique to identify sustained hypertension by allowing for the exclusion of whitecoat hypertension and by demonstrating the presence of masked hypertension. ABPM also offers diagnostic insights into nocturnal patterns of BP, and, despite less attention being given to nighttime BP in clinical practice, the increased risk of stroke with elevated nocturnal BP makes it important to assess the response to BPlowering medication during sleep. Surprisingly, although current guidelines give detailed recommendations on the diagnostic potential and use of ABPM, there are scant recommendations on the benefits and application of the technique for the initiation of BPlowering therapy in clinical practice and virtually no recommendations as to how it might be used to assess the efficacy of drug treatment and guide the prescribing physician on the most appropriate drug administration and dosage over time. Furthermore, the limited availability of ABPM to date has confined its use to the diagnosis of hypertension, rather than applying the technique to gauging more reliably the response to treatment, especially in patients at high risk, who may be taking a number of BPlowering drugs. The increasing approval of ABPM for reimbursement in many countries is an overdue and welcome initiative, which, although incurring substantial initial shortterm costs, will lead to improved BP control in the longer term and substantial savings in the prevention of the cardiovascular (CV) consequences of hypertension, most especially the prevention of stroke. However, we are now faced with a responsibility to use ABPM to achieve the maximum benefit, without applying the technique excessively. 2 | ABPM FOR THE DIAGNOSIS OF HYPERTENSION