Ambulatory blood pressure monitoring in clinical practice: a review

Abstract

Ambulatory blood pressure monitoring offers the ability to collect blood pressure readings several times an hour across a 24-hour period. Ambulatory blood pressure monitoring facilitates the identification of white-coat hypertension, the phenomenon whereby certain individuals who are not taking antihypertensive medication show elevated blood pressure in a clinical setting but show nonelevated blood pressure averages when assessed by ambulatory blood pressure monitoring. In addition, readings can be segmented into time windows of particular interest, for example, mean daytime and nighttime values. During sleep, blood pressure typically decreases, or dips, such that mean sleep blood pressure is lower than mean awake blood pressure. A nondipping pattern and nocturnal hypertension are strongly associated with increased cardiovascular morbidity and mortality. Approximately 70% of individuals have blood pressure dips of ≥10% at night, whereas 30% have nondipping patterns, when blood pressure remains similar to daytime average or occasionally increases above daytime average. The various blood pressure categorizations afforded by ambulatory blood pressure monitoring are valuable for clinical management of high blood pressure because they increase the accuracy for diagnosis and the prediction of cardiovascular risk.

Keywords: Ambulatory blood pressure monitoring; High blood pressure; Masked hypertension; Nocturnal blood pressure; White-coat hypertension.

Copyright © 2015 Elsevier Inc. All rights reserved.

Figures

FIGURE. Graph of 24-Hour Ambulatory Blood Pressure Monitoring Data

The shaded portion indicates the sleep period. This patient had 8 measurements recorded during sleep and 29 measurements while awake. The overall average is 130/79 mm Hg. Awake average is 134/82 mm Hg, and sleep average is 115/70 mm Hg, for a nocturnal systolic BP dip of 14%.