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Ambulatory blood pressure

Ambulatory blood pressure monitoring measures blood pressure at regular intervals throughout the day and night. It is believed to be able to reduce the white coat hypertension effect.

The list of evidences that support that ABPM is a far superior method than clinical measurements are listed below.


Nocturnal hypertension

Ambulatory blood pressure monitoring allows blood pressure to be continually monitored during sleep, and is useful to determine whether the patient is a dipper or non-dipper. In addition, nocturnal hypertension is associated with end organ damage1 and is a much better indicator than the daytime blood pressure reading.

Target Organ Damage

It's has being shown that end-organ damages related to hypertension, such as left ventricular hypertrophy, narrowing of the retinal arteries are more strongly associated with ABPM than with a clinical BP measurement, the reason being clinical BP measurement are referred to the marked variability of BP measurement and white coat effect.
see End_organ_damage

Morning Surge

The day-night time fluctuates with values rising in the daytime and falling after midnight. With these changes, its possible to calculate the BP dip, with categories such as non-dipper (<10%), dipper, extreme dipper, and reverse dipper. Independent studies have shown that for subject with blunted or abolished fall dip and abnormal ABP result in higher incidences of LV hypertrophy and CV mortality.
According to American Heart Association3 , it shows that an excessive morning blood pressure surge is a predictor of stroke in elderly people with high blood pressure.

Based on American Heart Association Dip = 1 − frac(sleepSBP)(AwakeSBP) * 100%
SBP => Systolic Blood Pressure

Range Class
<0% Reverse Dipper
0% - 10% Non-Dipper
10% - 20% Dipper
>20% Extreme Dipper

BP Variability

24 hours noninvasive ABPM monitoring allows estimates of BP variability.


1. [2]Use and interpretation of ambulatory blood pressure monitoring: recommendations of the British Hypertension Society
2. Clinical Usefulnesses of Ambulatory Blood Pressure Monitoring by PAOLO VERDECCHIA, FABIO ANGELI, ROBERTO GATTOBIGIO
3. [3]Morning surge in blood pressure linked to strokes in elderly
4. [4]Monday Morning Surge in Blood Pressure May Lead to Increase in Cardiovascular Events

External Links

  • [5] Ambulatory blood pressure monitoring


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