AMBULATORY BLOOD-PRESSURE MONITORING - COMING OF AGE IN NEPHROLOGY

The number of patients undergoing ambulatory blood pressure monitoring (ABPM) and the number of publications using this technique to evaluat e the risks and effects of high blood pressure on target organs has be en increasing, and dramatically so, in the last 5 years. Much of this growth has centered on the role of the blood pressure load (the percen tage of systolic or diastolic readings above a preset value during a s pecific time period) and the changes in blood pressures levels that oc cur with sleep. Although many studies are focused on the interaction b etween blood pressure (as assessed by ABPM) and the heart, interest is growing in the application of ABPM to the practice of nephrology, Thi s paper discusses some of the technical aspects of ABPM, followed by a review of five areas of clinical research using ABPM, and which are r elevant to renal medicine: microalbuminuria, renal function, renovascu lar hypertension, dialysis (hemodialysis and continuous ambulatory per itoneal dialysis), and transplantation. Despite a general lack of reim bursement for performance of the ABPM procedure, the growth in its usa ge and the willingness of clinicians to withhold or alter therapy on t he basis of ABPM readings is testimony to its clinical value in the ma nagement of hypertension.