Info For Doctors
Taken from the HBPRCA - NHF Consensus Statement update 2012
*Rationale for Use of Ambulatory Blood Pressure (ABP) Monitoring
While traditional management of hypertension has relied on clinic assessment of blood pressure (BP), increasing evidence strongly suggests that measurement of BP outside the clinic by ABP and/or home BP devices provides a more robust assessment of a patient’s actual BP throughout the day and the night [see also NHF, BHS/NICE and ESH guidelines]. Importantly, prospective studies have shown that ABP is a stronger predictor of clinical outcomes (such as myocardial infarction and stroke) than conventional clinic BP measurements. ABP is currently the only practical method to detect a lack of nocturnal dipping which has been shown to be associated with increased risk of stroke, end-organ damage and cardiovascular events including death. ABP monitoring has an important place in defining abnormal patterns of BP, particularly white-coat hypertension, episodic hypertension, and nocturnal or morning hypertension. ABP monitoring is also useful for evaluating labile clinic BP or for determining whether the presence of end-organ damage in the setting of normal clinic BP is due to masked hypertension. Due to its accuracy ABP can be used for risk stratification prior to commencing an antihypertensive drug regimen and for assessing adequacy of treatment. Recent publication of ABP equivalents for definitions of hypertension and threshold targets for BP can assist with the long-term management of the hypertensive patient at high cardiovascular risk. For these reasons the NHF/HBPRCA position is to suggest that ABP should be more widely used in conjunction with clinic and home based monitoring in the diagnosis and management of patients with hypertension.
Practical and cost considerations
ABP monitoring is a specialised technique that requires training, skills and experience, validated and well-calibrated monitors, and the use of correct cuff sizes and appropriate protocols. Only devices validated and approved (reaching grade A) by international standards (British Hypertension Society or American Association for the Advancement of Medical Instrumentation) should be used for ABP monitoring. The wider use of ABP monitoring while being well justified, is limited by its availability and cost due to the lack of Medicare subsidy. However, cost benefit analysis does suggest a cost saving in reduced numbers of inappropriate antihypertensive prescriptions.
*For detailed information including an extensive bibliography of supporting evidence please refer to the source paper “Consensus Statement 2012. Ambulatory blood pressure monitoring.” National Heart Foundation of Australia and the High Blood Pressure Research Council of Australia.