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Role of Ambulatory and Home Blood Pressure Monitoring in Clinical Practice: A Narrative ReviewBlood Pressure Monitoring

Daichi Shimbo, MD; Marwah Abdalla, MD; Louise Falzon; Raymond R. Townsend, MD; and Paul Muntner, PhD
[+] Article, Author, and Disclosure Information

This article was published online first at www.annals.org on 13 October 2015.

From Columbia University Medical Center, New York, New York; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and University of Alabama at Birmingham, Birmingham, Alabama.

Grant Support: By the National Heart, Lung, and Blood Institute, National Institutes of Health (HL047540, HL117323, HL117323-02S2, and K24-HL125704).

Disclosures: Dr. Townsend reports grants from the National Institutes of Health; grant support from Fukuda Denshi; and personal fees from Medtronic, GlaxoSmithKline, and Janssen during the conduct of the study. Dr. Muntner reports grants and personal fees from Amgen outside the submitted work. Authors not listed here have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-1270.

Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.

Requests for Single Reprints: Daichi Shimbo, MD, Columbia University Medical Center, 622 West 168th Street, PH 9-310, New York, NY 10032; e-mail, ds2231@cumc.columbia.edu.

Current Author Addresses: Dr. Shimbo: Columbia University Medical Center, 622 West 168th Street, PH 9-310, New York, NY 10032.

Dr. Abdalla: Columbia University Medical Center, 622 West 168th Street, PH 9-320, New York, NY 10032.

Ms. Falzon: Columbia University Medical Center, 622 West 168th Street, PH 9-322, New York, NY 10032.

Dr. Townsend: Renal, Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, 122 Founders Building, 3400 Spruce Street, Philadelphia, PA 19104.

Dr. Muntner: Department of Epidemiology, University of Alabama at Birmingham, 1700 University Boulevard, Suite 450, Birmingham, AL 35294.

Author Contributions: Conception and design: D. Shimbo, R.R. Townsend, P. Muntner.

Analysis and interpretation of the data: M. Abdalla, R.R. Townsend.

Drafting of the article: D. Shimbo, M. Abdalla, L. Falzon, R.R. Townsend.

Critical revision of the article for important intellectual content: M. Abdalla, P. Muntner.

Final approval of the article: D. Shimbo, M. Abdalla, L. Falzon, R.R. Townsend, P. Muntner.

Administrative, technical, or logistic support: D. Shimbo, M. Abdalla.

Collection and assembly of data: D. Shimbo, M. Abdalla, L. Falzon, P. Muntner.

Ann Intern Med. 2015;163(9):691-700. doi:10.7326/M15-1270
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Hypertension, a common risk factor for cardiovascular disease, is usually diagnosed and treated based on blood pressure readings obtained in the clinic setting. Blood pressure may differ considerably when measured inside versus outside of the clinic setting. Over the past several decades, evidence has accumulated on the following 2 approaches for measuring blood pressure outside of the clinic: ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM). Both of these methods have a stronger association with cardiovascular disease outcomes than clinic blood pressure measurement. Controversy exists about whether ABPM or HBPM is superior for estimating risk for cardiovascular disease and under what circumstances these methods should be used in clinical practice for assessing blood pressure outside of the clinic. This review describes ABPM and HBPM procedures, the blood pressure phenotypic measurements that can be ascertained, and the evidence that supports the use of each approach to measuring blood pressure outside of the clinic. It also describes barriers to the successful implementation of ABPM and HBPM in clinical practice, proposes core competencies for the conduct of these procedures, and highlights important areas for future research.


Grahic Jump Location

Blood pressure data from an untreated healthy person who had clinic blood pressure assessment followed by 24-h ABPM (top ) and then HBPM (bottom).

ABPM = ambulatory blood pressure monitoring; DBP = diastolic blood pressure; HBPM = home blood pressure monitoring; SBP = systolic blood pressure. Top. Clinic blood pressure assessment immediately followed by 24-h ABPM. The points for clinic blood pressure represent the average of 3 readings. On ABPM, blood pressure decreases to its lowest level during the night, followed by a surge in the morning hours coinciding with waking up. Average clinic blood pressure was 118/66 mm Hg, and average awake, sleep, and 24-h blood pressure was 129/86 mm Hg, 103/62 mm Hg, and 118/78 mm Hg, respectively. Bottom. After the 24-h ABPM assessment, HBPM was then done for 18 d. The points represent the average of 2 morning or 2 evening readings. Because blood pressure readings on HBPM are obtained at fixed times during the day and are measured at rest, the variability of blood pressure over time is less than what is seen on ABPM. Unlike ABPM, HBPM cannot measure blood pressure readings during sleep. Average home blood pressure was 116/79 mm Hg.

Grahic Jump Location




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