Current Role of Automated Ambulatory Blood Pressure and Self-Measured Blood Pressure Determinations in Clinical Practice

To discuss the clinical indications for use of automated indirect blood pressure measurement (ABPM) and self-monitoring of blood pressure. Available equipment, variations in blood pressure, and settings in which ABPM may be useful are reviewed. Measurement of blood pressure in the physician's office may not reflect the usual 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 procedures 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 with drug resistance, and cases of episodic hypertension or hypotension. ABPM can also be used to assess very abrupt changes in blood pressure (hypertension or hypotension) and changes in heart rate and blood pressure during sleep. An abbreviated (6-hour) ABPM can be used to confirm increased office blood pressure measurements. Thus, a 6-hour ABPM has the potential to decrease the misclassification of subjects with hypertension or normotension and to limit costs. Accurate self-monitored blood pressure measurements can be integrated with office blood pressure determinations to assist in the management of many patients with hypertension. Both ABPM and self-monitoring of blood pressure can improve blood pressure control and practice efficiencies.