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Concept
Ambulatory blood pressure
Summary
Ambulatory blood pressure monitoring (ABPM) measures blood pressure at regular intervals. It is believed to be able to reduce the white coat hypertension effect in which a patient's blood pressure is elevated during the examination process due to nervousness and anxiety caused by being in a clinical setting. ABPM can also detect the reverse condition, masked hypertension, where the patient has normal blood pressure during the examination but uncontrolled blood pressure outside the clinical setting, masking a high 24-hour average blood pressure. Out-of-office measurements are highly recommended as an adjunct to office measurements by almost all hypertension organizations.
24-hour, non-invasive ambulatory blood pressure (BP) monitoring allows estimates of cardiac risk factors including excessive BP variability or patterns of circadian variability known to increase risks of a cardiovascular event.
Ambulatory blood pressure monitoring allows blood pressure to be intermittently monitored during sleep and is useful to determine whether the patient is a "dipper" or "non-dipper"—that is to say, whether or not blood pressure falls at night compared to daytime values. A nighttime fall is normal and desirable. It correlates with relationship depth, and also other factors such as sleep quality, age, hypertensive status, marital status, and social network support. Absence of a nighttime dip is associated with poorer health outcomes; a 2011 study found increased mortality. Nocturnal hypertension is also associated with end organ damage, and is a much better indicator than the daytime blood pressure reading.
End organ damage
Readings revealing possible hypertension-related end organ damage, such as left ventricular hypertrophy or narrowing of the retinal arteries, are more likely to be obtained through ambulatory blood pressure monitoring than through clinical blood pressure measurement. Isolated clinical BP measurements are more subject to the general marked variability of BP measurements.
Official source
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