Ambulatory blood pressure monitoring in Australia: 2011 consensus position statement
2012
Objective:
Although most national guidelines for the
diagnosis and management of hypertension emphasize
that the initiation and modification of blood pressure
(BP)-lowering treatment should be related to absolute
cardiovascular disease (CVD) risk, there is only limited
information on how to incorporate ambulatory BP (ABP)
monitoring into this framework. The objective of this
initiative is to provide ABP equivalents for BP cut-points for
treatment initiation and targets to be included into
guidelines. Methods:
A critical analysis of the best available evidence
from clinical trials and observational studies was undertaken
to develop a new consensus statement for ABP monitoring. Results:
ABP monitoring has an important place in
defining abnormal patterns of BP, particularly white-coat
hypertension (including in pregnancy), episodic
hypertension, masked hypertension, labile BP and
nocturnal or morning hypertension. This consensus
statement provides a framework for appropriate inclusion
of ABP equivalents for low, moderate and high CVD risk
patients. The wider use of ABP monitoring, although
justified, is limited by its availability and cost due to the
lack of medical subsidy in Australia. However, cost–benefit
analysis does suggest a cost-saving in reduced numbers of
inappropriate antihypertensive treatments. Conclusion:
Although clinic measurement of BP will
continue to be useful for screening and management of
suspected and true hypertension, ABP monitoring provides
considerable added value toward accurate diagnosis and the
provision of optimal care in uncomplicated hypertension, as
well as for patients with moderate or severe CVD risk.
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