Fortnightly Review: Ambulatory blood pressure monitoring: a guide for general practitioners

Summary points

• Ambulatory blood pressure monitoring is an increasingly popular method of recording blood pressure

• It improves the precision and reproducibility of blood pressure measurement, eliminates observer errors and bias, and allows assessment of white coat hypertension and white coat responses

• It is indicated particularly in the evaluation of patients with borderline hypertension, resistant hypertension, or variable blood pressure

• None of the major trials of treatment in hypertension has been conducted using ambula- tory blood pressure recordings; because of this the prognostic value of such monitoring remains uncertain

• The optimal method of data analysis, the importance of day and night time readings and of white coat responses, cost effectiveness, and the fact that few marketed devices have been fully vali- dated also need addressing

• Despite these issues, ambulatory monitoring is already making an important contribution to the assessment and management of selected patients with high blood pressure