Clinical Use of Ambulatory Blood Pressure Monitoring: A Critical Appraisal

Traditional sphygmomanometric techniques are heavily affected by the ‘white-coat’ effect and cannot be used to assess blood pressure variability over the 24 h period. These limitations can be overcome in part using ambulatory monitoring, which (1) quantifies both the mean and the variability of blood pressure over 24 h, including blood pressure fluctuations between day and night, (2) does not trigger any alerting reaction in the patient, (3) provides reproducible 24 h blood pressure means and (4) allows the action of antihypertensive drugs to be assessed over 24 h without interference from a placebo effect. Moreover, ambulatory blood pressure values are more closely related to the end-organ damage associated with hypertension than are isolated clinic readings. However, the limited accuracy of ambulatory monitoring in ambulant individuals, the lack of normal reference values for 24 h blood pressure and the need for a longitudinal demonstration of the prognostic value of the technique do not permit the reco...