Ambulatory Blood Pressure Monitoring Is Ready to Replace Clinic Blood Pressure in the Diagnosis of Hypertension

Controversies in Hypertension 1175s ince the introduction of lightweight ambulatory blood pressure (Bp) monitoring (ABpM) devices into clinical use in the late 1980s, there has been a huge increase in their contribution not only to fundamental research on the diurnal patterns of Bp in humans, but increasingly for the diagnosis of hypertension.Clearly, the recognition of the value of multiple readings for accuracy and the detection of white coat, masked, and nocturnal hypertension has been critical to correctly determine the extent and impact of hypertension in the community.importantly, the prognostic value of ABpM for cardiovascular events has been a major impetus for the promotion of its widespread adoption in primary care.national and international guidelines have largely been supportive of this move, and the United Kingdom leads the way by adopting ABpM to diagnose hypertension in primary care. 1 thus, the question of whether ABpM is ready to replace clinic measurements for the diagnosis of hypertension is passé for some but still relevant for others.in either case, the arguments for and against need to be carefully considered as there are major implications to the way cardiovascular healthcare services are delivered.the case for using ABpM for the diagnosis is strong given that clinic measurements even when performed to best practice standards misdiagnose hypertension in ≈30% of individuals (see below). the evidence is so convincing that the medico-legal issue of not performing ABpM to diagnose hypertension has been raised.2 on the contrary, there is resistance to using ABpM particularly in some quarters exemplified by the editorial in 2011 that suggested that ABpM is not ready for prime time.3 the arguments presented are largely related to resources and costs and suggested alternatives.in order therefore to consider this important question, we need to first evaluate the medical imperative for the use of ABpM over other alternatives to determine whether they match the diagnostic sensitivity of ABpM.second, we need to determine whether the barriers of implementation really exist or whether they are simply inertia to change.it is understandable that the office/clinic measurement of Bp has been the cornerstone of clinical screening for hypertension, but is also used for a myriad of other reasons in assessing patient's health and condition.this should continue and be improved with wider use of automated office Bp devices.However, the proper diagnosis of hypertension requires a much more accurate assessment of the patient's Bp during their normal active life, during the night, and importantly, during the sleeping period, which is afforded only by ABpM.Although the current brief is to support the case that ABpM is ready to replace clinic Bp in the diagnosis of hypertension, it is not to discuss the growing support for the use of ABpM in guiding drug treatment or 24-hour efficacy of drug treatment, which is a separate but still important issue. ABPM Is the Most Accurate Method for Diagnosisof the 3 most common modalities for the assessment of Bp, clinic, home, and ambulatory, the latter has been well recognized to best reflect the individual's Bp profile over the 24-hour period.4,5 Current estimates from 3 studies suggest that clinic the opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.