Expanding the Use of Ambulatory Blood Pressure Monitoring for the Diagnosis and Management of Patients With Hypertension
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For patients with hypertension and their physicians who care for them, assessment of blood pressure (BP) over 24 hours with an automated monitor has considerable appeal. When done properly, ambulatory BP recordings yield far more reproducible values over fairly long periods of time compared with the doctor’s office BP.1 Because ambulatory BP monitoring yields multiple readings during all of a patient’s activities, including the sleeping period and time at work, this method gives a more comprehensive representation of the vascular burden of hypertension than a small number of BP readings in the office of a clinician.2,3 In fact, recent analyses of cohorts of patients with both untreated and treated hypertension followed for up to a decade have typically shown that ambulatory BP has better predictive values for future cardiovascular events than clinical measurements of BP.4,5
When the usefulness of ambulatory BP monitoring became recognized early on by hypertension specialists, the focus of its use was for the evaluation of white-coat hypertension. Unfortunately, the definition of white-coat hypertension has varied a great deal in the medical literature because of arbitrary differences between clinical measurements and various components of the ambulatory BP, such as 24-hour mean, daytime, or awake periods.6 The variability of the definition of white-coat hypertension in the prognostic studies and the duration of follow-up for cardiovascular outcomes has made direct comparisons among these studies difficult, if …