ambulatory blood pressure monitoring (ABPM)
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Indications
- assessment of 'white coat' hypertension
- borderline hypertension with target-organ damage
- abrupt changes in blood pressure, episodic hypertension
- hypotensive symptoms with treatment of chronic hypertension[4]
- possible nocturnal rise in blood pressure
- due to inadequate duration of antihypertensive therapy
- hypertension resistant to drug therapy
- possible autonomic dysfunction
- heart rate patterns do not correlate with blood pressure
- reference standard for confirming a diagnosis of chronic hypertension[5]
Contraindications
- not indicated for evaluation of prehypertension[1]
Reference interval
- 24 hour average blood pressure < 115/75 mm Hg
- daytime average blood pressure < 120/80 mm Hg
- nighttime average blood pressure < 100/65 mm Hg[1]
Clinical significance
- goals: daytime systolic BP < 135 mm Hg; night systolic BP < 125 mm Hg
- systolic BP goals correspond with threshold for treatment with antihypertensive agent[1]
- systolic BP correlates more with all-cause & cardiovascular mortality than diastolic BP[12]
- results correlate with left ventricular hypertrophy better than office-based measurements
- 24 hour ambulatory BP appears to have independent prognostic value, beyond that office measurements[2][12]
- better predictor of cardiovascular outcomes than office-based blood pressure measurements, including left ventricular hypertrophy & cardiac death[1]
- hypertension assessed by ambulatory blood pressure monitoring is associated with a higher risk of cardiovascular death than hypertension determined in the office or at home[1]
- 24 hour ambulatory systolic BP better predictor of all-cause & cardiovascular mortality than clinic systolic BP[12]
- nighttime systolic BP better predictor of all-cause & cardiovascular mortality than daytime systolic BP[12] (24 hour ambulatory monitoring)
- patients with masked hypertension at risk for excess all-cause mortality whereas patients with white-coat hypertension are not[12]
- for each level of office BP, 24 hour systolic BPs of > 135 mm Hg have 2-3 fold increased risk of adverse cardiovascular events[2]
- mean 24 hour BPs are generally lower than mean of office-based BPs, 21/9 mm Hg in one study[2]
- ambulatory BP is, on average, 7/2 mm Hg higher than clinic BP[8]
- 15-20% of ambulatory BP measurements elevated not a concern if average ambulatory BP ok[1]
- nocturnal blood pressure should be ~15% lower than daytime blood pressure (example of 16%/12% lower nocturnal BP ok)[1]
- nocturnal hypertension may be more predictive of mortality[4]
- increased systolic BP during sleep is associated with higher risks for stroke & cardiovascular disease[10]
- a graphene bioimpedance tattoo placed over the radial artery & ulnar artery, just above the wrist can monitor arterial blood pressure for > 300 minutes with high accuracy[1]
Notes
- cost-effective in primary care[3]
- home blood pressure monitoring may be an acceptable alternative[1]
- Proof BP calculator suggested as a surrogate for ambulatory blood pressure monitor[9]
More general terms
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 Medical Knowledge Self Assessment Program (MKSAP) 11, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2015, 2018, 2021.
- ↑ 2.0 2.1 2.2 2.3 Journal Watch 23(14):109, 2003 Clement DL, De Buyzere ML, De Bacquer DA et al Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension. NEJM 348(24):2407, 2003 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12802026
- ↑ 3.0 3.1 Lovibond K et al. Cost-effectiveness of options for the diagnosis of high blood pressure in primary care: A modelling study. Lancet 2011 Aug 24 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21868086 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61184-7/fulltext
- ↑ 4.0 4.1 4.2 Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
- ↑ 5.0 5.1 Siu AL on behalf of the U.S. Preventive Services Task Force Screening for High Blood Pressure in Adults: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. Published online 13 October 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26458123 <Internet> http://annals.org/article.aspx?articleid=2456129
Shimbo D et al. Role of ambulatory and home blood pressure monitoring in clinical practice: A narrative review. Ann Intern Med 2015 Oct 13 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26457954 - ↑ Minutolo R et al Prognostic Role of Ambulatory Blood Pressure Measurement in Patients With Nondialysis Chronic Kidney Disease Arch Intern Med. 2011;171(12):1090-1098. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21709109 <Internet> http://archinte.ama-assn.org/cgi/content/short/171/12/1090
- ↑ Pierdomenico SD, Cuccurullo F. Prognostic value of white-coat and masked hypertension diagnosed by ambulatory monitoring in initially untreated subjects: an updated meta analysis. Am J Hypertens. 2011 Jan;24(1):52-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20847724
- ↑ 8.0 8.1 Schwartz JE, Burg MM, Shimbo D et al Clinic Blood Pressure Underestimates Ambulatory Blood Pressure in an Untreated Employer-Based US Population. Circulation. 2016;134:1794-1807 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27920072 <Internet> http://circ.ahajournals.org/content/134/23/1794
- ↑ 9.0 9.1 Sheppard JP et al. Prospective external validation of the Predicting Out-of-Office Blood Pressure (PROOF-BP) strategy for triaging ambulatory monitoring in the diagnosis and management of hypertension: Observational cohort study. BMJ 2018 Jun 27; 361:k2478 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29950396 Free PMC Article https://www.bmj.com/content/361/bmj.k2478
- ↑ 10.0 10.1 Kario K et al. Nighttime blood pressure phenotype and cardiovascular prognosis: Practitioner-based nationwide JAMP study. Circulation 2020 Nov 2; PMID: https://www.ncbi.nlm.nih.gov/pubmed/33131317 https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.049730
- ↑ Kireev D et al. Continuous cuffless monitoring of arterial blood pressure via graphene bioimpedance tattoos. Nat Nanotechnol 2022 Jun 20 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35725927 https://www.nature.com/articles/s41565-022-01145-w
- ↑ 12.0 12.1 12.2 12.3 12.4 12.5 Staplin N et al. Relationship between clinic and ambulatory blood pressure and mortality: An observational cohort study in 59,124 patients. Lancet 2023 May 5; PMID: https://www.ncbi.nlm.nih.gov/pubmed/37156250 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00733-X/fulltext