Ambulatory blood pressure monitoring for the management of hypertension

Abstract

Ambulatory blood pressure monitoring (ABPM) has become indispensable in the current management of hypertension. ABPM is particularly useful in the accurate diagnosis of hypertension. Its diagnostic thresholds had been recently established based on hard clinical outcomes. Cross-classification of patients according to office and ambulatory blood pressure identifies white-coat, masked, and sustained hypertension. ABPM is also useful in cardiovascular (CV) risk assessment. It provides information on daytime and nighttime blood pressure and circadian rhythm, particularly nighttime blood pressure dipping. Nighttime blood pressure is predictive of CV risk independent of office and daytime blood pressure. Isolated nocturnal hypertension is a special form of masked hypertension, with normal daytime but elevated nocturnal blood pressure. It also helps in the evaluation of blood pressure fluctuation and variation, such as morning blood pressure surge and reading-to-reading blood pressure variability. ABPM may derive several other indexes, such as ambulatory blood pressure index and salt sensitivity index, which may be useful in CV evaluations.

A review: Blood pressure monitoring based on PPG and circadian rhythm

“…BP exhibits a circadian rhythm, with a decline during sleep and a gradual increase upon awakening. 86 In 1988, O'Brien et al 87 reported that individuals with a mean diurnal BP difference of less than 10 or 5 mm Hg had a history of recurrent stroke; these individuals are referred to as non-dippers. 87 Normally, blood pressure decreases by approximately 10%–20% during the night compared to daytime levels, which defines the dipper pattern.…”