Elevated arterial blood pressure is a major cardiovascular risk factor contributing to large numbers of deaths through ischaemic heart disease and stroke. Treatment of hypertension has had a major impact on morbidity and mortality from these events. This deceptively simplistic association has been described on the basis of measurement of blood pressure made largely by indirect sphygmomanometry and auscultation by individual physicians for their patients. However, blood pressure measured in the physician's office, however useful for both clinical and research purposes, is only weakly predictive for the target-organ damage associated with hypertension. This is unsurprising, as isolated and infrequent measurements are being made on a continuous and variable biological parameter. Non-invasive ambulatory blood pressure monitoring (ABPM) is now recognized as a useful technique to accurately profile blood pressure over 24 h; to monitor the effects of treatment; as a research tool to investigate the pathophysiology and the epidemiology of hypertension; and as an alternative means of assessing anti-hypertensive drugs. This allows better characterization of individual BP, because multiple readings are taken in a variety of settings appropriate to 'normal' activity. As with office measurement, the readings remain discontinuous. ABPM has proved particularly useful in defining the phenomenon of 'white coat' hypertension, where elevated blood pressure seems to occur only in the presence of a physician or nurse and in a hospital or clinic environment. ABPM by recording blood pressure in the patients 'normal' environment over a protracted period largely avoids this problem. As ABPM is increasingly seen as relevant to the assessment of a large majority, if not all patients with hypertension, it is important for all physicians to appreciate the role that this technique might play in the management of their individual patients. In this article we will consider key areas of current ABPM research and practice. We must remember that standard sphygmomanometric blood pressure measurement performed with care and precision remains an important clinical indicator. Ambulatory blood pressure measurement cannot fail to improve on this, simply because it is a standardized technique.
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