Ambulatory Blood Pressure Monitoring Is Ready to Replace Clinic Blood Pressure in the Diagnosis of HypertensionResponse to Ambulatory Blood Pressure Monitoring Is Ready to Replace Clinic Blood Pressure in the Diagnosis of Hypertension: Pro Side of the Argument

摘要

Since the introduction of lightweight ambulatory blood pressure (BP) monitoring (ABPM) devices into clinical use in the late 1980s, there has been a huge increase in their contribution not only to fundamental research on the diurnal patterns of BP in humans, but increasingly for the diagnosis of hypertension. Clearly, the recognition of the value of multiple readings for accuracy and the detection of white coat, masked, and nocturnal hypertension has been critical to correctly determine the extent and impact of hypertension in the community. Importantly, the prognostic value of ABPM for cardiovascular events has been a major impetus for the promotion of its widespread adoption in primary care. National and International guidelines have largely been supportive of this move, and the United Kingdom leads the way by adopting ABPM to diagnose hypertension in primary care.1 Thus, the question of whether ABPM is ready to replace clinic measurements for the diagnosis of hypertension is passé for some but still relevant for others. In either case, the arguments for and against need to be carefully considered as there are major implications to the way cardiovascular healthcare services are delivered. The case for using ABPM for the diagnosis is strong given that clinic measurements even when performed to best practice standards misdiagnose hypertension in ≈30% of individuals (see below). The evidence is so convincing that the medico-legal issue of NOT performing ABPM to diagnose hypertension has been raised.2 On the contrary, there is resistance to using ABPM particularly in some quarters exemplified by the editorial in 2011 that suggested that ABPM is not ready for prime time.3 The arguments presented are largely related to resources and costs and suggested alternatives.In order therefore to consider this important question, we need to first evaluate the medical imperative for the use of …