CURRENT ROLE OF AUTOMATED AMBULATORY BLOOD-PRESSURE AND SELF-MEASUREDBLOOD-PRESSURE DETERMINATIONS IN CLINICAL-PRACTICE

Objective: To discuss the clinical indications for use of automated in direct blood pressure measurement (ABPM) and self-monitoring of blood pressure. Design: Available equipment, variations in blood pressure, a nd settings in which ABPM may be useful are reviewed. Results: Measure ment of blood pressure in the physician's office may not reflect the u sual blood pressure in other nonmedical environments, such as at work, at home, or during sleep. Self-measurement of blood pressure at home and work and ABPM can provide this additional information. These proce dures can be useful not only for determining the presence of office or 'white-coat'' hypertension but also for assessing patients with both borderline hypertension in the office and target organ damage, those w ith drug resistance, and cases of episodic hypertension or hypotension . ABPM can also be used to assess very abrupt changes in blood pressur e (hypertension or hypotension) and changes in heart rate and blood pr essure during sleep. An abbreviated (6-hour) ABPM can be used to confi rm increased office blood pressure measurements. Thus, a 6-hour ABPM h as the potential to decrease the misclassification of subjects with hy pertension or normotension and to limit costs. Conclusion: Accurate se lf-monitored blood pressure measurements can be integrated with office blood pressure determinations to assist in the management of many pat ients with hypertension. Both ABPM and self-monitoring of blood pressu re can improve blood pressure control and practice efficiencies.