Comparative Study of Ambulatory Blood Pressure Monitoring and Clinic Blood Pressure Measurement in the Risk Assessment and Management of Hypertension

Objectives: Blood pressure (BP) measurements taken in a physician s clinic do not represent readings throughout the day. Ambulatory blood pressure monitoring (ABPM) overcomes this problem by providing multiple readings with minimal interference with the patient s daily activities. The purpose of our study was to evaluate the value of ABPM in risk assessment and management of hypertension compared to office measurements. Methods: A total of 104 consecutive hypertensive patients were retrospectively studied from January 2007 to December 2009. The following data were gathered: 1) clinic BP measurements; 2) routine blood test results; 3) electrocardiography, echocardiography, and 4) 24-hour ABPM. Results: The mean age of patients was 41.1 ± 8.6 years and 51.9% of them male. Indications for ABPM were: suspected white coat hypertension (10.6%), de novo hypertension (18.2%), resistant hypertension (27.9%) and others (43.3%). Mean daytime and nighttime BP were 134/82 and 124/73 mmHg respectively. A non-dipping pattern was reported in 64.4%. Echocardiographic evidence of left ventricular hypertrophy (LVH) and diastolic dysfunction (LVDD) was encountered in 22.1% and 29.8% respectively. ABPM parameters were significantly correlated with LVDD (P = 0.043). Patients with proved white coat hypertension did not receive antihypertensive therapy. Conclusion: Twenty-four hour ABPM is an important yet underused tool for proper risk stratification of treated hypertensive patients. The non-dipping profile is associated with a higher incidence of diastolic dysfunction. Our collective results revealed the superiority of ABPM over office BP measurement.