24 Hour Ambulatory Blood Pressure Monitoring: Is it Necessary to Establish a Diagnosis Before Instituting Treatment of Hypertension?
24 hour ambulatory blood pressure monitoring (ABPM) has been available for many years as a research tool, and is gradually finding its way into clinical practice, despite a general lack of reimbursement in the U.S. Although clinic readings remain the mainstay of blood pressure measurement, they may misrepresent the true blood pressure in a substantial number of patients. Reasons for this include poor measurement technique, the small number of readings that can be taken, and the white coat effect. Both home monitoring and ABPM can overcome these limitations: the former is superior for assessing changes of blood pressure over time, and the latter for assessing the true blood pressure. The major clinical indications for ABPM include newly diagnosed hypertensives in whom there is no target organ damage, patients with suspected white coat hypertension, and some patients with resistant hypertension. Home monitoring may be used as an initial screening test in these patients. (c)1999 by Le Jacq Communications, Inc.
Pickering
Thomas G.
TG
New York Presbyterian Hospital, New York, NY.