Ambulatory Blood Pressure Monitoring
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Contents |
Indications
- assessment of 'white coat' hypertension
- borderline hypertension with target-organ damage
- abrupt changes in blood pressure, episodic hypertension
- hypotensive symptoms with treatment of chronic hypertension [4]
- possible nocturnal rise in blood pressure
- due to inadequate duration of antihypertensive therapy
- hypertension resistant to drug therapy
- possible autonomic dysfunction
- heart rate patterns do not correlate with blood pressure
Clinical-significance
- results correlate with left ventricular hypertrophy better than office-based measurements
- 24 hour ambulatory BP appear to have independent prognostic value, beyond that office measurements. [2]
- for each level of office BP, 24 hour systolic BPs of > 135 mm Hg had 2-3 fold increased risk of adverse cardiovascular events [2]
- mean 24 hour BPs are generally lower than mean of office-based BPs, 21/9 mm Hg in one study [2]
- nocturnal hypertension may be more predictive of mortality [4]
Notes
- cost-effective in primary care [3]
- home blood pressure monitoring may be an acceptable alternative in certain circumstances
More General Terms
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
- Journal Watch 23(14):109, 2003 Clement DL et al, NEJM 348(24):2407, 2003
- Lovibond K et al. Cost-effectiveness of options for the diagnosis of high blood pressure in primary care: A modelling study. Lancet 2011 Aug 24 <PubMed> PMID: [1] <Internet> [2]
- Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
