24 Hour Ambulatory Blood Pressure Monitor (ABPM)

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The Ambulatory blood pressure monitor (ABPM) is the GOLD STANDARD for adequately and appropriately measuring blood pressure. In fact, you can’t properly evaluate and treat hypertension without it!

How can I say such a thing?

ABPM is the recommended screening of Hypertension in the UK. It is superior to office and home blood pressure monitoring to predict future cardiovascular events, morbidity, mortality, and target organ damage.

24-hour ABPM determines ‘dipping status’, white coat hypertension, masked hypertension, circadian rhythm with early morning blood pressure surges, and adequacy of blood control. ABPM is cost effective and reduces the number of patients needing drug therapy for hypertension by 25%.[1-3]

I’ve seen multiple patients who appeared to have hypertension in the office who turned out to have white-coat hypertension and didn’t need blood pressure medications.

Who should get 24-hour Ambulatory Blood Pressure Monitoring (ABPM)?

  • Identify white-coat hypertension
  • Identify masked hypertension
  • Identify normal 24-hour blood pressure patterns (dipping, daytime/nocturnal hypertension)
  • Assess hypertension treatment
  • Assessing hypertension in the elderly, children/adolescents, pregnancy, high-risk patients
  • Identify ambulatory hypotension
  • Identify blood pressure patterns in Parkinson’s Disease
  • Endocrine hypertension

Dipping versus Non-dipping

Your blood pressure should decrease 10-20% at night while you sleep. This is referred to as dipping.

At night, you have decreased sympathetic nervous system (SNS) tone which should decrease blood pressure. If you have increased SNS tone and elevated Angiotensin II then you won’t have sufficient dipping (less than 10%). The non-dipping allows for sodium excretion in the kidney.

Non-dippers have increased platelet volume. Non-dipping is correlated with :

  • cardiovascular disease
  • stroke
  • left-ventricular hypertrophy
  • congestive heart failure
  • increased CIMT
  • multifocal leukoencephalopathy
  • white matter disease
  • silent cerebral infarctions

Risk for ischemic stroke increases if there is excessive dipping (more than 20%).

 


References:

  1. J of Clinical Hypertension 2011;13(12):871
  2. J of Clinical Hypertension 2013;31:1812
  3. J of the Am Society of Hypertension;2014;8:939