Ambulatory blood pressure monitoring

Thus, the physician must establish with certainty that hypertension is persistent and requires treatment and must exclude secondary causes of hypertension that might be treated by definitive surgical procedures. Persistence of hypertension, particularly in persons with mild elevation of blood pressure, should be established by finding an elevated blood pressure on at least three different office visits. Ambulatory blood pressure monitoring may be the best predictor of risk and therefore of need for therapy in mild hypertension. Isolated systolic hypertension and hypertension in the elderly also benefit from therapy. 

Late in 2004, the American Heart Association advocated home monitoring in its revised guidelines for blood pressure measurements, published in the February 2005 issue of the journal Hypertension. The lead author of that report. Dr. Thomas Pickering of Columbia University in New York, said, We ve found that blood pressure measurements taken by doctors in their offices may actually be unreliable in many patients. For that reason, there is wider acceptance of blood pressure readings taken by patients in their homes, and of ambulatory blood pressure monitoring. ... 

Neutel JM, Smith DH, Ram CV, Kaplan NM, Papademetriou V, Fagan TC, Lefkowitz MP, Kazempour MK, Weber MA. Application of ambulatory blood pressure monitoring in differentiating between antihypertensive agents. Am J Med 1993 94(2) 181-7. 

A 64-year-old man developed a right hemiparesis after taking one dose of doxazosin 4 mg for prostatic symptoms. A CT scan of the brain and carotid ultrasound studies were normal. He recovered most of his neurological function within a few days. Ambulatory blood pressure monitoring after treatment with doxazosin 2 mg showed striking blood pressure reduction during sleep. 

Ambulatory blood pressure monitoring showed changes in blood pressure and heart rate in boys aged 7-11 years taking stimulant therapy (13). This preliminary study with chronic methylphenidate or AdderaU (dex-amfetamine + levamfetamine) for ADHD showed alterations in awake and asleep blood pressures, with profound nocturnal dipping. Modified-release formulations of methylphenidate and AdderaU now allow more sustained blood concentrations in children. The effects of these newer formulations on cardiovascular indices should be evaluated. 

Stowe CD, Gardner SF, Gist CC, Schulz EG, Wells TG, Felin JF. 24-hour ambulatory blood pressure monitoring in male children receiving stimulant therapy. Ann Pharmacother 2002 36(7-8) 1142-9. 

Pickering T. Recommendations for the use of home (self) and ambulatory blood pressure monitoring. American Society of Hypertension Ad Hoc Panel. Am J Hypertens 1996 9 1-11. 

Aboy M, Fernandez JR, Hermida RC (2005) Methodological considerations in the evaluation of the duration of action of antihypertensive therapy using ambulatory blood pressure monitoring. Blood Pressure Monitoring 10 111-115. 

Note. Technical specifications were omitted here due to the multiplicity of parameters. The reader is referred to the manufacturers information outlets (e.g, Internet homepages). Ambulant ECG (Holter) recorder, ambulatory blood pressure monitors, and sleep apnea recorders were not included. 

Poreba, R., M. Poreba, P. Gac, and R. Andrzejak. 2011b. Ambulatory blood pressure monitoring and structural changes in carotid arteries in normotensive workers occupationally exposed to lead. Hum. Exp. Toxicol. 30(9) 1174-1180. 

P. Owens, N. Atkins, E. O Brien, Diagnosis of white coat hypertension by ambulatory blood pressure monitoring. Hypertension 34 (2) (1999) 267—272. 

Learning from the Employment of Ambulatory Blood Pressure Monitoring in the Clinical Development... 

Turner JR, Viera AJ, Shimbo D (2015) Ambulatory blood pressure monitoring in clinical practice a review. Am J Med 128 14-20... 

O Brien and Turner (2013) commented on this case study as follows The HOPE study was designed to prove the beneficial effect of a drug on cardiovascular outcome, and were it not for the ambulatory blood pressure monitoring study, the... 

O Brien and Turner (2013) offered some thoughts on the inclusion of ambulatory blood pressure monitoring in preapproval clinical development programs, noting that this blood pressure measurement modality provides powerful evidence concerning a drug s blood pressure liability and that it should therefore be a central... 

If the clinic blood pressure is 140/90 mmHg or higher, offer ambulatory blood pressure monitoring to confirm the diagnosis of hypertension. 

---