Clinical use of ambulatory blood pressure monitoring

This paper describes the alerting reaction and blood pressure rise induced in the patient when blood pressure measurement is taken by the doctor, emphasizing that this may be responsible for important errors in estimating the real untreated or treated blood pressure in hypertension. It then examines the advantages offered by ambulatory blood pressure monitoring. It is shown that when performed intra-arterially this approach may be useful in the diagnosis of pheochromocytoma. However, its wider use as a means to better discriminate between normotensive and borderline or mild hypertensive subjects should not yet be advocated because information on normalcy of ambulatory blood pressure values is limited. Furthermore, although target organ damage of hypertension correlates more closely with 24-hour or day-time blood pressure mean than with sphygmomanometric values, there is insufficient prospective evidence that ambulatory blood pressure is prognostically superior to cuff blood pressure. Finally, noninvasive ambulatory blood pressure monitoring (ie, the only approach suitable for clinical practice) is not accurate because of the relatively large number of artifactual readings and their limited correspondence to intra-arterial values.