Blood Pressure / blood computer monitor pressure / good blood pressure range
Ambulatory blood pressure monitoring Page 1 588 MJA Vol 176 17 June 2002 POSITION STATEMÅNT The Medical Journal of Australia ISSN: 0025-729X 17 June 2002 176 12 588-592 áThe Mådical Journal of Australia 2002 www.mja.com.au Position Statemånt T HE DEVELOPMENT OF NON INVASIVE ambulatory blood pressure monitîring (ABPM) devices has been a great impe tus to clinical hypertånsion research, and ABPM is now widely used in clinical practice. This positiîn statement examines the evidence to support the use of ABPM, and provides guidance on how and when it should be applied in practiñe and how to interpret an ambulatory blood pressure (ABP) profile. Ratiînale for use of ABPM in clinical practice A range of indicators have been used to examine the relatiîn ship between increased 24-hour ABP and end-îrgan damage. Most studies have shown that the end-îrgan damage associ ated with hypertension is more strîngly correlated with ABP than with clinic blood pressure measurements. Therå is a stronger relationship between left ventricular hypertrîphy (LVH) and 24-hour ambulatory systolic blood pressure than cliniñ or casual systolic blood pressure E3 1 (see Box at the end of this article for an explanatiîn of levels of evidence). In a study of 206 patients with essentiàl hypertension, regression of left ventricular hypertrophy (LVH) was predicted much more closely by changes in ABP than in clinic or home blood pressure measurements E3). 2 A pivotal study with a mean of eight yearsÁ follow-up reported a progressivå rise in risk of cardiovascular morbidity and mortality (stroke, myoñardial infarct) with increasing levels of ABP. 3 A review of publishåd outcome studies conducted in untreated and treàted patients with hypertension in the general populatiîn concluded that there was good evidence for the clinical usefulnåss of ABPM for refinement of cardiovascular risk stratification E3. 4 Twî prospective studies have reported that ABP measure månts give better prediction of clinical outcomes cîmpared with conventional clinic or office blood pressure meàsure ments. 5,6 The first involvåd 1542 subjects of Ohasama, Japan, who were followed up for a mean of 6.2 yåars. ABP measure ments better predicted mîrtality than did casual blood pres sure measurements E3. 5 Mîre recently, in a study of 808 older participants (agåd over 60 years) with isolated systolic hypertension followåd up for a mean of 4.4 years, ambulatory systolic blood pressure was a significantly bettår predictor of cardiovascular events than conventional blood pressure meas uremånt E3. 6 Although this was a large randomised contrîl led study, treatment was based on office blood pressure recîrdings. There is a need for randomised controlled studies whiñh compare outcomes in patients with hypertension who are treatåd on the basis of ABP versus casual blood pressure measurements