24-hour blood pressure monitoring in clinical practice: do we overestimate its value?

Ambulatory 24-hour blood pressure (BP) monitoring (24-h BPM) occupies its right place as one of the greatest advances in cardiology. By paying a well-deserved tribute to the evident advantages of this technique, is the question of whether this expensive labor-intensive method that is burdensome for a patient and provides very much information is optimally used in clinical practice and whether we always consider the findings critically rightful? Many cross-sectional and longitudinal studies have demonstrated that ambulatory BP is closer correlated with target organ lesions than clinical BP and it is of greater prognostic value for the development of cardiovascular complications. By interpreting the data of these studies, it should be remembered that while on the subject of clinical BP, we mean the mean value of less than 10 measurements of BP over a short period of time while 24-h BPM provides information on several tens of BP measurements. There is evidence for the fact that only patients with a good reproducibility of 24-h BPM exhibit a closer correlation of the latter with lesion to target organs than that with clinical BP. Most patients with arterial hypertension may be followed up with repeated clinical measurements of BP or its self-control. But 24-h BPM is the method of choice in assessing patients with wide variations in clinical and domestic BP, the symptoms of hypotension, sporadic hypertension, unexplained target organ lesions. 24-h BPM preserves its leading role in evaluating the antihypertensive efficacy of novel drugs under the conditions of clinical studies.