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RESEARCH PRODUCT

Ambulatory blood pressure monitoring is ready to replace clinic blood pressure in the diagnosis of hypertension: con side of the argument.

subject

description

The San Francisco experience with Perloff and Sokolow was the starting point for the clinical application of ambulatory blood pressure (ABP) measurement. Using a semiautomatic device, the superiority of ABP to office measurement was demonstrated in the relationship with hypertension-induced organ damage1 and in the risk for cardiovascular events.2 This seminal study impelled an issue with the largest production and impact in the field of hypertension in recent decades, boosting research and having an enormous influence on daily clinical practice. Initially restricted to specialized clinics, ABP monitoring (ABPM) has largely expanded to primary care in many countries. Similarly, scientific production has increased extraordinarily. The number of articles that include 24-hour ABPM in the title or abstract has grown exponentially from the beginning of the 1990s to ≈600 articles per year. Fifty years on from the pioneering work, ABPM is now considered a keystone in hypertension management. Several guidelines and consensus have been published with recommendations for the monitoring process, reference values, and clinical and research use.3–6 Recently, the ESH-ESC 2013 guidelines7 upgraded the importance of out-of-office BP measurement for hypertension management, and the NICE guidelines8 recommend that, “If the clinic BP is 140/90 mm Hg or higher, offer ABPM to confirm the diagnosis of HTN.” Likewise, the Canadian Education Program in Hypertension9 recommended, “At visit 2 for the assessment of hypertension, patients without macrovascular target organ damage, diabetes mellitus, or CKD but with BP lower than 180/110 mm Hg, should undergo further evaluation using repeated office BP, ABPM or home monitoring.” Moreover, a recent full document10 and a summary11 from the European Working Group on BP Monitoring updated the information available and emphasized fundamentals and recommendations. More recent guidelines in hypertension management from the American Heart Association12 and from …