Education And Debate

Use and interpretation of ambulatory blood pressure monitoring: recommendations of the British Hypertension Society

BMJ 2000; 320 doi: http://dx.doi.org/10.1136/bmj.320.7242.1128 (Published 22 April 2000) Cite this as: BMJ 2000;320:1128
  1. Eoin O'Brien, professor, cardiovascular medicine (eobrien@iol.ie)a,
  2. Andrew Coats, director, clinical cardiologyb,
  3. Patrick Owens, clinical lecturer in medicinec,
  4. James Petrie, professor, clinical pharmacologyd,
  5. Paul L Padfield, consultant physiciane,
  6. William A Littler, professor, clinical cardiologyf,
  7. Michael de Swiet, consultant physiciang,
  8. Fáinsía Mee, representative, Nurses Hypertension Societya
  1. a Blood Pressure Unit, Beaumont Hospital, Dublin 9, Ireland
  2. b Royal Brompton Hospital, London SW3 6NP
  3. c Cardiology Department, Royal Cornwall Hospital, Truro TR1 3LJ
  4. d Clinical Pharmacology Unit, Department of Medicine and Therapeutics, Aberdeen Royal Infirmary, Aberdeen AB9 2ZB
  5. e Department of Medical Sciences, Western General Hospital, Edinburgh EH4 2XU
  6. f Department of Cardiovascular Medicine, Queen Elizabeth Hospital, Birmingham B15 2TH
  7. g Imperial College School of Medicine, Institute of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, London W6 0XG
  1. Correspondence to: E O'Brien
  • Accepted 13 March 2000

Over the past 20 years or so, the accuracy of using the conventional Riva-Rocci sphygmomanometer and Korotkoff's sounds to measure blood pressure has been questioned, and efforts have been made to improve measurements with automated devices.1 2 In the same period, the phenomenon of white coat hypertension has been recognised—whereby some patients who apparently have raised blood pressure actually have normal blood pressure when the measurement is repeated away from the medical environment; this has focused attention on methods of measurement that provide profiles of blood pressure rather than rely on isolated measurements made under circumstances that may influence blood pressure.3 These methods have included repeated measurements of blood pressure using the traditional technique, self measurement of blood pressure in the home or workplace, and ambulatory blood pressure measurement using automated devices.2 Ambulatory monitoring is advantageous because it gives multiple measurements throughout the day and night

This paper considers only the ambulatory measurement of blood pressure in adults. Its purpose is not to make a case for or against ambulatory measurement; others have already done so.4 5 Although the results of a number of ongoing, longitudinal studies are forthcoming, there is now firm evidence that ambulatory blood pressure measurement is a more sensitive predictor of cardiovascular outcome than conventional measurement.6 We have not considered the complex issues of health economics that the increasing use of ambulatory measurement raises.7 We realise that this technique is being used more often and that doctors who find ambulatory measurement useful in the day to day management of patients with high blood pressure need recommendations from those who have experience. However, regardless of the technique used to diagnose hypertension it is only one factor in determining a patient's risk profile and must be assessed in relation to concomitant disease, …

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