Ambulatory blood pressure monitoring (ABPM) remains a critical tool in managing hypertension, according to an article published in the 6 August issue of the Medical Journal of Australia. The article was in response to an article by Professors Bruce Neal and Les Irwig (Medical Journal of Australia, 5/19 December 2011), who argued that risk-based assessment was superior to ABPM, which measures blood pressure at regular intervals using a portable device worn on the body. While ABPM was an excellent research tool, Professors Neal and Irwig argued it added “little to clinical decision making for most patients”.
However, the latest evidence strongly supports the continued use of ABPM, according to Professor Geoffrey Head, principal research fellow at Baker IDI Heart and Diabetes Institute, and coauthors.
“To suggest that there is no need for ABPM is of great concern, as it ignores the benefits that have been amply demonstrated by research”, they wrote.
After an “exhaustive literature analysis”, the UK National Institute for Health and Clinical Excellence issued new guidelines for hypertension that recommended all suspected hypertensive patients should have ABPM, the authors wrote.
In Australia, the National Heart Foundation and the High Blood Pressure Research Council of Australia issued a consensus statement on ABPM, which advocated its wider use for assessing and managing BP and cardiovascular risk.
A strong body of evidence showed that ambulatory measurement outside the clinic provided a more robust assessment of a patient’s actual BP, the authors noted. They said it had an important place in defining abnormal patterns of BP, particularly white coat, masked, episodic and morning hypertension. “Importantly, ABPM is a stronger predictor of clinical outcomes (such as myocardial infarction and stroke) than conventional clinic BP measurements”, the authors wrote.
“We therefore encourage the use of ABPM to best define BP and to enable better absolute CVD risk estimation, as well as more informed clinical decision making”.