Clinical usefulness of ambulatory blood pressure monitoring

During the last decade, ambulatory blood pressure monitoring (ABPM) made a transition from a method reserved for clinical investigators to a technique considered useful by practicing physicians in assessing certain problems in hypertension. Recent recommendations of the National High Blood Pressure Education Program (NHBPEP) Working Group on Ambulatory Blood Pressure Monitoring suggested using ABPM for a number of clinical problems, including borderline hypertension without target organ damage, evaluation of drug resistance, and white-coat hypertension. We evaluated the clinical indications for ordering ABPM by Connecticut physicians both in hospital and community-based practices. Through specific questionnaires, the clinical indications used by referring physicians to order ABPM and their inclinations for future use of the methodology were assessed. Forty-seven of 70 physicians (65%) responded to the questionnaire, basing their answers on 237 patients. The majority of physicians were internists (57%) or cardiologists (25%). Leading indications for patient referral for ABPM included borderline hypertension (27%), assessment of drug therapy/BP control (25%), and possible white-coat hypertension (22%). Far fewer referrals were observed for severe hypertension or as a routine test for the diagnosis of hypertension. These data suggest that practicing physicians have become aware of the usefulness of ambulatory blood pressure recordings and are following the NHBPEP guidelines on referral for the study.