Ambulatory monitoring is critical in accurately assessing blood pressure to calculate absolute cardiovascular risk
Recently, there has been debate about the need for ambulatory blood pressure monitoring (ABPM) in clinical decision making, promoting instead the use of an absolute cardiovascular disease (CVD) risk-based approach.1 While we fully endorse hypertension management based on absolute risk, inherent in this assessment is the accurate measurement of blood pressure (BP). The available data suggest this can best be achieved by ABPM. Following an exhaustive literature analysis, the new British National Institute for Health and Clinical Excellence guidelines for hypertension2 have recommended that all suspected hypertensive patients require ABPM.3 An issue in Australia is whether there is financial justification for routine use of ABPM for such diagnostic purposes. Evidence strongly supports ABPM as more cost-effective than the repeated clinic measurements required to establish a patient’s true BP.4
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- 1. Neal BC, Irwig L. Not much need for ambulatory blood pressure monitoring. Med J Aust 2011; 195: 634-635. <MJA full text>
- 2. National Institute for Health and Clinical Excellence. Hypertension: clinical management of primary hypertension in adults. Clinical guideline 127. London: NICE, 2011. http://www.nice.org.uk/nicemedia/live/13561/56008/56008.pdf (accessed Apr 2012).
- 3. Head GA, McGrath BP, Mihailidou AS, et al. Ambulatory blood pressure monitoring in Australia: 2011 consensus position statement. J Hypertens 2012; 30: 253-266.
- 4. Lovibond K, Jowett S, Barton P, et al. Cost-effectiveness of options for the diagnosis of high blood pressure in primary care: a modelling study. Lancet 2011; 378: 1219-1230.
- 5. Fagard RH, Thijs L, Staessen JA, et al. Prognostic significance of ambulatory blood pressure in hypertensive patients with history of cardiovascular disease. Blood Press Monit 2008; 13: 325-332.
- 6. Rothwell PM, Howard SC, Dolan E, et al. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet 2010; 375: 895-905.
- 7. Mancia G, Bombelli M, Facchetti R, et al. Increased long-term risk of new-onset diabetes mellitus in white-coat and masked hypertension. J Hypertens 2009; 27: 1672-1678.
- 8. Howes F, Hansen E, Williams D, Nelson M. Barriers to diagnosing and managing hypertension - a qualitative study in Australian general practice. Aust Fam Physician 2010; 39: 511-516.
- 9. Head GA, Mihailidou AS, Duggan KA, et al; Ambulatory Blood Pressure Working Group of the High Blood Pressure Research Council of Australia. Definition of ambulatory blood pressure targets for diagnosis and treatment of hypertension in relation to clinic blood pressure: prospective cohort study. BMJ 2010; 340: c1104.
- 10. National Heart Foundation and High Blood Pressure Research Council of Australia Ambulatory Blood Pressure Monitoring Consensus Committee. Ambulatory blood pressure monitoring. Aust Fam Physician 2011; 40: 877-880.
Barry McGrath has participated in trials of new pharmaceutical agents, sponsored by Bristol-Myers Squibb, Johnson and Johnson Pharmaceutical Research and Development USA, Novartis Pharmaceuticals Australia, Pfizer Australia and Servier International. He has recently served or is serving on advisory boards for Abbott Australia, AstraZeneca Australia, Boehringer Ingelheim Australia and Solvay Pharmaceuticals. He has received conference travel support from Boehringer Ingelheim Australia. Mark Nelson has participated in trials that have received funding from SmithKline Beecham, AstraZeneca, Bayer, Sanofi-Aventis, Merck Sharpe and Dohme, Pfizer, Servier Laboratories and Bristol-Myers Squibb. He has served on advisory boards for Sanofi-Aventis, Novartis, Schering-Plough and Solvay Pharmaceuticals, and has prepared educational material for Servier Laboratories, AstraZeneca and Bristol-Myers Squibb. He has also received conference and travel support from Bayer HealthCare AG, Merck Sharpe and Dohme, Novartis and Sanofi-Aventis.