The role of twenty-four-hour ambulatory blood pressure measurement in clinical practice

Twenty-four-hour ambulatory blood pressure monitoring is passing from research into clinical practice and it is necessary to clarify circumstances for which 24-h ambulatory measurement will be most beneficial. Devices should be accurate and reasonably priced. The operator should be able to interpret 24-h recordings and be familiar with the operation of the equipment. The subject must be capable of complying with the instructions necessary for successful use of the device. In diagnosis, 24-h ambulatory blood pressure measurement is particularly useful in deciding whether subjects with borderline hypertension have a genuinely elevated blood pressure, in identifying white-coat hypertension, in determining dipper status and in diagnosing symptomatic hypotension. In the management of antihypertensive drug treatment, the technique helps the clinician to select the drug best suited to the individual patient in terms of duration of action and suitability for the individual 24-h profile; the technique also identifies any excessive reduction in blood pressure and provides a means of assessing resistant cases of hypertension.